Medicare Improvements for Patients and Providers Act of 2008/Title II

TITLE II — MEDICAID

Sec. 201. Extension of Transitional Medical Assistance (TMA) and Abstinence Education Program.

Section 401 of division B of the Tax Relief and Health Care Act of 2006 (Public Law 109-432, 120 Stat. 2994), as amended by section 1 of Public Law 110-48 (121 Stat. 244), section 2 of the TMA, Abstinence, Education, and QI Programs Extension Act of 2007 (Public Law 110-90, 121 Stat. 984), and section 202 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173) is amended—

(1) by striking ``June 30, 2008´´ and inserting ``June 30, 2009´´;

(2) by striking ``the third quarter of fiscal year 2008´´ and inserting ``the third quarter of fiscal year 2009´´; and

(3) by striking ``the third quarter of fiscal year 2007´´ and inserting ``the third quarter of fiscal year 2008´´.

Sec. 202. Medicaid DSH Extension.

Section 1923(f)(6) of the Social Security Act (42 U.S.C. 1396r–4(f)(6)) is amended—

(1) in the heading, by striking ``fiscal year 2007 and portions of fiscal year 2008´´ and inserting ``fiscal years 2007 through 2009 and the first calendar quarter of fiscal year 2010´´; and

(2) in subparagraph (A)—

(A) in clause (i)—

(i) in the second sentence—

(I) by striking ``fiscal year 2008 for the period ending on June 30, 2008´´ and inserting ``fiscal years 2008 and 2009´´; and

(II) by striking ``¾ of´´; and

(ii) by adding at the end the following new sentences: ``Only with respect to fiscal year 2010 for the period ending on December 31, 2009, the DSH allotment for Tennessee for such portion of the fiscal year, notwithstanding such table or terms, shall be ¼ of the amount specified in the first sentence for fiscal year 2007.´´;

(B) in clause (ii), by striking ``or for a period in fiscal year 2008´´ and inserting ``, 2008, 2009, or for a period in fiscal year 2010´´;

(C) in clause (iv)—

(i) in the heading, by striking ``fiscal year 2007 and fiscal year 2008´´ and inserting ``fiscal years 2007 through 2009 and the first calendar quarter of fiscal year 2010´´;

(ii) in subclause (I), by striking ``or for a period in fiscal year 2008´´ and inserting ``, 2008, 2009, or for a period in fiscal year 2010´´; and

(iii) in subclause (II), by striking ``or for a period in fiscal year 2008´´ and inserting ``, 2008, 2009, or for a period in fiscal year 2010´´; and

(3) in subparagraph (B)(i)—

(A) in the first sentence, by striking ``fiscal year 2007´´ and inserting ``each of fiscal years 2007 through 2009´´; and

(B) by striking the second sentence and inserting the following: ``Only with respect to fiscal year 2010 for the period ending on December 31, 2009, the DSH allotment for Hawaii for such portion of the fiscal year, notwithstanding the table set forth in paragraph (2), shall be $2,500,000.´´.

Sec. 203. Pharmacy Reimbursement Under Medicaid.

(a) Delay in Application of New Payment Limit for Multiple Source Drugs Under Medicaid.—

Notwithstanding paragraphs (4) and (5) of subsection (e) of section 1927 of the Social Security Act (42 U.S.C. 1396r–8) or part 447 of title 42, Code of Federal Regulations, as published on July 17, 2007 (72 FR 39142)—

(1) the specific upper limit under section 447.332 of title 42, Code of Federal Regulations (as in effect on December 31, 2006) applicable to payments made by a State for multiple source drugs under a State Medicaid plan shall continue to apply through September 30, 2009, for purposes of the availability of Federal financial participation for such payments; and

(2) the Secretary of Health and Human Services shall not, prior to October 1, 2009, finalize, implement, enforce, or otherwise 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 the specific upper limit established under section 447.514(b) of title 42, Code of Federal Regulations as published on July 17, 2007 (72 FR 39142).

