[Congressional Bills 110th Congress]
[From the U.S. Government Printing Office]
[H.R. 5613 Placed on Calendar Senate (PCS)]
Calendar No. 719
110th CONGRESS
2d Session
H. R. 5613
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
April 24, 2008
Received and read the first time
April 28, 2008
Read the second time and placed on the calendar
_______________________________________________________________________
AN ACT
To extend certain moratoria and impose additional moratoria on certain
Medicaid regulations through April 1, 2009, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Protecting the Medicaid Safety Net
Act of 2008''.
SEC. 2. MORATORIA ON CERTAIN MEDICAID REGULATIONS.
(a) Extension of Certain Moratoria in Public Law 110-28.--Section
7002(a)(1) of the U.S. Troop Readiness, Veterans' Care, Katrina
Recovery, and Iraq Accountability Appropriations Act, 2007 (Public Law
110-28) is amended--
(1) by striking ``prior to the date that is 1 year after
the date of enactment of this Act'' and inserting ``prior to
April 1, 2009'';
(2) in subparagraph (A), by inserting after ``Federal
Regulations)'' the following: ``or in the final regulation,
relating to such parts, published on May 29, 2007 (72 Federal
Register 29748)''; and
(3) in subparagraph (C), by inserting before the period at
the end the following: ``, including the proposed regulation
published on May 23, 2007 (72 Federal Register 28930)''.
(b) Extension of Certain Moratoria in Public Law 110-173.--Section
206 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public
Law 110-173) is amended--
(1) by striking ``June 30, 2008'' and inserting ``April 1,
2009'';
(2) by inserting ``, including the proposed regulation
published on August 13, 2007 (72 Federal Register 45201),''
after ``rehabilitation services''; and
(3) by inserting ``, including the final regulation
published on December 28, 2007 (72 Federal Register 73635),''
after ``school-based transportation''.
(c) Additional Moratoria.--
(1) 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 (A), (B), or (C) of paragraph (2) if such
restrictions are more restrictive in any aspect than those
applied to the respective provision as of the date specified in
paragraph (3) for such provision.
(2) Provisions described.--
(A) 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).
(B) Proposed regulation relating to redefinition of
medicaid outpatient hospital services.--The provision
described in this subparagraph is the proposed
regulation relating to clarification of outpatient
clinic and hospital facility services definition and
upper payment limit under the Medicaid program
published on September 28, 2007 (72 Federal Register
55158) in its entirety.
(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).
(3) Date specified.--The date specified in this paragraph
for the provision described in--
(A) subparagraph (A) of paragraph (2) is December
3, 2007;
(B) subparagraph (B) of such paragraph is September
27, 2007; or
(C) subparagraph (C) of such paragraph is February
21, 2008.
SEC. 3. FUNDS TO REDUCE MEDICAID FRAUD AND ABUSE.
(a) In General.--For purposes of reducing fraud and abuse in the
Medicaid program under title XIX of the Social Security Act, there is
appropriated to the Secretary of Health and Human Services, out of any
money in the Treasury not otherwise appropriated, $25,000,000, for each
fiscal year (beginning with fiscal year 2009). 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 the Secretary for such purposes with respect to the
Medicaid program.
(b) Annual Report.--Not later than September 30 of 2009 and of each
subsequent year, 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 on
the activities (and the results of such activities) funded under
subsection (a) to reduce waste, fraud, and abuse in the Medicaid
program under title XIX of the Social Security Act during the previous
12 month period, including the amount of funds appropriated under such
subsection (a) for each such activity and an estimate of the savings to
the Medicaid program resulting from each such activity.
SEC. 4. STUDY AND REPORTS TO CONGRESS.
(a) Secretarial Report Identifying Problems.--Not later than July
1, 2008, 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--
(1) outlines the specific problems the Medicaid regulations
referred to in the amendments made by subsections (a) and (b)
of section 2 and in the provisions described in subsection
(c)(2) of such section were intended to address;
(2) detailing how these regulations were designed to
address these specific problems; and
(3) cites the legal authority for such regulations.
(b) Independent Comprehensive Study and Report.--
(1) In general.--Not later than July 1, 2008, the Secretary
of Health and Human Services shall enter into a contract with
an independent organization for the purpose of--
(A) producing a comprehensive report on the
prevalence of the problems outlined in the report
submitted under subsection (a);
(B) identifying strategies in existence to address
these problems; and
(C) assessing the impact of each regulation
referred to in such subsection on each State and the
District of Columbia.
(2) Additional matter.--The report under paragraph (1)
shall also include--
(A) 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;
(B) an examination of the reasons why these claims
for such items and services are not processed through
such systems; and
(C) 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.
(3) Deadline.--The report under paragraph (1) 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 March 1, 2009.
(4) 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 subsection, the Secretary
shall reduce the amount paid to the State or District under
section 1903(a) of the Social Security 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.
(c) Funding.--
(1) 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 section.
