IB 
Union Calendar No. 373 
110TH CONGRESS 
2D SESSION 
H. R. 5613 
[Report No. 110–600] 
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 
APRIL 22, 2008 
Additional sponsors: Mr. PALLONE, Mr. ALLEN, Ms. SCHAKOWSKY, Mr. 
ENGEL, Mr. KING of New York, Mr. WAXMAN, Mr. TOWNS, Mr. BOU-
CHER, Mr. ROSS, Ms. ESHOO, Mr. GORDON of Tennessee, Mrs. MALONEY 
of New York, Mr. HARE, Ms. SUTTON, Mr. MCDERMOTT, Mr. BOSWELL, 
Mr. MARKEY, Mr. GOODE, Mr. HOLT, Mr. HOEKSTRA, Ms. BERKLEY, 
Mr. MCNULTY, Mr. BRALEY of Iowa, Mr. FARR, Mrs. CAPPS, Mr. GENE 
GREEN of Texas, Mr. REYES, Mr. RUPPERSBERGER, Mr. SARBANES, Mr. 
INSLEE, Ms. HARMAN, Mr. FERGUSON, Mr. CAPUANO, Mr. WELCH of 
Vermont, Mr. DOYLE, Mr. CUMMINGS, Ms. MATSUI, Mr. WU, Mr. STARK, 
Ms. DEGETTE, Mr. MARSHALL, Ms. SOLIS, Ms. CASTOR, Mr. 
RODRIGUEZ, Mr. JOHNSON of Georgia, Mr. VAN HOLLEN, Mr. FRANK 
of Massachusetts, Mr. ABERCROMBIE, Mr. KILDEE, Mr. DELAHUNT, Mr. 
ALTMIRE, Mr. KAGEN, Mr. STUPAK, Mr. TIERNEY, Mr. CARDOZA, Mr. 
WYNN, Mr. NEAL of Massachusetts, Ms. ROYBAL-ALLARD, Ms. BALD-
WIN, Ms. MCCOLLUM of Minnesota, Ms. CLARKE, Ms. EDDIE BERNICE 
JOHNSON of Texas, Mr. OLVER, Mr. MCGOVERN, Mr. SPRATT, Mr. 
DAVIS of Alabama, Mr. MCCOTTER, Mr. PRICE of North Carolina, Mr. 
ISRAEL, Mr. MILLER of North Carolina, Mr. FATTAH, Ms. MOORE of 
Wisconsin, Mr. PASCRELL, Ms. KAPTUR, Mr. SAM JOHNSON of Texas, 
Mr. MEEKS of New York, Mrs. WILSON of New Mexico, Ms. WOOLSEY, 
Ms. DELAURO, Mrs. MCCARTHY of New York, Mr. SCOTT of Virginia, 
Ms. RICHARDSON, Mr. HALL of New York, Mr. BISHOP of Georgia, Mr. 
WEXLER, Mr. LANGEVIN, Mr. PASTOR, Mr. MORAN of Kansas, Mr. 
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HONDA, Mr. LEWIS of Georgia, Mr. GEORGE MILLER of California, Mr. 
RANGEL, Mr. GONZALEZ, Mr. PERLMUTTER, Mr. GRIJALVA, Mr. BECER-
RA, Ms. LEE, Mr. UDALL of New Mexico, Mr. WALSH of New York, Mr. 
WALZ of Minnesota, Mr. LYNCH, Mr. LOEBSACK, Ms. VELA´ZQUEZ, Ms. 
LINDA T. SA´NCHEZ of California, Mr. HINCHEY, Mr. ELLISON, Mr. 
CLAY, Mr. THOMPSON of California, Mr. KENNEDY, Mr. NADLER, Mr. 
FILNER, Mrs. LOWEY, Mr. ACKERMAN, Mr. PLATTS, Mr. OBERSTAR, Ms. 
NORTON, Mr. CROWLEY, Mrs. GILLIBRAND, Mr. MICHAUD, Ms. HOOLEY, 
Mr. HIGGINS, Mr. SERRANO, Mr. BERMAN, Mrs. DAVIS of California, Mr. 
HAYES, Mr. GERLACH, Mrs. TAUSCHER, Mr. RAMSTAD, Ms. GIFFORDS, 
Mr. DENT, Mr. AL GREEN of Texas, Mr. RAHALL, Mr. MCHUGH, Mr. 
MATHESON, Mr. SCOTT of Georgia, Ms. TSONGAS, Mr. ARCURI, Mr. 
KUHL of New York, Mr. SKELTON, Ms. SLAUGHTER, Mr. MCNERNEY, 
Mr. THOMPSON of Mississippi, Mr. YARMUTH, Mr. DAVIS of Illinois, Ms. 
