this issue, Congress passed the Balanced Budget Act of 1997 (BBA) eliminating the grandfather clause for RHCs that had allowed them to retain their status despite the fact that the RHC's location requirements no longer qualified the RHC for the program.[8] However, the Centers for Medicare and Medicaid Services (CMS) released the final regulations implementing the BBA more than three years after they proposed those regulations which voided the final regulations due to the Medicare Modernization Act of 2003 (MMA). The MMA requires that CMS finalize any rule within three years of proposing that rule. If the rule is not finalized within three years, it must be proposed again before it can be finalized. Before the rule could take effect, lobbying groups, such as the American Medical Association (AMA), National Rural Health Association (NRHA), American Academy of Family Physicians (AAFP), and the National Association of Rural Health Clinics (NARHC), put pressure on Congress to change the law. On June 26, 2008, CMS released a second proposed rule to implement the BBA-required elimination of the grandfather clause and to make changes to the RHC and Federally Qualified Health Center (FQHC) conditions of participation.[9] However, President Obama put a hold on all pending rules from the George W. Bush Administration, and once again, CMS failed to finalize the rules within the three year time period. References External links National Rural Health Association RHC topic page Rural Health Information Hub RHC Topic Guide American Academy of Family Physicians RHC page Centers for Medicare & Medicaid Services Rural Health Center National Association of Rural Health Clinics Clinics in the United States Medicare and Medicaid (United States)