[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6518 Introduced in House (IH)]

<DOC>






114th CONGRESS
  2d Session
                                H. R. 6518

 To amend title XIX of the Social Security Act to improve the Medicaid 
            and CHIP Payment and Access Commission (MACPAC).


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            December 8, 2016

    Mr. Pitts (for himself, Mr. Flores, Mrs. Brooks of Indiana, Mr. 
Bucshon, Mr. Collins of New York, Mr. Guthrie, Mrs. Blackburn, and Mr. 
   Mullin) 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 improve the Medicaid 
            and CHIP Payment and Access Commission (MACPAC).

    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 ``MACPAC Improvement Act of 2016''.

SEC. 2. IMPROVEMENT OF MACPAC.

    (a) Duties.--Section 1900(b) of the Social Security Act (42 U.S.C. 
1396(b)) is amended--
            (1) in paragraph (1)--
                    (A) in the heading, by inserting ``, payment, 
                financing, and program integrity'' after ``access'';
                    (B) in subparagraph (A), by inserting ``, payment, 
                financing, or program integrity'' after ``affecting 
                access to covered items and services'';
                    (C) in subparagraph (B), by striking ``access'';
                    (D) in subparagraph (C), by striking ``such 
                policies'' and inserting the following: ``policies of 
                such programs relating to financing and program 
                integrity, including--
                            ``(i) the implications of such policies 
                        with respect to changes in health care delivery 
                        in the United States; and
                            ``(ii) with respect to the market for 
                        health care items and services, the impact of 
                        such policies on the cost and spending growth 
                        under such programs;''; and
                    (E) in subparagraph (D), by striking ``containing'' 
                and all that follows through the period and inserting 
                the following: ``containing the results of such reviews 
                and MACPAC's recommendations concerning the policies of 
                such programs relating to access and payment, 
                including--
                            ``(i) the implications of such policies 
                        with respect to changes in health care delivery 
                        in the United States; and
                            ``(ii) with respect to the market for 
                        health care items and services, the impact of 
                        such policies on access and payment under such 
                        programs.'';
            (2) in paragraph (2)--
                    (A) in subparagraph (A)--
                            (i) in clause (ii), by striking ``and'' at 
                        the end;
                            (ii) in clause (iii), by striking the 
                        period at the end and inserting ``; and''; and
                            (iii) by adding at the end the following 
                        new clause:
                            ``(iv) such payment policies that may 
                        result in total payments (taking into account 
                        additional or supplemental payments or payment 
                        adjustments) under this title or title XXI that 
                        exceed the cost of providing items and services 
                        to Medicaid or CHIP beneficiaries (as 
                        applicable) and changes in such payment 
                        policies that could improve efficiency without 
                        negatively impacting access to care for such 
                        beneficiaries.''; and
                    (B) by adding at the end the following new 
                subparagraph:
                    ``(I) Data.--National and State-specific Medicaid 
                and CHIP data.'';
            (3) by amending paragraph (3) to read as follows:
            ``(3) Annual policy recommendations.--Not less frequently 
        than once a year, MACPAC shall make recommendations regarding 
        Federal statutes that could be enacted or policies which the 
        Secretary or States could implement to achieve, with respect to 
        Medicaid and CHIP, the following goals:
                    ``(A) Federal and state outlays.--Reducing Federal 
                and State outlays to make such programs more 
                sustainable.
                    ``(B) Financing.--Improving the transparency, 
                integrity, and sustainability of financing.
                    ``(C) State flexibility and efficiency.--Improving 
                State flexibility, predictability, accountability, 
                integrity, and efficiency in oversight and 
                administration.
                    ``(D) Program integrity and reduce waste, fraud, 
                and abuse.--Enhancing program integrity, reducing the 
                amount and rate of improper payments, improving 
                internal administrative and financial controls, and 
                enhancing efforts to curb waste, fraud, and abuse.
                    ``(E) Prioritizing the most vulnerable.--
                Prioritizing benefits, care, and services for the most 
                vulnerable, low-income Medicaid and CHIP beneficiaries, 
                such as children and pregnant women whose family income 
                is at or below the Federal poverty line, the elderly, 
                and individuals with disabilities.
                    ``(F) Empowering beneficiaries.--Improving the 
                independence, self-direction, self-sufficiency, and 
                empowerment of beneficiaries.'';
            (4) in paragraph (4)--
                    (A) in the heading, by striking ``system'' and 
                inserting ``systems'';
                    (B) by striking ``MACPAC shall create'' and 
                inserting the following:
                    ``(A) System related to access.--MACPAC shall 
                create''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(B) System related to program growth.--MACPAC 
                shall create an early-warning system to identify 
                challenges with sustaining Federal and State funding 
                for Medicaid during the mid-term and long-term. MACPAC 
                shall include in the annual report required under 
                paragraph (1)(C) a description of such challenges, 
                including challenges posed by budgetary pressures which 
                could lead to increased Federal or State deficits, 
