II 

110TH CONGRESS 

2D SESSION S. 3656 

To preserve access to healthcare under the Medicare and Medicaid programs. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 30 (legislative day, SEPTEMBER 17), 2008 

Mr. SCHUMER (for himself and Mrs. CLINTON) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To preserve access to healthcare under the Medicare and 

Medicaid programs. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Preserving Access to Healthcare (PATH) Act of 2008’’. 

6 (b) TABLE OF CONTENTS.—The table of contents of 

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Temporary non-application of Medicare phased-out indirect medical education adjustment factor. 

Sec. 3. Delay in implementation of Medicaid outpatient hospital services regulation. 

Sec. 4. Delay in phase out of the Medicare hospice budget neutrality adjustment factor. 

Sec. 5. Treatment of certain Medicaid family demonstration project. 


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Sec. 6. Delay in implementation of certain provisions relating to Medicare rural 

health clinics and federally qualified health centers. 

Sec. 7. Mandatory State use of National Correct Coding Initiative. 

Sec. 8. Medicaid Improvement Fund technical correction. 

Sec. 9. Funding for the Medicare Improvement Fund. 

1 SEC. 2. TEMPORARY NON-APPLICATION OF MEDICARE 

2 PHASED-OUT INDIRECT MEDICAL EDU3 CATION ADJUSTMENT FACTOR. 

4 (a) IN GENERAL.—Notwithstanding any other provi5 sion of law, during the period beginning on October 1, 

6 2008, and ending on March 31, 2009, section 412.322 of 

7 title 42, Code of Federal Regulations, shall be applied 

8 without regard to paragraph (c) of such section. 

9 (b) NO EFFECT ON SUBSEQUENT PERIODS.—Noth10 ing in subsection (a) shall be construed as having any ef11 fect on the application of section 412.322 of title 42, Code 

12 of Federal Regulations, after March 31, 2009. 

13 SEC. 3. DELAY IN IMPLEMENTATION OF MEDICAID OUT14 PATIENT HOSPITAL SERVICES REGULATION. 

15 Notwithstanding any other provision of law, during 

16 the 6-month period that begins on the date of enactment 

17 of this Act, the Secretary of Health and Human Services 

18 shall not finalize or otherwise implement provisions con19 tained in the proposed rule published on September 28, 

20 2007, on pages 55158 through 55166 of volume 72, Fed21 eral Register (relating to parts 440 and 447 of title 42, 

22 Code of Federal Regulations). 


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1 SEC. 4. DELAY IN PHASE OUT OF THE MEDICARE HOSPICE 

2 BUDGET NEUTRALITY ADJUSTMENT FACTOR. 

3 Notwithstanding any other provision of law, including 

4 the provisions contained in the final rule published on Au5 gust 8, 2008, on pages 46464 through 46522 of volume 

6 73, Federal Register (relating to part 418 of title 42, Code 

7 of Federal Regulations), the Secretary of Health and 

8 Human Services shall not phase out or eliminate the budg9 et neutrality adjustment factor in the Medicare hospice 

10 wage index prior to April 1, 2009. 

11 SEC. 5. TREATMENT OF CERTAIN MEDICAID FAMILY DEM12 ONSTRATION PROJECT. 

13 The Secretary of Health and Human Services, acting 

14 through the Administer of the Centers for Medicare & 

15 Medicaid Services and upon the request of the State of 

16 California, shall extend approval, and full Federal finan17 cial participation, of the State’s Medicaid family planning 

18 demonstration project, which was approved under a waiver 

19 pursuant to section 1115 of the Social Security Act, until 

20 June 30, 2009, under the eligibility requirements and 

21 processes that were in place for such project as of the date 

22 before the first extension period for such project. 


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1 SEC. 6. DELAY IN IMPLEMENTATION OF CERTAIN PROVI2 SIONS RELATING TO MEDICARE RURAL 

3 HEALTH CLINICS AND FEDERALLY QUALI4 FIED HEALTH CENTERS. 

5 Notwithstanding any other provision of law, the Sec6 retary of Health and Human Services shall not, prior to 

7 April 1, 2009, take any action (through promulgation of 

8 regulation, issuance of regulatory guidance, or other ad9 ministrative action) to— 

10 (1) finalize or otherwise implement provisions 

11 contained in the proposed rule published on June 

12 27, 2008, on pages 36696 through 36719 of volume 

13 73, Federal Register, that relate to— 

14 (A) decertifying rural health clinics under 

15 the Medicare program under title XVIII of the 

16 Social Security Act that are determined to no 

17 longer be in nonurbanized areas; and 

18 (B) changes in the payment methodology 

19 for rural health clinics and federally qualified 

20 health centers under the Medicare program as 

21 described in sections 405.2410 and 

22 405.2466(b)(1)(iii) of title 42, Code of Federal 

23 Regulations; or 

24 (2) promulgate or implement any rule or provi25 sions similar to the provisions described in para26 graph (1). 