ZOE LOFGREN of California, Mr. SHERMAN, Mr. BISHOP of New York, 
Mrs. NAPOLITANO, Mr. CHANDLER, Ms. SCHWARTZ, Ms. PRYCE of Ohio, 
Mr. PAYNE, Mr. ENGLISH of Pennsylvania, Mr. YOUNG of Alaska, Mr. 
BARROW, Mr. HODES, Mr. DOGGETT, Mr. MURPHY of Connecticut, Mr. 
MORAN of Virginia, Mrs. DRAKE, Mr. LATOURETTE, Mr. SHAYS, Ms. 
WATERS, Mr. GUTIERREZ, Mr. BILIRAKIS, Mr. SESTAK, Mr. WEINER, 
Mr. UDALL of Colorado, Mr. ALEXANDER, Mr. SIRES, Mr. REYNOLDS, 
Mr. DICKS, Mr. TIBERI, Ms. WASSERMAN SCHULTZ, Mr. SNYDER, Mr. 
FOSSELLA, Mr. BUTTERFIELD, Mr. EDWARDS, Mr. TERRY, Ms. LORET-
TA SANCHEZ of California, Mr. LOBIONDO, Mr. BRADY of Pennsylvania, 
Mr. KLEIN of Florida, Mr. LINCOLN DIAZ-BALART of Florida, Mr. 
MELANCON, Mr. RUSH, Mr. COHEN, Mr. BACA, Mr. HINOJOSA, Mr. 
COURTNEY, Mr. RYAN of Ohio, Mr. KUCINICH, Mr. LIPINSKI, Mr. 
LARSON of Connecticut, Mr. RENZI, Mr. CARNEY, Mrs. BONO MACK, Mr. 
COSTELLO, Mr. COSTA, Mr. ORTIZ, Mr. SCHIFF, Ms. WATSON, Mrs. 
EMERSON, and Mr. HOBSON 
APRIL 22, 2008 
Reported with amendments, committed to the Committee of the Whole House 
on the State of the Union, and ordered to be printed 
[Strike out all after the enacting clause and insert the part printed in italic] 
[For text of the introduced bill, see bill as introduced on March 13, 2008] 
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, 
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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 Readi-
ness, Veterans’ Care, Katrina Recovery, and Iraq Account-
ability 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 pro-
posed regulation published on May 23, 2007 (72 Fed-
eral 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’’; 
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(2) by inserting ‘‘, including the proposed regu-
lation published on August 13, 2007 (72 Federal Reg-
ister 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 de-
scribed in subparagraph (A), (B), or (C) of para-
graph (2) if such restrictions are more restrictive in 
any aspect than those applied to the respective provi-
sion as of the date specified in paragraph (3) for such 
provision. 
(2) PROVISIONS DESCRIBED.— 
(A) PORTION OF INTERIM FINAL REGULA-
TION RELATING TO MEDICAID TREATMENT OF OP-
TIONAL CASE MANAGEMENT SERVICES.— 
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(i) IN
GENERAL.—Subject to clause 
(ii), the provision described in this subpara-
graph is the interim final regulation relat-
ing to optional State plan case management 
services under the Medicaid program pub-
lished on December 4, 2007 (72 Federal 
Register 68077) in its entirety. 
(ii) EXCEPTION.—The provision de-
scribed in this subparagraph does not in-
clude the portion of such regulation as re-
lates 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 manage-
ment services and targeted case manage-
ment services contained in proposed section 
440.169 of title 42, Code of Federal Regula-
tions, but only to the extent that such por-
tion is not more restrictive than the policies 
set forth in the Dear State Medicaid Direc-
tor letter on case management issued on 
January 19, 2001 (SMDL #01–013), and 
with respect to community transition case 
management, the Dear State Medicaid Di-
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rector letter issued on July 25, 2000 
(Olmstead Update 3). 
(B) PROPOSED REGULATION RELATING TO 
REDEFINITION OF MEDICAID OUTPATIENT HOS-
PITAL
SERVICES.—The provision described in 
this subparagraph is the proposed regulation re-
lating to clarification of outpatient clinic and 
hospital facility services definition and upper 
payment limit under the Medicaid program pub-
lished on September 28, 2007 (72 Federal Reg-
ister 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 subpara-
graph 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 de-
scribed in this subparagraph does not in-
clude the portions of such regulation as re-
late to the following: 
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(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 Secu-
rity 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 Regula-
tions, as required to carry out section 
1903(w)(7)(A)(viii) of the Social Secu-
rity 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— 
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(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 So-
cial 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 ap-
propriated under this section shall remain available for ex-
penditure until expended and shall be in addition to any 
other amounts appropriated or made available to the Sec-
retary for such purposes with respect to the Medicaid pro-
gram. 
(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 En-
ergy 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 Med-
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