                crowd out discretionary Federal or State spending, or 
                necessitate increases in revenues, and proposed 
                recommendations for addressing such challenges.'';
            (5) in paragraph (5)--
                    (A) in the heading, by striking ``and regulations'' 
                and inserting ``, regulations, and guidance'';
                    (B) in subparagraph (B), by inserting 
                ``financing,'' after ``quality,''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(C) CMS guidance.--MACPAC shall review guidance 
                issued to States by the Centers for Medicare & Medicaid 
                Services with respect to Medicaid or CHIP and shall, 
                not later than the date that is 90 days after the date 
                of such issuance, submit a report to the appropriate 
                committees of Congress and the Secretary on the degree 
                to which such guidance is projected to change Federal 
                or State outlays for Medicaid or CHIP.'';
            (6) in paragraph (7)--
                    (A) in the heading by inserting ``and working 
                documents'' after ``reports'';
                    (B) by striking ``MACPAC shall transmit'' and 
                inserting the following:
                    ``(A) Reports.--MACPAC shall submit''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(B) Working documents.--MACPAC shall make 
                available to the appropriate committees of Congress 
                copies of draft report chapters, white papers, and 
                other materials distributed among members of MACPAC.'';
            (7) in paragraph (8), by striking ``of the House of 
        Representatives and the Committee on Finance of the Senate'' 
        and inserting ``, the Committee on Appropriations, and the 
        Committee on Oversight and Government Reform of the House of 
        Representatives and the Committee on Finance, the Committee on 
        Homeland Security and Governmental Affairs, and the Committee 
        on Appropriations of the Senate'';
            (8) in paragraph (10), by adding at the end the following: 
        ``For each recommendation that MACPAC determines would increase 
        Federal or State outlays for Medicaid or CHIP, MACPAC shall 
        make a recommendation regarding changes in Federal or State 
        policy to offset such increased outlays.''; and
            (9) by adding at the end the following new paragraph:
            ``(15) Annual report.--Not later than three months after 
        the end of a fiscal year, MACPAC shall prepare and make 
        available on the MACPAC website a report with respect to such 
        fiscal year on its activities that includes--
                    ``(A) information related to MACPAC's expenses, 
                contracts, accomplishments, and activities for such 
                fiscal year; and
                    ``(B) the status of MACPAC's recommendations, 
                including updates on Federal statutes that have been 
                enacted or policies which the Secretary or States have 
                implemented to effect such recommendations.''.
    (b) Membership.--Section 1900(c) of the Social Security Act (42 
U.S.C. 1396(c)) is amended--
            (1) by amending paragraph (2) to read as follows:
            ``(2) Qualifications.--
                    ``(A) In general.--The membership of MACPAC shall 
                include the following:
                            ``(i) At least three individuals 
                        representing health care providers, such as 
                        physicians, nurses, or dentists.
                            ``(ii) At least two individuals 
                        representing health plans that enroll Medicaid 
                        or CHIP beneficiaries, including one or more 
                        individuals representing a Medicaid managed 
                        care plan.
                            ``(iii) At least one individual who is an 
                        actuary with expertise in health care.
                            ``(iv) At least two individuals who are or 
                        have been directors of Medicaid for a State, 
                        including at least one individual who is such a 
                        director at the time of appointment to MACPAC.
                            ``(v) At least one individual who is or has 
                        been a director of CHIP for a State.
                            ``(vi) At least one individual with 
                        expertise in health care finance and health 
                        economics.
                            ``(vii) At least two individuals who are 
                        representatives of Medicaid and CHIP 
                        beneficiaries, such as children, pregnant 
                        women, the elderly, and individuals with 
                        disabilities.
                            ``(viii) At least one individual with 
                        expertise in long-term services and supports, 
                        such as in the financing or delivery of long-
                        term services and supports or managed long-term 
                        care services, including care delivered in 
                        nursing homes or home and community-based 
                        settings.
                    ``(B) Inclusion.--The membership of MACPAC shall 
                include individuals with expertise in--
                            ``(i) Federal safety net health programs;
                            ``(ii) developing, negotiating, or 
                        implementing a Medicaid waiver based on 
                        experience working for a State;
                            ``(iii) health care payment and financing 
                        reforms;
                            ``(iv) integrated health care delivery 
                        systems, coordinated care models, and value-
                        based contracting;
                            ``(v) public health;
                            ``(vi) program integrity and fraud 
                        prevention;
                            ``(vii) health information technology and 
                        telehealth;
                            ``(viii) prescription drug pricing or 
                        payment; and
                            ``(ix) operating a Medicaid program, health 
                        plan, hospital, or health care delivery system.
                    ``(C) Diversity.--The membership of MACPAC shall 
                also provide representation from a variety of different 
                professions and geographic areas and provide for a 
