II 110th CONGRESS 1st Session S. 2460 IN THE SENATE OF THE UNITED STATES December 12, 2007 Mr. Bingaman (for himself, Mrs. Dole, Mr. Durbin, Mrs. Feinstein, Ms. Stabenow, Mr. Salazar, Mr. Kerry, Mr. Brown, Mrs. McCaskill, Mr. Schumer, Mrs. Boxer, Mr. Levin, Mr. Bayh, Mr. Burr, Mr. Martinez, Mrs. Clinton, Mr. Pryor, Mr. Leahy, Mrs. Lincoln, Mrs. Hutchison, Mr. Chambliss, Mr. Rockefeller, Mr. Isakson, and Mr. Bond) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To extend by one year the moratorium on implementation of a rule relating to the Federal-State financial partnership under Medicaid and the State Children's Health Insurance Program and on finalization of a rule regarding graduate medical education under Medicaid and to include a moratorium on the finalization of the outpatient Medicaid rule making similar changes.

1.

Extension of moratorium on implementation of rule relating to the Federal-State financial partnership under medicaid and SCHIP and on finalization of a rule relating to the treatment of graduate medical education under medicaid; moratorium on the finalization of the outpatient Medicaid rule making similar change

(a)

Findings

Congress makes the following findings: (1)A proposed rule was published on January 18, 2007, on pages 2236 through 2248 of volume 72, Federal Register, and a rule purporting to finalize that rule was published on May 29, 2007, on pages 29748 through 29836 of volume 72, Federal Register (relating to parts 433, 447, and 457 of title 42, Code of Federal Regulations). This rule would significantly change the Federal-State financial partnership under the Medicaid and the State Children’s Health Insurance Programs by— (A)imposing a cost limit on payments made under such programs to governmentally operated providers; (B)limiting the permissible sources of the non-Federal shares required under such programs and the types of entities permitted to contribute to such shares; and (C)imposing new requirements on participating providers and States under such programs. (2)A proposed rule was published on May 23, 2007, on pages 28930 through 28936 of volume 72, Federal Register (relating to parts 438 and 447 of title 42, Code of Federal Regulations) that would significantly change the scope of permissible payments under Medicaid by removing the ability for States to make payments related to graduate medical education. (3)Permitting these rules to take effect would drastically alter the Federal-State financial partnership in Medicaid and the State Children’s Health Insurance Programs, undermine the discretion traditionally accorded States, and have a negative impact on States, providers, and beneficiaries in the following manner: (A)Implementation of the rule regarding the Federal-State financial partnership would force billions of dollars of payment reductions, thus hampering the ability of impacted providers to provide essential services including allowing those providers to be ready and available for emergency situations and to provide care to the increasing numbers of uninsured. (B)Implementation of the rule regarding graduate medical education would force billions of dollars in payment reductions to teaching hospitals, thus hampering the ability of those providers to provide essential services including the education of the next generation of medical professionals despite a shortage of medical professionals. (4)By including a one-year moratorium in the U.S. Troop Readiness, Veterans’ Care, Katrina Recovery, and Iraq Accountability Appropriations Act of 2007, Congress intended to forestall administrative action to allow itself time to assess the proposals and consider alternatives that would not negatively impact States, providers, and beneficiaries. (5)After Congressional approval of the moratorium contained in the U.S. Troop Readiness, Veterans’ Care, Katrina Recovery, and Iraq Accountability Appropriations Act of 2007, the Centers for Medicare & Medicaid Services on May 25, 2007, submitted for publication its final rule, which was not significantly different from the January proposed regulation. (6)The publication of a final rule in May regarding the Federal-State financial partnership was not anticipated by Congress and accelerates the negative impact on States, providers, and beneficiaries, thus undermining the intent of the moratorium passed by Congress. (7)The publication of a proposed rule in May regarding graduate medical education was not anticipated by Congress and undermines the intent of the moratorium passed by Congress. (8)A proposed rule was published on September 28, 2007, on pages 55158 through 55166 of volume 72, Federal Register (relating to parts 440 and 447 of title 42, Code of Federal Regulations) that would significantly change the scope of permissible payments under Medicaid by redefining outpatient hospital services and dictating methodologies for calculation of the outpatient services upper payment limit. (9)Congress did not anticipate continued changes after the moratorium to reduce State flexibility to make adequate Medicaid payments. (10)Expansion and extension of the moratorium is necessary to effectuate Congressional intent. (b)

Extension of prohibition

Section 7002(a)(1) of the U.S. Troop Readiness, Veterans’ Care, Katrina Recovery, and Iraq Accountability Appropriations Act of 2007 (Public Law 110–28) is amended— (1)by striking 1 year and inserting 2 years; (2)by inserting or (D) after described in subparagraph (A) in subparagraph (B); (3)by striking or at the end of subparagraph (B); (4)by striking the period at the end of subparagraph (C) and inserting ; or; and (5)by inserting at the end the following: (D)finalize or otherwise implement provisions contained in the proposed rule published on September 28, 2007, on pages 55158 through 55166 of volume 72, Federal Register (relating to parts 440 and 447 of title 42, Code of Federal Regulations). .