(2) Availability; amounts in addition to other amounts
appropriated for such activities.--Amounts appropriated
pursuant to paragraph (1) shall--
(A) remain available until expended; and
(B) 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.
SEC. 5. ASSET VERIFICATION THROUGH ACCESS TO INFORMATION HELD BY
FINANCIAL INSTITUTIONS.
(a) Addition of Authority.--Title XIX of the Social Security Act is
amended by inserting after section 1939 the following new section:
``asset verification through access to information held by financial
institutions
``Sec. 1940. (a) Implementation.--
``(1) In general.--Subject to the provisions of this
section, each State shall implement an asset verification
program described in subsection (b), for purposes of
determining or redetermining the eligibility of an individual
for medical assistance under the State plan under this title.
``(2) Plan submittal.--In order to meet the requirement of
paragraph (1), each State shall--
``(A) submit not later than a deadline specified by
the Secretary consistent with paragraph (3), a State
plan amendment under this title that describes how the
State intends to implement the asset verification
program; and
``(B) provide for implementation of such program
for eligibility determinations and redeterminations
made on or after 6 months after the deadline
established for submittal of such plan amendment.
``(3) Phase-in.--
``(A) In general.--
``(i) Implementation in current asset
verification demo states.--The Secretary shall
require those States specified in subparagraph
(C) (to which an asset verification program has
been applied before the date of the enactment
of this section) to implement an asset
verification program under this subsection by
the end of fiscal year 2009.
``(ii) Implementation in other states.--The
Secretary shall require other States to submit
and implement an asset verification program
under this subsection in such manner as is
designed to result in the application of such
programs, in the aggregate for all such other
States, to enrollment of approximately, but not
less than, the following percentage of
enrollees, in the aggregate for all such other
States, by the end of the fiscal year involved:
``(I) 12.5 percent by the end of
fiscal year 2009.
``(II) 25 percent by the end of
fiscal year 2010.
``(III) 50 percent by the end of
fiscal year 2011.
``(IV) 75 percent by the end of
fiscal year 2012.
``(V) 100 percent by the end of
fiscal year 2013.
``(B) Consideration.--In selecting States under
subparagraph (A)(ii), the Secretary shall consult with
the States involved and take into account the
feasibility of implementing asset verification programs
in each such State.
``(C) States specified.--The States specified in
this subparagraph are California, New York, and New
Jersey.
``(D) Construction.--Nothing in subparagraph
(A)(ii) shall be construed as preventing a State from
requesting, and the Secretary approving, the
implementation of an asset verification program in
advance of the deadline otherwise established under
such subparagraph.
``(4) Exemption of territories.--This section shall only
apply to the 50 States and the District of Columbia.
``(b) Asset Verification Program.--
``(1) In general.--For purposes of this section, an asset
verification program means a program described in paragraph (2)
under which a State--
``(A) requires each applicant for, or recipient of,
medical assistance under the State plan under this
title on the basis of being aged, blind, or disabled to
provide authorization by such applicant or recipient
(and any other person whose resources are material to
the determination of the eligibility of the applicant
or recipient for such assistance) for the State to
obtain (subject to the cost reimbursement requirements
of section 1115(a) of the Right to Financial Privacy
Act but at no cost to the applicant or recipient) from
any financial institution (within the meaning of
section 1101(1) of such Act) any financial record
(within the meaning of section 1101(2) of such Act)
held by the institution with respect to the applicant
or recipient (and such other person, as applicable),
whenever the State determines the record is needed in
connection with a determination with respect to such
eligibility for (or the amount or extent of) such
medical assistance; and
``(B) uses the authorization provided under
subparagraph (A) to verify the financial resources of
such applicant or recipient (and such other person, as
applicable), in order to determine or redetermine the
eligibility of such applicant or recipient for medical
assistance under the State plan.
``(2) Program described.--A program described in this
paragraph is a program for verifying individual assets in a
manner consistent with the approach used by the Commissioner of
Social Security under section 1631(e)(1)(B)(ii).
``(c) Duration of Authorization.--Notwithstanding section
1104(a)(1) of the Right to Financial Privacy Act, an authorization
provided to a State under subsection (b)(1) shall remain effective
until the earliest of--
``(1) the rendering of a final adverse decision on the
applicant's application for medical assistance under the
State's plan under this title;
``(2) the cessation of the recipient's eligibility for such
medical assistance; or
``(3) the express revocation by the applicant or recipient
(or such other person described in subsection (b)(1), as
applicable) of the authorization, in a written notification to
the State.
``(d) Treatment of Right to Financial Privacy Act Requirements.--
``(1) An authorization obtained by the State under
subsection (b)(1) shall be considered to meet the requirements
of the Right to Financial Privacy Act for purposes of section
1103(a) of such Act, and need not be furnished to the financial
institution, notwithstanding section 1104(a) of such Act.
``(2) The certification requirements of section 1103(b) of
the Right to Financial Privacy Act shall not apply to requests
by the State pursuant to an authorization provided under
subsection (b)(1).
