[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3716 Introduced in House (IH)]

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114th CONGRESS
  1st Session
                                H. R. 3716

  To amend title XIX of the Social Security Act to require States to 
     provide to the Secretary of Health and Human Services certain 
   information with respect to provider terminations, and for other 
                               purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 8, 2015

 Mr. Bucshon (for himself, Mr. Welch, and Mr. Butterfield) introduced 
 the following bill; which was referred to the Committee on Energy and 
                                Commerce

_______________________________________________________________________

                                 A BILL


 
  To amend title XIX of the Social Security Act to require States to 
     provide to the Secretary of Health and Human Services certain 
   information with respect to provider terminations, and for other 
                               purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Ensuring Terminated Providers are 
Removed from Medicaid and CHIP Act''.

SEC. 2. INCREASING OVERSIGHT OF TERMINATION OF MEDICAID PROVIDERS.

    (a) Increased Oversight and Reporting.--
            (1) State reporting requirements.--Section 1902(kk) of the 
        Social Security Act (42 U.S.C. 1396a(kk)) is amended--
                    (A) by redesignating paragraph (8) as paragraph 
                (9); and
                    (B) by inserting after paragraph (7) the following 
                new paragraph:
            ``(8) Provider terminations.--
                    ``(A) In general.--Beginning 180 days after the 
                date of the enactment of this paragraph, in the case of 
                a notification under subsection (a)(41) with respect to 
                a termination for cause of the participation of any 
                individual or entity under the State plan under 
                subsection (a)(39), the State, not later than 14 
                business days after the effective date of such 
                termination, submits to the Secretary with respect to 
                any such individual or entity--
                            ``(i) the name of such individual or 
                        entity;
                            ``(ii) the provider type of such individual 
                        or entity;
                            ``(iii) the specialty of such individual's 
                        or entity's practice;
                            ``(iv) the date of birth, Social Security 
                        number, national provider identifier, Federal 
                        taxpayer identification number, and the State 
                        license or certification number of such 
                        individual or entity;
                            ``(v) the reason for the termination;
                            ``(vi) the effective date of such 
                        termination; and
                            ``(vii) a copy of the notice of termination 
                        sent to the individual or entity.
                    ``(B) Managed care entities.--
                            ``(i) In general.--With respect to managed 
                        care entities (as defined in section 
                        1932(a)(1)), beginning on the later of the date 
                        that is 180 days after the date of the 
                        enactment of this paragraph or the first day of 
                        the first plan year for such an entity that 
                        begins after such date of enactment, the State 
                        requires that any contract the State plan has 
                        with any such entity includes a provision that 
                        individuals terminated for cause from 
                        participation under the program under title 
                        XVIII, this title, or title XXI be terminated 
                        from participation in the provider networks of 
                        managed care entities under this title that 
                        serve individuals eligible to receive medical 
                        assistance under this title.
                            ``(ii) Notification of termination.--For 
                        the period beginning on the date that is 180 
                        days after the date of the enactment of this 
                        paragraph and ending on the date on which the 
                        enrollment of providers under section 
                        1932(d)(5) is complete for the State, the State 
                        provides for a system for notifying managed 
                        care entities (as defined in section 
                        1932(a)(1)) of the termination of individuals 
                        or entities from participation under the 
                        program under title XVIII, this title, or title 
                        XXI.''.
            (2) Termination notification database.--Section 1902 of the 
        Social Security Act (42 U.S.C. 1396a) is amended by adding at 
        the end the following new subsection:
    ``(ll) Termination Notification Database.--In the case of an 
individual or entity whose participation in the program under title 
XVIII, this title, or title XXI is terminated for cause under 
subsection (a)(39), the Secretary shall, not later than 14 business 
days after the date on which the Secretary is notified of such 
termination under subsection (a)(41), include such termination in any 
database or similar system developed pursuant to section 6401(b)(2) of 
the Patient Protection and Affordable Care Act (42 U.S.C. 1395cc note; 
Public Law 111-148).''.
            (3) No federal funds for items and services furnished by 
        terminated providers.--Section 1903(i)(2) of the Social 
        Security Act (42 U.S.C. 1396b(i)(2)) is amended--
                    (A) in subparagraph (A), by striking the comma at 
                the end and inserting a semicolon;
