F:\P11\NHI\TRICOMM\AAHCA09_001.

XML

785
1 volved to provide health care at childbirth and who pro-
2 vides such care within the scope of practice under which
3 the individual is legally authorized to perform such care
4 under State law (or the State regulatory mechanism pro-
5 vided by State law), regardless of whether the individual
6 is under the supervision of, or associated with, a physician
7 or other health care provider. Nothing in this subpara-
8 graph shall be construed as changing State law require-
9 ments applicable to a licensed birth attendant.’’.
10 (b) EFFECTIVE DATE.—The amendments made by
11 this section shall apply to items and services furnished on
12 or after the date of the enactment of this Act.
13 SEC. 1725. INCLUSION OF PUBLIC HEALTH CLINICS UNDER

14 THE VACCINES FOR CHILDREN PROGRAM.

15 Section 1928(b)(2)(A)(iii)(I) of the Social Security

16 Act (42 U.S.C. 1396s(b)(2)(A)(iii)(I)) is amended—
17 (1) by striking ‘‘or a rural health clinic’’ and in-
18 serting ‘‘, a rural health clinic’’; and
19 (2) by inserting ‘‘or a public health clinic,’’
20 after ‘‘‘1905(l)(1)),’’.

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00785 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

786
1 Subtitle D—Coverage
2 SEC. 1731. OPTIONAL MEDICAID COVERAGE OF LOW-IN-

3 COME HIV-INFECTED INDIVIDUALS.

4 (a) IN GENERAL.— Section 1902 of the Social Secu-

5 rity Act (42 U.S.C. 1396a), as amended by section
6 1714(a)(1), is amended—
7 (1) in subsection (a)(10)(A)(ii)—
8 (A) by striking ‘‘or’’ at the end of sub-
9 clause (XIX);
10 (B) by adding ‘‘or’’ at the end of subclause
11 (XX); and
12 (C) by adding at the end the following:
13 ‘‘(XXI) who are described in subsection (ii) (re-
14 lating to HIV-infected individuals);’’; and
15 (2) by adding at the end, as amended by sec-
16 tions 1703 and 1714(a), the following:
17 ‘‘(ii) individuals described in this subsection are indi-
18 viduals not described in subsection (a)(10)(A)(i)—
19 ‘‘(1) who have HIV infection;
20 ‘‘(2) whose income (as determined under the
21 State plan under this title with respect to disabled
22 individuals) does not exceed the maximum amount
23 of income a disabled individual described in sub-
24 section (a)(10)(A)(i) may have and obtain medical
25 assistance under the plan; and

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00786 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

787
1 ‘‘(3) whose resources (as determined under the
2 State plan under this title with respect to disabled
3 individuals) do not exceed the maximum amount of
4 resources a disabled individual described in sub-
5 section (a)(10)(A)(i) may have and obtain medical
6 assistance under the plan.’’.
7 (b) ENHANCED MATCH.—The first sentence of sec-
8 tion 1905(b) of such Act (42 U.S.C. 1396d(b)) is amended
9 by striking ‘‘section 1902(a)(10)(A)(ii)(XVIII)’’ and in-
10 serting ‘‘subclause (XVIII) or (XX) of section
11 1902(a)(10)(A)(ii)’’.
12 (c) CONFORMING AMENDMENTS.—Section 1905(a) of
13 such Act (42 U.S.C. 1396d(a)) is amended, in the matter
14 preceding paragraph (1)—
15 (1) by striking ‘‘or’’ at the end of clause (xii);
16 (2) by adding ‘‘or’’ at the end of clause (xiii);
17 and
18 (3) by inserting after clause (xiii) the following:
19 ‘‘(xiv) individuals described in section
20 1902(ii),’’.
21 (d) EXEMPTION FROM FUNDING LIMITATION FOR

22 TERRITORIES.—Section 1108(g) of the Social Security

23 Act (42 U.S.C. 1308(g)) is amended by adding at the end
24 the following:

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00787 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

788
1 ‘‘(5) DISREGARDING MEDICAL ASSISTANCE FOR

2 OPTIONAL LOW-INCOME HIV-INFECTED INDIVID-

3 UALS.—The limitations under subsection (f) and the

4 previous provisions of this subsection shall not apply
5 to amounts expended for medical assistance for indi-
6 viduals described in section 1902(ii) who are only el-
7 igible for such assistance on the basis of section
8 1902(a)(10)(A)(ii)(XX).’’.
9 (e) EFFECTIVE DATE; SUNSET.—The amendments
10 made by this section shall apply to expenditures for cal-
11 endar quarters beginning on or after the date of the enact-
12 ment of this Act, and before January 1, 2013, without
13 regard to whether or not final regulations to carry out
14 such amendments have been promulgated by such date.
15 SEC. 1732. EXTENDING TRANSITIONAL MEDICAID ASSIST-

16 ANCE (TMA).

17 Sections 1902(e)(1)(B) and 1925(f) of the Social Se-

18 curity Act (42 U.S.C. 1396a(e)(1)(B), 1396r–6(f)), as
19 amended by section 5004(a)(1) of the American Recovery
20 and Reinvestment Act of 2009 (Public Law 111–5), are
21 each amended by striking ‘‘December 31, 2010’’ and in-
22 serting ‘‘December 31, 2012’’.