``(3) A request by the State pursuant to an authorization
provided under subsection (b)(1) is deemed to meet the
requirements of section 1104(a)(3) of the Right to Financial
Privacy Act and of section 1102 of such Act, relating to a
reasonable description of financial records.
``(e) Required Disclosure.--The State shall inform any person who
provides authorization pursuant to subsection (b)(1)(A) of the duration
and scope of the authorization.
``(f) Refusal or Revocation of Authorization.--If an applicant for,
or recipient of, medical assistance under the State plan under this
title (or such other person described in subsection (b)(1), as
applicable) refuses to provide, or revokes, any authorization made by
the applicant or recipient (or such other person, as applicable) under
subsection (b)(1)(A) for the State to obtain from any financial
institution any financial record, the State may, on that basis,
determine that the applicant or recipient is ineligible for medical
assistance.
``(g) Use of Contractor.--For purposes of implementing an asset
verification program under this section, a State may select and enter
into a contract with a public or private entity meeting such criteria
and qualifications as the State determines appropriate, consistent with
requirements in regulations relating to general contracting provisions
and with section 1903(i)(2). In carrying out activities under such
contract, such an entity shall be subject to the same requirements and
limitations on use and disclosure of information as would apply if the
State were to carry out such activities directly.
``(h) Technical Assistance.--The Secretary shall provide States
with technical assistance to aid in implementation of an asset
verification program under this section.
``(i) Reports.--A State implementing an asset verification program
under this section shall furnish to the Secretary such reports
concerning the program, at such times, in such format, and containing
such information as the Secretary determines appropriate.
``(j) Treatment of Program Expenses.--Notwithstanding any other
provision of law, reasonable expenses of States in carrying out the
program under this section shall be treated, for purposes of section
1903(a), in the same manner as State expenditures specified in
paragraph (7) of such section.''.
(b) State Plan Requirements.--Section 1902(a) of such Act (42
U.S.C. 1396a(a)) is amended--
(1) in paragraph (69) by striking ``and'' at the end;
(2) in paragraph (70) by striking the period at the end and
inserting ``; and''; and
(3) by inserting after paragraph (70), as so amended, the
following new paragraph:
``(71) provide that the State will implement an asset
verification program as required under section 1940.''.
(c) Withholding of Federal Matching Payments for Noncompliant
States.--Section 1903(i) of such Act (42 U.S.C. 1396b(i)) is amended--
(1) in paragraph (22) by striking ``or'' at the end;
(2) in paragraph (23) by striking the period at the end and
inserting ``; or''; and
(3) by adding after paragraph (23) the following new
paragraph:
``(24) if a State is required to implement an asset
verification program under section 1940 and fails to implement
such program in accordance with such section, with respect to
amounts expended by such State for medical assistance for
individuals subject to asset verification under such section,
unless--
``(A) the State demonstrates to the Secretary's
satisfaction that the State made a good faith effort to
comply;
``(B) not later than 60 days after the date of a
finding that the State is in noncompliance, the State
submits to the Secretary (and the Secretary approves) a
corrective action plan to remedy such noncompliance;
and
``(C) not later than 12 months after the date of
such submission (and approval), the State fulfills the
terms of such corrective action plan.''.
(d) Repeal.--Section 4 of Public Law 110-90 is repealed.
SEC. 6. ADJUSTMENT TO PAQI FUND.
Section 1848(l)(2) of the Social Security Act (42 U.S.C. 1395w-
4(l)(2)), as amended by section 101(a)(2) of the Medicare, Medicaid,
and SCHIP Extension Act of 2007 (Public Law 110-173), is amended--
(1) in subparagraph (A)(i)--
(A) in subclause (III), by striking
``$4,960,000,000'' and inserting ``$3,790,000,000'';
and
(B) by adding at the end the following new
subclause:
``(IV) For expenditures during
2014, an amount equal to
$3,690,000,000.'';
(2) in subparagraph (A)(ii), by adding at the end the
following new subclause:
``(IV) 2014.--The amount available
for expenditures during 2014 shall only
be available for an adjustment to the
update of the conversion factor under
subsection (d) for that year.''; and
(3) in subparagraph (B)--
(A) in clause (ii), by striking ``and'' at the end;
(B) in clause (iii), by striking the period at the
end and inserting ``; and''; and
(C) by adding at the end the following new clause:
``(iv) 2014 for payment with respect to
physicians' services furnished during 2014.''.
Passed the House of Representatives April 23, 2008.
Attest:
LORRAINE C. MILLER,
Clerk.
Calendar No. 719
110th CONGRESS
2d Session
H. R. 5613
_______________________________________________________________________
AN ACT
To extend certain moratoria and impose additional moratoria on certain
Medicaid regulations through April 1, 2009, and for other purposes.
_______________________________________________________________________
April 28, 2008
Read the second time and placed on the calendar