                    (B) in subparagraph (B), by striking ``or'' at the 
                end; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(D) beginning 2 years after the date of the 
                enactment of this subparagraph, under the plan by any 
                individual or entity whose participation in the State 
                plan is terminated for cause under subsection (a)(39) 
                of section 1902 after the date that is 60 days after 
                the date on which such termination is included in the 
                database or other system under subsection (ll) of such 
                section; or''.
            (4) Development of uniform terminology for reasons for 
        provider termination.--Not later than 180 days after the date 
        of the enactment of this Act, the Secretary of Health and Human 
        Services shall issue regulations establishing uniform 
        terminology to be used with respect to specifying reasons under 
        paragraph (8)(A) of section 1902(kk) of the Social Security Act 
        (42 U.S.C. 1396a(kk)) for the termination of the participation 
        of certain providers in the Medicaid program under title XIX of 
        such Act or the Children's Health Insurance Program under title 
        XXI of such Act.
            (5) Conforming amendment.--Section 1902(a)(41) of the 
        Social Security Act (42 U.S.C. 1396a(a)(41)) is amended by 
        striking ``provide that whenever'' and inserting ``provide, in 
        accordance with subsection (kk)(8) (as applicable), that 
        whenever''.
    (b) Increasing Availability of Medicaid Provider Information.--
            (1) FFS provider enrollment.--Section 1902(a) of the Social 
        Security Act (42 U.S.C. 1396a(a)) is amended by inserting after 
        paragraph (77) the following new paragraph:
            ``(78) provide that, not later than 180 days after the date 
        of the enactment of this paragraph, in the case of a State plan 
        that provides medical assistance on a fee-for-service basis, 
        the State shall require each provider furnishing items and 
        services to individuals eligible to receive medical assistance 
        under such plan to enroll with the State agency and provide to 
        the State agency the provider's identifying information, 
        including the name, specialty, date of birth, Social Security 
        number, national provider identifier, Federal taxpayer 
        identification number, and the State license or certification 
        number of the provider;''.
            (2) Managed care provider enrollment.--Section 1932(d) of 
        the Social Security Act (42 U.S.C. 1396u-2(d)) is amended by 
        adding at the end the following new paragraph:
            ``(5) Enrollment of participating providers.--
                    ``(A) In general.--Beginning not later than one 
                year after the date of the enactment of this paragraph, 
                a State shall require that, as a condition on the 
                participation in the provider network of a managed care 
                entity of a provider that provides services to, or 
                orders or provides referrals for services for, 
                individuals who are eligible for medical assistance 
                under the State plan under this title and who are 
                enrolled with the entity, the provider enrolls with the 
                State agency administering the State plan under this 
                title. Such enrollment shall include providing to the 
                State agency the provider's identifying information, 
                including the name, specialty, date of birth, Social 
                Security number, national provider identifier, Federal 
                taxpayer identification number, and the State license 
                or certification number of the provider.
                    ``(B) Rule of construction.--Nothing in 
                subparagraph (A) shall be construed as requiring a 
                provider described in such subparagraph to provide 
                services to individuals who are not enrolled with a 
                managed care entity under this title.''.
    (c) Coordination With CHIP.--
            (1) In general.--Section 2107(e)(1) of the Social Security 
        Act (42 U.S.C. 1397gg(e)(1)) is amended--
                    (A) by redesignating subparagraphs (B) through (O) 
                as subparagraphs (D) through (Q), respectively;
                    (B) by inserting after subparagraph (A) the 
                following new subparagraphs:
                    ``(B) Section 1902(a)(39) (relating to termination 
                of participation of certain providers).
                    ``(C) Section 1902(a)(78) (relating to the 
                enrollment of providers participating in State plans 
                providing medical assistance on a fee-for-service 
                basis).''; and
                    (C) in subparagraph (O) (as redesignated by 
                paragraph (1)), by striking ``(a)(2)(C) and (h)'' and 
                inserting ``(a)(2)(C) (relating to Indian enrollment), 
                (d)(5) (relating to enrollment of providers 
                participating with a managed care entity), and (h) 
                (relating to special rules with respect to Indian 
                enrollees, Indian health care providers, and Indian 
                managed care entities)''.
            (2) Excluding from medicaid providers excluded from chip.--
        Section 1902(a)(39) of the Social Security Act (42 U.S.C. 
        1396a(a)(39)) is amended by striking ``title XVIII or any other 
        State plan under this title'' and inserting ``title XVIII, any 
        other State plan under this title, or any State child health 
        plan under title XXI''.
    (d) Rule of Construction.--Nothing in this section shall be 
construed as changing the appeal rights of providers or the process for 
appeals of States under the Social Security Act.
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