Table 1: Estimate of Effects on Direct Spending for H.R.

4213, the American Jobs and Closing Tax Loopholes Act of 2010, Title V, Subtitle B
(As posted on the Web site of the Committee on Ways and Means on May 20, 2010, and with subsequent amendment f:\VHLC\052610\052610.336.xml; May 26, 2010 (5:25 p.m.))
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
511 Extension of premium assistance for COBRA benefits Included in the table provided by the Joint Committee on Taxation
512 Extension of Sec. 508 reclassifications 0 0.3 * 0 0 0 0 0 0 0 0 0.3 0.3
513 Repeal of delay of RUG-IV 0 0 0 0 0 0 0 0 0 0 0 0 0
514 Limitation on reasonable cost payments for certain lab tests in rural areas * * 0 0 0 0 0 0 0 0 0 * *
515 Funding for claims reprocessing 0.1 0.1 0 0 0 0 0 0 0 0 0 0.2 0.2
516 Extension of ARRA increase in FMAP 0 25.3 -1.2 * 0 0 0 0 0 0 0 24.1 24.1
517 Medicaid and CHIP technical corrections 0 0 0 0 0 0 0 0 0 0 0 0 0
518 Addition of inpatient drug discount program to 340B drug discount program 0 * * * * * * * * * * * *
519 Continued inclusion of orphan drugs in definition of covered outpatient drugs in 0 0 0 0 0 0 0 0 0 0 0 0 0
520 340B
Conforming amendment related to waiver of coinsurance for preventive services 0 0 0 0 0 0 0 0 0 0 0 0 0
521 CMS-IRS data match Included in the table provided by the Joint Committee on Taxation
522 Clarification of effective date of Part B special enrollment period for disabled
TRICARE beneficiaries 0 * * * * * * * * * * * *
523 Physician Payment Update 1/ 3.1 16.6 5.5 0 0 0 0 0 0 0 0 25.2 25.2
524 Adjustment to Medicare payment localities 0 0 * 0.1 0.1 0.1 0.1 * 0 0 0 0.3 0.4
525 Clarification of 3-day payment window -3.2 -1.1 0 0 0 0 0 0 0 0 0 -4.2 -4.2

INTERACTIONS

Medicare Advantage Interaction 0 0 1.1 * * * * * 0 0 0 1.2 1.2

Premium Interactions 0 -2.1 -1.1 0.2 * * * * 0 0 0 -3.1 -3.1
Medicaid Interactions with Medicare Part B Provisions 0 0 0 0.1 0 0 0 0 0 0 0 0.1 0.1
TRICARE Interaction * 0.3 0.1 * * * * * 0 0 0 0.3 0.3
IPAB Interaction 0 0 0 0 0 0 0 0 * 0.1 0.1 0 0.2

Total, Changes in On-Budget Direct Spending 2/ * 39.4 4.4 0.3 0.1 0.1 0.1 * 0.1 0.1 0.1 44.2 44.5
Total, Changes in Unified-Budget Direct Spending 2/ * 39.4 4.4 0.3 0.1 0.1 0.1 * 0.1 0.1 0.1 44.2 44.5

NOTES: " * " is between $50 million and -$50 million.

Components may not sum to totals because of rounding.

1/ Does not include MA, Part B premium, Medicaid, or TRICARE interactions.

2/ Total does not include the amounts included in the 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;
COBRA = Consolidated Omnibus Reconciliation Act; 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.

Net Effects for Section 523: Physician Payment Update

Includes estimated interactions with Medicare Advantage, Medicaid,
TRICARE, and Part B Premiums 3.1 14.5 5.3 0 0 0 0 0 0 0 0 22.9 22.9

Congressional Budget Office Page 1 of 2 May 27, 2010

Table 2: Estimate of H.R. 4213, the American Jobs and Closing Tax Loopholes Act of 2010, Title V, Subtitle B
(As posted on the Web site of the Committee on Ways and Means on May 20, 2010, and with subsequent amendment f:\VHLC\052610\052610.336.xml; May 26, 2010 (5:25 p.m.))
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

Effect on Deficits of Provisions in Title V, Subtitle B Estimated by CBO and the

staff of the Joint Committee on Taxation

Changes in Direct Spending Outlays

Changes in On-Budget Direct Spending in table prepared by CBO * 39.4 4.4 0.3 0.1 0.1 0.1 * 0.1 0.1 0.1 44.2 44.5

Changes in On-Budget Direct Spending in table prepared by JCT

511 Extension of premium assistance for COBRA benefits 0.3 0.3 0.5 0 0 0 0 0 0 0 0 1.1 1.1
521 CMS-IRS data match 0 0 * * -0.1 -0.1 -0.1 -0.1 -0.1 -0.1 -0.1 -0.2 -0.4

Total Changes in Direct Spending 0.3 39.7 4.9 0.3 * * * * * * * 45.1 45.2

Changes in On-Budget Revenues 1/

511 Extension of premium assistance for COBRA benefits -2.3 -3.0 -0.5 * * * * * * 0 0 -5.8 -5.7

Total Estimated Increase or Decrease (-) in On-Budget Deficits of

Provisions included in Title V, Subtitle B 2.6 42.7 5.3 0.2 * * * * * * * 50.9 50.9

NOTES: " * " is between $50 million and -$50 million.

Components may not sum to totals because of rounding.

1/ Negative numbers denote a DECREASE in federal revenues.

CMS = Centers for Medicare & Medicaid Services; COBRA = Consolidated Omnibus Reconciliation Act; IRS = Internal Revenue Service.

Congressional Budget Office Page 2 of 2 May 27, 2010