I 
110TH CONGRESS 
2D SESSION 
H. R. 5613 
To extend certain moratoria and impose additional moratoria on certain 
Medicaid regulations through April 1, 2009. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 13, 2008 
Mr. DINGELL (for himself and Mr. TIM MURPHY of Pennsylvania) introduced 
the following bill; which was referred to the Committee on Energy and 
Commerce 
A BILL 
To extend certain moratoria and impose additional moratoria 
on certain Medicaid regulations through April 1, 2009. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Protecting the Med-
icaid 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 
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(3) by inserting ‘‘, including the final regulation 
published on December 28, 2007 (72 Federal Reg-
ister 73635),’’ after ‘‘school-based transportation’’. 
(c) ADDITIONAL MORATORIA.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services may not, prior to April 1, 2009, im-
pose (or continue in effect) any requirement, prevent 
the implementation of any provision, or condition the 
approval of any provision under any State plan 
under title XIX or XXI of the Social Security Act, 
any amendment of such a plan, or demonstration 
project request relating to such plan or title, on the 
basis of any policy or interpretation relating to a 
provision described in paragraph (2) or to any rule, 
provision, policy, or interpretation similar to such a 
provision. 
(2) PROVISIONS
DESCRIBED.—The provisions 
described in this paragraph are the following: 
(A) PORTION OF INTERIM FINAL REGULA-
TION RELATING TO MEDICAID TREATMENT OF 
OPTIONAL CASE MANAGEMENT SERVICES.— 
(i) The interim final regulation relat-
ing to optional State plan case manage-
ment services under the Medicaid program 
published on December 4, 2007 (72 Fed-
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eral Register 68007) in its entirety, except 
as provided in clause (ii). 
(ii) Clause (i) shall not apply to the 
portion of such regulation as relates di-
rectly 
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 pro-
posed 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 HOS-
PITAL SERVICES.—The proposed regulation re-
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lating 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.—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, other than the 
portion of such regulation as relates to the fol-
lowing: 
(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). 
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(ii) CHANGE IN DEFINITION OF MAN-
AGED CARE.—The change in the definition 
of managed care as proposed in the revi-
sion 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). 
Æ 
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