[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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