During 2007 and 2008, the Centers for Medicare and Medicaid Services (CMS), the federal agency within the Department of Health and Human Services (HHS) that administers Medicaid, issued a number of regulations for this program. 110-252 , Section 7001), six of these seven rules were under a congressional moratorium preventing further administrative action until April 1, 2009. The American Recovery and Reinvestment Act of 2009 ( P.L. 111-5 ) extended the existing moratorium on the final or interim final regulations on case management services, provider taxes, and school-based administration and transportation services until July 1, 2009. In addition, P.L. 111-5 prohibited all administrative actions to implement the final rule on outpatient hospital services until after June 30, 2009. This law included a "sense of Congress" that the Secretary of HHS should not promulgate final regulations for the cost limits on public providers, graduate medical education, and rehabilitation services. Since that time, these rules have been affected by other federal actions (see Table 1 ). The rule on cost limits for public providers was vacated by a federal judge. The Obama Administration has taken additional actions on the remaining six rules. The three rules regarding school-based administration and transportation services, outpatient hospital services, and case management have been rescinded in part or altogether. Enforcement of a portion of the rule on provider taxes has been delayed. Finally, the two proposed rules on rehabilitation services and payments for graduate medical education were withdrawn. This rule was withdrawn by the Obama Administration. P.L. In addition, on June 30, 2009, the Obama Administration issued a final rule that rescinded the school-based administration/transportation rule in its entirety.
This report provides a summary of seven proposed, interim final, and final rules affecting the Medicaid program that were issued by the George W. Bush Administration during 2007 and 2008. These rules addressed Medicaid and graduate medical education, cost limits on public providers, provider taxes, rehabilitation services, case management, school-based administration and transportation services, and outpatient hospital services. Six of the seven rules (excluding the rule on outpatient hospital services) were under a congressional moratorium on further administrative action until April 1, 2009. The American Recovery and Reinvestment Act of 2009 (P.L. 111-5) extended the existing moratorium on the final or interim final regulations on case management services, provider taxes, and school-based administration and transportation services until July 1, 2009. In addition, P.L. 111-5 prohibited all administrative actions to implement the final rule on outpatient hospital services until after June 30, 2009. This law also included a "sense of Congress" that the Secretary of Health and Human Services (HHS) should not promulgate final regulations for the cost limit on public providers, graduate medical education, and rehabilitation services.
Other actions regarding these rules have occurred since they were first proposed or issued by the Bush Administration. The final rule affecting cost limits on public providers was vacated by a federal judge in May 2008. The Obama Administration has taken additional actions on the remaining rules. The three rules regarding school-based administration and transportation services, outpatient hospital services, and case management have been rescinded in part or altogether. Enforcement of a portion of the rule on provider taxes was delayed until June 30, 2010. Finally, two other proposed rules on rehabilitation services and payments for graduate medical education were withdrawn. These rules were not affected by the health reform legislation that became law earlier this year—the Patient Protection and Affordable Care Act (PPACA, P.L. 111-148), provisions of which were amended by the Health Care and Education Reconciliation Act of 2010 (HCERA, P.L. 111-152).