P.L. 110–252, Approved June 30, 2008 (122 Stat. 2323)

Supplemental Appropriations Act of 2008

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TITLE VII—MEDICAID PROVISIONS

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SEC. 7001. [None Assigned]  Moratoria on Certain Medicaid Regulations.

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(3)  Additional moratoria.—

(A)  In general.—Notwithstanding any other provision of law, the Secretary of Health and Human Services shall not, prior to April 1, 2009, take any action (through promulgation of regulation, issuance of regulatory guidance, use of Federal payment audit procedures, or other administrative action, policy, or practice, including a Medical Assistance Manual transmittal or letter to State Medicaid directors) to impose any restrictions relating to a provision described in subparagraph (B) or (C) if such restrictions are more restrictive in an aspect than those applied to the respective provision as of the date specified in subparagraph (D) for such provision.

(B)  Portion of interim final regulation relating to medicaid treatment of optional case management services.—

(i)  In general.—Subject to clause (ii), the provision described in this subparagraph is the interim final regulation relating to optional State plan case management services under the Medicaid program published on December 4, 2007 (72 Federal Register 68077) in its entirety.

(ii)  Exception.—The provision described in this subparagraph does not include the portion of such regulation as relates directly to implementing section 1915(g)(2)(A)(ii) of the Social Security Act, as amended by section 6052 of the Deficit Reduction Act of 2005 (Public Law 109–171), through the definition of case management services and targeted case management services contained in proposed section 440.169 of title 42, Code of Federal Regulations, but only to the extent that such portion is not more restrictive than the policies set forth in the Dear State Medicaid Director letter on case management issued on January 19, 2001 (SMDL #01–013), and with respect to community transition case management, the Dear State Medicaid Director letter issued on July 25, 2000 (Olmstead Update 3).

(C)  Portion of proposed regulation relating to medicaid allowable provider taxes.—

(i)  In general.—Subject to clause (ii), the provision described in this subparagraph is the final regulation relating to health-care-related taxes under the Medicaid program published on February 22, 2008 (73 Federal Register 9685) in its entirety.

(ii)  Exception.—The provision described in this subparagraph does not include the portions of such regulation as relate to the following:

(I)  Reduction in threshold.—The reduction from 6 percent to 5.5 percent in the threshold applied under section 433.68(f)(3)(i) of title 42, Code of Federal Regulations, for determining whether or not there is an indirect guarantee to hold a taxpayer harmless, as required to carry out section 1903(w)(4)(C)(ii) of the Social Security Act, as added by section 403 of the Medicare Improvement and Extension Act of 2006 (division B of Public Law 109–432).

(II)  Change in definition of managed care.—The change in the definition of managed care as proposed in the revision of section 433.56(a)(8) of title 42, Code of Federal Regulations, as required to carry out section 1903(w)(7)(A)(viii) of the Social Security Act, as amended by section 6051 of the Deficit Reduction Act of 2005 (Public Law 109–171).

(D)  Date specified.—The date specified in this subparagraph for the provision described in—

(i)  subparagraph (B) is December 3, 2007; or

(ii)  subparagraph (C) is February 21, 2008.

(b) [42 U.S.C. 1320A-7g]  Funds to Reduce Medicaid Fraud and Abuse.—

(1)  In general.—For purposes of reducing fraud and abuse in the Medicaid program under title XIX of the Social Security Act—

(A)  there is appropriated to the Office of the Inspector General of the Department of Health and Human Services, out of any money in the Treasury not otherwise appropriated, $25,000,000, for fiscal year 2009; and

(B)  there is authorized to be appropriated to such Office $25,000,000 for fiscal year 2010 and each subsequent fiscal year.

Amounts appropriated under this section shall remain available for expenditure until expended and shall be in addition to any other amounts appropriated or made available to such Office for such purposes with respect to the Medicaid program.

(2)  Annual report.—Not later than September 30 of 2009 and of each subsequent year, the Inspector General of the Department of Health and Human Services shall submit to the Committees on Energy and Commerce and Appropriations of the House of Representatives and the Committees on Finance and Appropriations of the Senate a report on the activities (and the results of such activities) funded under paragraph (1) to reduce waste, fraud, and abuse in the Medicaid program under title XIX of the Social Security Act during the previous 12 month period, includingthe amount of funds appropriated under such paragraph for each such activity and an estimate of the savings to the Medicaid program resulting from each such activity.

(c)  Study and Reports to Congress.—

(1)  Secretarial report identifying problems.—Not later than January 1, 2009, the Secretary of Health and Human Services shall submit to the Committee on Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate a report that—

(A)  outlines the specific problems the Medicaid regulations referred to in the amendments made by paragraphs (1) and (2) of subsection (a) were intended to address;

(B)  details how these regulations were designed to address these specific problems; and

(C)  cites the legal authority for such regulations.

(2)  Independent comprehensive study and report.—

(A)  In general.—Not later than January 1, 2009, the Secretary of Health and Human Services shall enter into a contract with an independent organization for the purpose of—

(i)  producing a comprehensive report on the prevalence of the problems outlined in the report submitted under paragraph (1);

(ii)  identifying strategies in existence to address these problems; and

(iii)  assessing the impact of each regulation referred to in such paragraph on each State and the District of Columbia.

(B)  Additional matter.—The report under subparagraph (A) shall also include—

(i)  an identification of which claims for items and services (including administrative activities) under title XIX of the Social Security Act are not processed through systems described in section 1903(r) of such Act;

(ii)  an examination of the reasons why these claims for such items and services are not processed through such systems; and

(iii)  recommendations on actions by the Federal government and the States that can make claims for such items and services more accurate and complete consistent with such title.

(C)  Deadline.—The report under subparagraph (A) shall be submitted to the Committee on Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate not later than September 1, 2009.

(D)  Cooperation of states.—If the Secretary of Health and Human Services determines that a State or the District of Columbia has not cooperated with the independent organization for purposes of the report under this paragraph, the Secretary shall reduce the amount paid to the State or District under section 1903(a) of the SocialSecurity Act (42 U.S.C. 1396b(a)) by $25,000 for each day on which the Secretary determines such State or District has not so cooperated. Such reduction shall be made through a process that permits the State or District to challenge the Secretary’s determination.

(3)  Funding.—

(A)  In general.—Out of any money in the Treasury of the United States not otherwise appropriated, there are appropriated to the Secretary without further appropriation, $5,000,000 to carry out this subsection.

(B)  Availability; amounts in addition to other amounts appropriated for such activities.—Amounts appropriated pursuant to subparagraph (A) shall—

(i)  remain available until expended; and

(ii)  be in addition to any other amounts appropriated or made available to the Secretary of Health and Human Services with respect to the Medicaid program.

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[Internal References.—SSAct Title XI, Part A, and Title XIX headings have footnotes referring to P.L. 110-252.]