                balanced representation among urban, suburban, and 
                rural areas.
                    ``(D) Balance of perspectives.--The Comptroller 
                General of the United States shall ensure members 
                appointed for initial or subsequent terms to MACPAC 
                reflect an appropriate balance of political 
                perspectives, including by taking into account 
                political party registration and contributions made to 
                political candidates and parties.
                    ``(E) Majority nonproviders.--
                            ``(i) In general.--Individuals who are 
                        directly involved in the provision, or 
                        management of the delivery, of items and 
                        services covered under Medicaid or CHIP shall 
                        not constitute a majority of the membership of 
                        MACPAC.
                            ``(ii) Medicaid and chip directors.--For 
                        purposes of this subparagraph, Medicaid and 
                        CHIP directors shall not be considered to be 
                        directly involved in the provision, or 
                        management of the delivery, of items and 
                        services covered under Medicaid or CHIP.
                    ``(F) Ethical disclosure.--
                            ``(i) In general.--The Comptroller General 
                        of the United States shall establish a system 
                        for the public disclosure of financial, 
                        professional, political, advocacy, or other 
                        activities of members of MACPAC that may result 
                        in, or be perceived to result in, conflicts of 
                        interest relating to such members' service on 
                        MACPAC.
                            ``(ii) Timing of disclosures.--The 
                        Comptroller General shall require that each 
                        member of MACPAC make--
                                    ``(I) the disclosure described in 
                                clause (i) on an annual basis; and
                                    ``(II) in the case of a significant 
                                change in any of the activities of the 
                                member described in such clause, a 
                                supplemental disclosure at the time of 
                                such significant change.
                            ``(iii) Treatment as employees of 
                        congress.--Members of MACPAC shall be treated 
                        as employees of Congress for purposes of 
                        applying title I of the Ethics in Government 
                        Act of 1978 (Public Law 95-521).''; and
            (2) in paragraph (5), by adding at the end the following: 
        ``Such designation shall be based on previous management 
        experience. The Comptroller General may not exclude a member 
        from consideration for such designation based on the fact that 
        such member is an individual employed by a State or by an 
        entity that receives Medicaid or CHIP payments, including a 
        local government, a health plan that enrolls Medicaid or CHIP 
        beneficiaries, or a health care provider.''.
    (c) Conflicts of Interest.--Section 1900 of the Social Security Act 
(42 U.S.C. 1396) is amended by adding at the end the following new 
subsection:
    ``(g) Conflict of Interest Policy.--MACPAC shall maintain and make 
available on the MACPAC website a conflict of interest policy outlining 
requirements for members and personnel of MACPAC. Such policy shall 
include the following:
            ``(1) Disclosure.--Requirements for initially disclosing, 
        and periodically updating, any substantial political activity 
        or significant financial interests that might influence, or 
        that might reasonably appear to influence, perspectives on 
        issues that could come before MACPAC.
            ``(2) Legal involvement.--With respect to any matter under 
        adjudication before a court, administrative law judge, or other 
        judicial entities:
                    ``(A) A requirement of disclosure of any direct or 
                indirect involvement in any such matter related to a 
                Federal or State health care program (as such terms are 
                defined in sections 1128(h) and 1128B(f), 
                respectively), including filing an amicus brief.
                    ``(B) A prohibition on direct or indirect 
                involvement in any such matter that involves the 
                Congress as a party, including filing an amicus brief.
            ``(3) Recusal.--The criteria and circumstances under which 
        a member of MACPAC shall suspend participation in MACPAC or 
        otherwise seek recusal from MACPAC votes, including the process 
        by which MACPAC discloses recommendations for such a 
        recusal.''.
    (d) Application.--
            (1) Duties.--The amendments made by subsection (a) shall 
        apply with respect to reports (and recommendations included in 
        reports) submitted on or after the date that is more than one 
        year after the date of the enactment of this Act.
            (2) Guidance.--The amendments made by subsection (b)(5) 
        shall apply with respect to guidance issued on or after the 
        date of the enactment of this Act.
            (3) Membership.--
                    (A) Appointment of new members.--The Comptroller 
                General of the United States shall apply the changes to 
                the membership of the Medicaid and CHIP Payment and 
                Access Commission required by amendments made by 
                subsection (b) as soon as is practicable, consistent 
                with subparagraph (B), and in no event later than the 
                date that is three years after the date of the 
                enactment of this Act.
                    (B) Retention of current members.--An individual 
                who is a member of the Medicaid and CHIP Payment and 
                Access Commission as of the date of the enactment of 
                this Act may continue to serve until the end of the 
                individual's term as of such date without regard to the 
                amendments made by subsection (b).
            (4) Conflicts of interest.--The amendment made by 
        subsection (c) shall apply beginning on the date that is 90 
        days after the date of the enactment of this Act.
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