(b) Temporary Suspension of Updated Publicly Available AMP Data.—

Notwithstanding clause (v) of section 1927(b)(3)(D) of the Social Security Act (42 U.S.C. 1396r–8(b)(3)(D)), the Secretary of Health and Human Services shall not, prior to October 1, 2009, make publicly available any AMP disclosed to the Secretary.

(c) Definitions.—

In this subsection:

(1) The term ``multiple source drug´´ has the meaning given that term in section 1927(k)(7)(A)(i) of the Social Security Act (42 U.S.C. 1396r–8(k)(7)(A)(i)).

(2) The term ``AMP´´ has the meaning given ``average manufacturer price´´ in section 1927(k)(1) of the Social Security Act (42 U.S.C. 1396r–8(k)(1)) and ``AMP´´ in section 447.504(a) of title 42, Code of Federal Regulations as published on July 17, 2007 (72 FR 39142).

Sec. 204. Review of Administrative Claim Determinations.

(a) In General.—

Section 1116 of the Social Security Act (42 U.S.C. 1316) is amended by adding at the end the following new subsection:

``(e)(1) Whenever the Secretary determines that any item or class of items on account of which Federal financial participation is claimed under title XIX shall be disallowed for such participation, the State shall be entitled to and upon request shall receive a reconsideration of the disallowance, provided that such request is made during the 60-day period that begins on the date the State receives notice of the disallowance.

``(2)(A) A State may appeal a disallowance of a claim for federal financial participation under title XIX by the Secretary, or an unfavorable reconsideration of a disallowance, during the 60-day period that begins on the date the State receives notice of the disallowance or of the unfavorable reconsideration, in whole or in part, to the Departmental Appeals Board, established in the Department of Health and Human Services (in this paragraph referred to as the ‘Board’), by filing a notice of appeal with the Board.

``(B) The Board shall consider a State’s appeal of a disallowance of such a claim (or of an unfavorable reconsideration of a disallowance) on the basis of such documentation as the State may submit and as the Board may require to support the final decision of the Board. In deciding whether to uphold a disallowance of such a claim or any portion thereof, the Board shall be bound by all applicable laws and regulations and shall conduct a thorough review of the issues, taking into account all relevant evidence. The Board’s decision of an appeal under subparagraph (A) shall be the final decision of the Secretary and shall be subject to reconsideration by the Board only upon motion of either party filed during the 60-day period that begins on the date of the Board's decision or to judicial review in accordance with subparagraph (C).

``(C) A State may obtain judicial review of a decision of the Board by filing an action in any United States District Court located within the appealing State (or, if several States jointly appeal the disallowance of claims for Federal financial participation under section 1903, in any United States District Court that is located within any State that is a party to the appeal) or the United States District Court for the District of Columbia. Such an action may only be filed—

``(i) if no motion for reconsideration was filed within the 60-day period specified in subparagraph (B), during such 60-day period; or

``(ii) if such a motion was filed within such period, during the 60-day period that begins on the date of the Board's decision on such motion.´´.

(b) Conforming Amendment.—

Section 1116(d) of such Act (42 U.S.C. 1316(d)) is amended by striking ``or XIX,´´.

(c) Effective Date.—

The amendments made by this section take effect on the date of the enactment of this Act and apply to any disallowance of a claim for Federal financial participation under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) made on or after such date or during the 60-day period prior to such date.

Sec. 205. County Medicaid Health Insuring Organizations.

(a) In General.—

Section 9517(c)(3) of the Consolidated Omnibus Budget Reconciliation Act of 1985 (42 U.S.C. 1396b note), as added by section 4734 of the Omnibus Budget Reconciliation Act of 1990 and as amended by section 704 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, is amended—

(1) in subparagraph (A), by inserting ``, in the case of any health insuring organization described in such subparagraph that is operated by a public entity established by Ventura County, and in the case of any health insuring organization described in such subparagraph that is operated by a public entity established by Merced County´´ after ``described in subparagraph (B)´´; and

(2) in subparagraph (C), by striking ``14 percent´´ and inserting ``16 percent´´.

(b) Effective Date.—

The amendments made by subsection (a) shall take effect on the date of the enactment of this Act.