Medicare Rural Health Access Improvement Act of 2008

Medicare Rural Health Access Improvement Act of 2008 - Amends title XVIII (Medicare) of the Social Security Act to: (1) extend Medicare flex grants; (2) revise requirements for the Medicare-dependent hospital (MDH) program; (3) permit rebasing for sole community hospitals; (4) revise the Medicare inpatient hospital payment adjustment for low-volume hospitals; (5) eliminate temporarily the disproportionate share hospital (DSH) adjustment cap; and (6) extend and revise the Medicare hold harmless provision under the prospective payment system (PPS) for hospital outpatient department (HOPD) services for certain hospitals.

Revises requirements for: (1) the treatment of rural sole community hospitals and Medicare dependent, small rural hospitals under the PPS for HOPD services; (2) the treatment of Medicare reasonable costs payments for certain clinical diagnostic laboratory tests furnished to hospital patients in certain rural areas; and (3) payment for clinical laboratory tests furnished by critical access hospitals.

Extends the Medicare incentive payment program for physician scarcity areas.

Revises the work geographic adjustment and the practice expense geographic adjustment under the Medicare physician fee schedule.

Extends the treatment of certain physician pathology services, and increased Medicare payments for rural ground ambulance services.

Makes hospital-based renal dialysis centers (including satellites) and skilled nursing facilities (SNFs) originating sites for payment of telehealth services.

Directs the Secretary of Health and Human Services to set $92 as the maximum rate of payment per visit in 2009 for independent rural health clinics.

Requires the Secretary to exempt from competitive acquisition requirements rural areas and small metropolitan statistical areas (MSAs) with a population of 600,000 or less.

Permits physician assistants to order post-hospital extended care services. Recognizes attending physician assistants as attending physicians for the purpose of serving hospice patients.