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1 SEC. 7. MANDATORY STATE USE OF NATIONAL CORRECT 

2 CODING INITIATIVE. 

3 (a) IN GENERAL.—Section 1903(r) of the Social Se4 curity Act (42 U.S.C. 1396b(r)) is amended— 

5 (1) in paragraph (1)(B)— 

6 (A) in clause (ii), by striking ‘‘and’’ at the 

7 end; 

8 (B) in clause (iii), by adding ‘‘and’’ after 

9 the semicolon; and 

10 (C) by adding at the end the following new 

11 clause: 

12 ‘‘(iv) effective for claims filed on or 

13 after October 1, 2009, incorporate compat14 ible methodologies of the National Correct 

15 Coding Initiative administered by the Sec16 retary (or any successor initiative to pro17 mote correct coding and to control im18 proper coding leading to inappropriate pay19 ment) and such other methodologies of 

20 that Initiative (or such other national cor21 rect coding methodologies) as the Sec22 retary identifies in accordance with para23 graph (3);’’; and 

24 (2) by adding at the end the following new 

25 paragraph: 


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1 ‘‘(3) Not later than September 1, 2009, the Secretary 

2 shall do the following: 

3 ‘‘(A) Identify those methodologies of the Na4 tional Correct Coding Initiative administered by the 

5 Secretary (or any successor initiative to promote cor6 rect coding and to control improper coding leading 

7 to inappropriate payment) which are compatible to 

8 claims filed under this title. 

9 ‘‘(B) Identify those methodologies of such Ini10 tiative (or such other national correct coding meth11 odologies) that should be incorporated into claims 

12 filed under this title with respect to items or services 

13 for which States provide medical assistance under 

14 this title and no national correct coding methodolo15 gies have been established under such Initiative with 

16 respect to title XVIII. 

17 ‘‘(C) Notify States of— 

18 ‘‘(i) the methodologies identified under 

19 subparagraphs (A) and (B) (and of any other 

20 national correct coding methodologies identified 

21 under subparagraph (B)); and 

22 ‘‘(ii) how States are to incorporate such 

23 methodologies into claims filed under this title. 

24 ‘‘(D) Submit a report to Congress that includes 

25 the notice to States under subparagraph (C) and an 


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1 analysis supporting the identification of the meth2 odologies made under subparagraphs (A) and (B).’’. 

3 (b) EXTENSION FOR STATE LAW AMENDMENT.—In 

4 the case of a State plan under title XIX of the Social Se5 curity Act (42 U.S.C. 1396 et seq.) which the Secretary 

6 of Health and Human Services determines requires State 

7 legislation in order for the plan to meet the additional re8 quirements imposed by the amendment made by sub9 section (a)(1)(C), the State plan shall not be regarded as 

10 failing to comply with the requirements of such title solely 

11 on the basis of its failure to meet these additional require12 ments before the first day of the first calendar quarter 

13 beginning after the close of the first regular session of the 

14 State legislature that begins after the date of enactment 

15 of this Act. For purposes of the previous sentence, in the 

16 case of a State that has a 2-year legislative session, each 

17 year of the session is considered to be a separate regular 

18 session of the State legislature. 

19 SEC. 8. MEDICAID IMPROVEMENT FUND TECHNICAL COR20 RECTION. 

21 (a) IN GENERAL.—Section 1941(b)(1)(B) of the So22 cial Security Act, as added by section 7002(b) of the Sup23 plemental Appropriations Act, 2008, is amended by insert24 ing ‘‘each of’’ after ‘‘for’’. 


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1 (b) EFFECTIVE DATE.—The amendment made by 

2 subsection (a) shall take effect as if included in the enact3 ment of the Supplemental Appropriations Act, 2008 (Pub4 lic Law 110–252). 

5 SEC. 9. FUNDING FOR THE MEDICARE IMPROVEMENT 

6 FUND. 

7 Section 1898(b)(1) of the Social Security Act, as 

8 added by section 7002(a) of the Supplemental Appropria9 tions Act, 2008 (Public Law 110–252) and as amended 

10 by section 188(a)(2) of the Medicare Improvements for 

11 Patients and Providers Act of 2008 (Public Law 110–275) 

12 and by section 6 of the QI Program Supplemental Fund13 ing Act of 2008, is amended by striking ‘‘$2,290,000,000’’ 

14 and inserting ‘‘$2,590,000,000’’. 

Æ 


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