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

<DOC>





                                                 Union Calendar No. 326
114th CONGRESS
  2d Session
                                H. R. 3716

                          [Report No. 114-427]

  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

                           February 23, 2016

  Reported with an amendment, committed to the Committee of the Whole 
       House on the State of the Union, and ordered to be printed
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]
[For text of introduced bill, see copy of bill as introduced on October 
                                8, 2015]


_______________________________________________________________________

                                 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 Removal of Terminated 
Providers 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 on January 1, 2017, in 
                the case of a notification under subsection (a)(41) 
                with respect to a termination for a reason specified in 
                section 455.101 of title 42, Code of Federal 
                Regulations (as in effect on November 1, 2015) or for 
                any other reason specified by the Secretary, of the 
                participation of a provider of services or any other 
                person under the State plan, the State, not later than 
                21 business days after the effective date of such 
                termination, submits to the Secretary with respect to 
                any such provider or person, as appropriate--
                            ``(i) the name of such provider or person;
                            ``(ii) the provider type of such provider 
                        or person;
                            ``(iii) the specialty of such provider's or 
                        person'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 
                        provider or person;
                            ``(v) the reason for the termination;
                            ``(vi) a copy of the notice of termination 
                        sent to the provider or person;
                            ``(vii) the effective date of such 
                        termination specified in such notice; and
                            ``(viii) any other information required by 
                        the Secretary.
                    ``(B) Effective date defined.--For purposes of this 
                paragraph, the term `effective date' means, with 
                respect to a termination described in subparagraph (A), 
                the later of--
                            ``(i) the date on which such termination is 
                        effective, as specified in the notice of such 
                        termination; or
                            ``(ii) the date on which all appeal rights 
                        applicable to such termination have been 
                        exhausted or the timeline for any such appeal 
                        has expired.''.
            (2) Reporting requirements for managed care entities.--
        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) State reporting requirements for managed care 
        entities.--
                    ``(A) In general.--With respect to any contract 
                with a managed care entity under section 1903(m) or 
                1905(t)(3) (as applicable), beginning on the later of 
                the first day of the first plan year for such managed 
                care entity that begins after the date of the enactment 
                of this paragraph or January 1, 2017, the State shall 
                require that such contract include a provision that 
                providers of services or persons terminated (as 
                described in section 1902(kk)(8)) from participation 
                under this title, title XVIII, or title XXI be 
                terminated from participating under this title as a 
                provider in any network of such entity that serves 
                individuals eligible to receive medical assistance 
                under this title.
                    ``(B) Notification of termination.--For the period 
                beginning on January 1, 2017, and ending on the date on 
                which the enrollment of providers under paragraph (6) 
                is complete for a State, the State shall provide for a 
                system for notifying managed care entities (as defined 
                in subsection (a)(1)) of the termination (as described 
                in section 1902(kk)(8)) of providers of services or 
                persons from participation under this title, title 
                XVIII, or title XXI.''.
            (3) 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 a 
provider of services or any other person whose participation under this 
title, title XVIII, or title XXI is terminated (as described in 
subsection (kk)(8)), the Secretary shall, not later than 21 business 
days after the date on which the Secretary terminates such 
participation under title XVIII or is notified of such termination 
under subsection (a)(41) (as applicable), review such termination and, 
if the Secretary determines appropriate, 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).''.
            (4) No federal funds for items and services furnished by 
        terminated providers.--Section 1903 of the Social Security Act 
        (42 U.S.C. 1396b) is amended--
                    (A) in subsection (i)(2)--
                            (i) in subparagraph (A), by striking the 
                        comma at the end and inserting a semicolon;
                            (ii) in subparagraph (B), by striking 
                        ``or'' at the end; and
                            (iii) by adding at the end the following 
                        new subparagraph:
                    ``(D) beginning not later than January 1, 2018, 
                under the plan by any provider of services or person 
                whose participation in the State plan is terminated (as 
                described in section 1902(kk)(8)) after the date that 
                is 60 days after the date on which such termination is 
                included in the database or other system under section 
                1902(ll); or''; and
                    (B) in subsection (m), by inserting after paragraph 
                (2) the following new paragraph:
    ``(3) No payment shall be made under this title to a State with 
respect to expenditures incurred by the State for payment for services 
provided by a managed care entity (as defined under section 1932(a)(1)) 
under the State plan under this title (or under a waiver of the plan) 
unless the State--
            ``(A) beginning on the applicable date specified in 
        subparagraph (A) of section 1932(d)(5), has a contract with 
        such entity that complies with the requirement specified in 
        such subparagraph; and
            ``(B)(i) for the period specified in subparagraph (B) of 
        such section, has a system in effect that meets the requirement 
        specified in such subparagraph; and
            ``(ii) after such period, complies with section 
        1932(d)(6).''.
            (5) Development of uniform terminology for reasons for 
        provider termination.--Not later than January 1, 2017, the 
        Secretary of Health and Human Services shall, in consultation 
        with the heads of State agencies administering State Medicaid 
        plans (or waivers of such plans), issue regulations 
        establishing uniform terminology to be used with respect to 
        specifying reasons under subparagraph (A)(v) of paragraph (8) 
        of section 1902(kk) of the Social Security Act (42 U.S.C. 
        1396a(kk)), as amended by paragraph (1), for the termination 
        (as described in such paragraph) 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.
            (6) 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 January 1, 2017, 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)), as amended by 
        subsection (a)(2), is amended by adding at the end the 
        following new paragraph:
            ``(6) Enrollment of participating providers.--
                    ``(A) In general.--Beginning not later than January 
                1, 2018, a State shall require that, in order to 
                participate as a provider in the network of a managed 
                care entity that provides services to, or orders, 
                prescribes, refers, or certifies eligibility 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 is 
                enrolled 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), (C), (D), 
                (E), (F), (G), (H), (I), (J), (K), (L), (M), (N), and 
                (O) as subparagraphs (D), (E), (F), (G), (H), (I), (J), 
                (K), (M), (N), (O), (P), (Q), and (R), 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 enrollment 
                of providers participating in State plans providing 
                medical assistance on a fee-for-service basis).'';
                    (C) by inserting after subparagraph (K) (as 
                redesignated by paragraph (1)) the following new 
                subparagraph:
                    ``(L) Section 1903(m)(3) (relating to limitation on 
                payment with respect to managed care).''; and
                    (D) in subparagraph (P) (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 reporting requirements for managed 
                care entities), (d)(6) (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 or limiting the appeal rights of providers or the 
process for appeals of States under the Social Security Act.
                                                 Union Calendar No. 326

114th CONGRESS

  2d Session

                               H. R. 3716

                          [Report No. 114-427]

_______________________________________________________________________

                                 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.

_______________________________________________________________________

                           February 23, 2016

  Reported with an amendment, committed to the Committee of the Whole 
       House on the State of the Union, and ordered to be printed