3.0.0 2701 2023-01-11T13:31:44Z 2023-01-11T13:31:44Z Senate S 2016-03-17 114 ssfi00 Finance Committee Senate Standing Referred to 2016-03-17T15:48:41Z Medicaid Program Integrity Enhancement Act of 2016 114 4802 HR 2016-03-18 Referred to the Subcommittee on Health. Identical bill CRS 2016-03-17 ssfi00 Finance Committee Senate Read twice and referred to the Committee on Finance. IntroReferral 2016-03-17 Introduced in Senate IntroReferral 10000 9 Library of Congress H001046 Sen. Heinrich, Martin [D-NM] Martin Heinrich D NM T. N U000039 Sen. Udall, Tom [D-NM] TOM UDALL D NM 2016-03-17 True Health Administrative law and regulatory procedures Administrative remedies Criminal investigation, prosecution, interrogation Department of Health and Human Services Fraud offenses and financial crimes Government studies and investigations Intergovernmental relations Medicaid State and local government operations Health 00 2016-03-17 Introduced in Senate 2016-11-02T11:06:45Z Medicaid Program Integrity Enhancement Act of 2016

This bill amends title XIX (Medicaid) of the Social Security Act to require a state Medicaid agency to establish a process by which a provider may appeal a decision by the agency to suspend payment to the provider on the basis of credible fraud allegations.

The Centers for Medicare & Medicaid Services (CMS) must revise specified regulations related to such suspensions in order to comply with due process requirements established by the bill.

Specifically, a state Medicaid agency may not suspend payment until the agency: (1) consults with the state's Medicaid fraud control unit or, if the state has no such unit, with the state's attorney general; (2) certifies that it has considered whether the suspension will jeopardize beneficiary access and whether there is good cause not to suspend payment; and (3) furnishes the provider with the agency's reasons for finding no such good cause.

Furthermore, the agency must periodically evaluate whether there is good cause to discontinue a suspension for which an investigation is pending. With specified exceptions, such good cause shall be deemed to exist if the investigation remains unresolved after a suspension has been in effect for 18 months.

CMS must also revise specified regulations to provide that an allegation of fraud shall be considered credible only if the allegation has indications of reliability and the state Medicaid agency: (1) has reviewed all allegations, facts, and evidence carefully; (2) acts judiciously on a case-by-case basis; and (3) has considered the potential impact a payment suspension may have on beneficiary access to care.

]]> Medicaid Program Integrity Enhancement Act of 2016 Display Title Medicaid Program Integrity Enhancement Act of 2016 Official Title as Introduced A bill to require consideration of the impact on beneficiary access to care and to enhance due process protections in procedures for suspending payments to Medicaid providers. Introduced in Senate IS Short Titles as Introduced Medicaid Program Integrity Enhancement Act of 2016 Introduced in Senate 2016-03-17T04:00:00Z https://www.govinfo.gov/content/pkg/BILLS-114s2701is/xml/BILLS-114s2701is.xml 2016-03-17 Read twice and referred to the Committee on Finance. text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain. Congressional Research Service, Library of Congress This file contains bill summaries and statuses for federal legislation. A bill summary describes the most significant provisions of a piece of legislation and details the effects the legislative text may have on current law and federal programs. Bill summaries are authored by the Congressional Research Service (CRS) of the Library of Congress. As stated in Public Law 91-510 (2 USC 166 (d)(6)), one of the duties of CRS is "to prepare summaries and digests of bills and resolutions of a public general nature introduced in the Senate or House of Representatives". For more information, refer to the User Guide that accompanies this file.