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00788 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

789
1 SEC. 1733. REQUIREMENT OF 12-MONTH CONTINUOUS COV-

2 ERAGE UNDER CERTAIN CHIP PROGRAMS.

3 (a) IN GENERAL.—Section 2102(b) of the Social Se-

4 curity Act (42 U.S.C. 1397bb(b)) is amended by adding
5 at the end the following new paragraph:
6 ‘‘(6) REQUIREMENT FOR 12-MONTH CONTIN-

7 UOUS ELIGIBILITY.—In the case of a State child

8 health plan that provides child health assistance
9 under this title through a means other than de-
10 scribed in section 2101(a)(2), the plan shall provide
11 for implementation under this title of the 12-month
12 continuous eligibility option described in section
13 1902(e)(12) for targeted low-income children whose
14 family income is below 200 percent of the poverty
15 line.’’.
16 (b) EFFECTIVE DATE.—The amendment made by
17 subsection (a) shall apply to determinations (and redeter-
18 minations) of eligibility made on or after January 1, 2010.
19 Subtitle E—Financing
20 SEC. 1741. PAYMENTS TO PHARMACISTS.

21 (a) PHARMACY REIMBURSEMENT LIMITS.—

22 (1) IN GENERAL.—Section 1927(e) of the So-
23 cial Security Act (42 U.S.C. 1396r–8(e)) is amend-
24 ed—
25 (A) by striking paragraph (5) and insert-
26 ing the following:
f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00789 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

790
1 ‘‘(5) USE OF AMP IN UPPER PAYMENT LIM-

2 ITS.—The Secretary shall calculate the Federal

3 upper reimbursement limit established under para-
4 graph (4) as 130 percent of the weighted average
5 (determined on the basis of manufacturer utiliza-
6 tion) of monthly average manufacturer prices.’’
7 (2) DEFINITION OF AMP.—Section

8 1927(k)(1)(B) of such Act (42 U.S.C. 1396r–

9 8(k)(1)(B)) is amended—
10 (B) in the heading, by striking ‘‘EX-
11 TENDED TO WHOLESALERS’’ and inserting
12 ‘‘AND OTHER PAYMENTS’’; and
13 (C) by striking ‘‘regard to’’ and all that
14 follows through the period and inserting the fol-
15 lowing: ‘‘regard to—
16 ‘‘(i) customary prompt pay discounts
17 extended to wholesalers;
18 ‘‘(ii) bona fide service fees paid by
19 manufacturers;
20 ‘‘(iii) reimbursement by manufactur-
21 ers for recalled, damaged, expired, or oth-
22 erwise unsalable returned goods, including
23 reimbursement for the cost of the goods
24 and any reimbursement of costs associated

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00790 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

791
1 with return goods handling and processing,
2 reverse logistics, and drug destruction;
3 ‘‘(iv) sales directly to, or rebates, dis-
4 counts, or other price concessions provided
5 to, pharmacy benefit managers, managed
6 care organizations, health maintenance or-
7 ganizations, insurers, mail order phar-
8 macies that are not open to all members of
9 the public, or long term care providers,
10 provided that these rebates, discounts, or
11 price concessions are not passed through to
12 retail pharmacies;
13 ‘‘(v) sales directly to, or rebates, dis-
14 counts, or other price concessions provided
15 to, hospitals, clinics, and physicians, unless
16 the drug is an inhalation, infusion, or
17 injectable drug, or unless the Secretary de-
18 termines, as allowed for in Agency admin-
19 istrative procedures, that it is necessary to
20 include such sales, rebates, discounts, and
21 price concessions in order to obtain an ac-
22 curate AMP for the drug. Such a deter-
23 mination shall not be subject to judicial re-
24 view; or

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00791 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

792
1 ‘‘(vi) rebates, discounts, and other
2 price concessions required to be provided
3 under agreements under subsections (f)
4 and (g) of section 1860D–2(f).’’.
5 (3) MANUFACTURER REPORTING REQUIRE-

6 MENTS.—Section 1927(b)(3) of such Act (42 U.S.C.

7 1396r–8(b)(3)) is amended—
8 (A) in subparagraph (A), by adding at the
9 end the following new clause:
10 ‘‘(iv) not later than 30 days after the
11 last day of each month of a rebate period
12 under the agreement, on the manufactur-
13 er’s total number of units that are used to
14 calculate the monthly average manufac-
15 turer price for each covered outpatient
16 drug.’’
17 (4) AUTHORITY TO PROMULGATE REGULA-

18 TION.—The Secretary of Health and Human Serv-

19 ices may promulgate regulations to clarify the re-
20 quirements for upper payment limits and for the de-
21 termination of the average manufacturer price in an
22 expedited manner. Such regulations may become ef-
23 fective on an interim final basis, pending oppor-
24 tunity for public comment.

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00792 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC