P.L. 110–90, Approved September 29, 2007 (121 Stat. 984)

TMA, Abstinence Education, and QI Programs Extension Act of 2007

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SEC. 4. [42 U.S.C. 1396a note]  EXTENSION OF SSI WEB-BASED ASSET DEMONSTRATION PROJECT TO THE MEDICAID PROGRAM

(a)  In General.—Beginning on October 1, 2007, and ending on September 30, 2012, the Secretary of Health and Human Services shall provide for the application to asset eligibility under the Medicaid program under title XIX of the Social Security Act of the automated, secure, web-based asset verification request and response process being applied for determining eligibility for benefits under the Supplemental Security Income (SSI) program under title XVI of such Act under a demonstration project conducted under the authority of section 1631(e)(1)(B)(ii) of such Act (42 U.S.C. 1383(e)(1)(B)(ii)).

(b)  Limitation.—Such application shall only extend to those States in which such demonstration project is operating and only for the period in which such project is otherwise provided.

(c)  Rules of Application.—For purposes of carrying out subsection (a), notwithstanding any other provision of law, information obtained from a financial institution that is used for purposes of eligibility determinations under such demonstration project with respect to the Secretary of Health and Human Services under the SSI program may also be shared and used by States for purposes of eligibility determinations under the Medicaid program. In applying section 1631(e)(1)(B)(ii) of the Social Security Act under this subsection, references to the Commissioner of Social Security and benefits under title XVI of such Act shall be treated as including a reference to a State described in subsection (b) and medical assistance under title XIX of such Act provided by such a State.

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SEC. 7. [None Assigned]  DOCUMENTATION AND CODING ADJUSTMENTS[218] TO THE IMPLEMENTATION OF THE MEDICARE SEVERITY DIAGNOSIS RELATED GROUP (MS-DRG) SYSTEM UNDER THE MEDICARE PROSPECTIVE PAYMENT SYSTEM FOR INPATIENT HOSPITAL SERVICES.

(a)  In General.—In implementing the final rule published on August 22, 2007, on pages 47130 through 48175 of volume 72 of the Federal Register, the Secretary of Health and Human Services (in this section referred to as the “Secretary”) shall apply prospective documentation and coding adjustments (made in response to the implementation of a Medicare Severity Diagnosis Related Group (MS-DRG) system under the hospital inpatient prospective payment system under section 1886(d) of the Social Security Act (42 U.S.C. 1395ww(d)) of—

(1)  for discharges occurring during fiscal year 2008, 0.6 percent rather than the 1.2 percent specified in such final rule; and

(2)  for discharges occurring during fiscal year 2009, 0.9 percent rather than the 1.8 percent specified in such final rule.

(b)  Subsequent Adjustments.—

(1)  In general.—Notwithstanding any other provision of law, if the Secretary determines that implementation of such Medicare Severity Diagnosis Related Group (MS-DRG) system resulted in changes in coding and classification that did not reflect real changes in case mix under section 1886(d) of the Social Security Act (42 U.S.C. 1395ww(d)) for discharges occurring during fiscal year 2008 , 2009 or 2010[219]that are different than the prospective documentation and coding adjustments applied under subsection (a) or otherwise applied for such year[220], the Secretary shall—

(A)  make an appropriate adjustment under paragraph (3)(A)(vi) of such section 1886(d); and

(B)(i)[221]  make an additional adjustment to the standardized amounts under such section 1886(d) for discharges occurring only during fiscal years 2010, 2011, and 2012 to offset the estimated amount of the increase [222] in aggregate payments (including interest as determined by the Secretary) determined, based upon a retrospective evaluation of claims data submitted under such Medicare Severity Diagnosis Related Group (MS-DRG) system, by the Secretary with respect to discharges occurring during fiscal years 2008 and 2009; and[223]

(ii)[224]  make an additional adjustment to the standardized amounts under such section 1886(d) based upon the Secretary’s estimates for discharges occurring only during fiscal years 2014, 2015, 2016, and 2017 to fully offset $11,000,000,000 (which represents the amount of the increase in aggregate payments from fiscal years 2008 through 2013 for which an adjustment was not previously applied).

(2)  Requirement.—Any adjustment under paragraph (1)(B) shall reflect the difference between the amount the Secretary estimates that implementation of such Medicare Severity Diagnosis Related Group (MS-DRG) system resulted in changes in coding and classification that did not reflect real changes in case mix and the prospective documentation and coding adjustments applied under subsection (a). An adjustment made under paragraph (1)(B) for discharges occurring in a year shall not be included in the determination of standardized amounts for discharges occurring in a subsequent year.

(3)  Rule of construction.—

(A)  requiring the Secretary to adjust the average standardized amounts under paragraph (3)(A)(vi) of such section 1886(d) other than as provided under this section or affecting the Secretary’s authority under such paragraph to apply a prospective adjustment to offset aggregate additional payments related to documentation and coding improvements made with respect to discharges during fiscal year 2010[225]; or

(B)  providing authority to apply the adjustment under paragraph (1)(B) other than for discharges occurring during fiscal years 2010, 2011, 2012, 2014, 2015, 2016, and 2017[226].

(4)  Judicial review.—There shall be no administrative or judicial review under section 1878 of the Social Security Act (42 U.S.C. 1395oo) or otherwise of any determination or adjustments made under this subsection. Approved September 29, 2007.

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[Internal References.— SSAct Title XIX (heading) and §§1631(e)(1)(B)(ii) and 1886(d) have footnotes referring to P.L. 110-90.]



[218]  P.L. 112-240, §631(b)(1), struck out “LIMITATION ON IMPLEMENTATION FOR FISCAL YEARS 2008 AND 2009 OF A PROSPECTIVE DOCUMENTATION AND CODING ADJUSTMENT” and inserted “DOCUMENTATION AND CODING ADJUSTMENTS”, effective January 2, 2013.

[219]  P.L. 112–240, §631(b)((2)(A)(i)(I), struck out “or 2009” and inserted “, 2009, or 2010”, effective January 2, 2013.

[220]  P.L. 112–240, §631(b)((2)(A)(i)(II), inserted “or otherwise applied for such year”, effective January 2, 2013.

[221]  P.L. 112–240, §631(b)((2)(A)(ii)(I), inserted “(i)”.

[222]  P.L. 112–240, §631(b)((2)(A)(ii)(II), struck out “or decrease”, effective January 2, 2013.

[223]  P.L. 112–240, §631(b)((2)(A)(i)(I), struck out the period and inserted “; and”

[224]  P.L. 112–240, §631(b)((2)(A)(ii)(IV), added this new clause (ii), effective January 2, 2013.

[225]  P.L. 112–240, §631(b)((2)(B)(i), inserted “or affecting the Secretary’s authority under such paragraph to apply a prospective adjustment to offset aggregate additional payments related to documentation and coding improvements made with respect to discharges during fiscal year 2010”, effective January 2, 2013.

[226]  P.L. 112–240, §631(b)((2)(B)(ii), struck out “and 2012” and inserted “2012, 2014, 2015, 2016, and 2017’’, effective January 2, 2013.