[Congressional Record Volume 162, Number 34 (Wednesday, March 2, 2016)]
[House]
[Pages H1095-H1097]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PROVIDING FOR CONSIDERATION OF H.R. 3716, ENSURING REMOVAL OF
TERMINATED PROVIDERS FROM MEDICAID AND CHIP ACT
Mr. BURGESS. Mr. Speaker, by direction of the Committee on Rules, I
call up House Resolution 632 and ask for its immediate consideration.
The Clerk read the resolution, as follows:
H. Res. 632
Resolved, That at any time after adoption of this
resolution the Speaker may, pursuant to clause 2(b) of rule
XVIII, declare the House resolved into the Committee of the
Whole House on the state of the Union for consideration of
the bill (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. The first
reading of the bill shall be dispensed with. All points of
order against consideration of the bill are waived. General
debate shall be confined to the bill and shall not exceed one
hour equally divided and controlled by the chair and ranking
minority member of the Committee on Energy and Commerce.
After general debate the bill shall be considered for
amendment under the five-minute rule. In lieu of the
amendment in the nature of a substitute recommended by the
Committee on Energy and Commerce now printed in the bill, it
shall be in order to consider as an original bill for the
purpose of amendment under the five-minute rule an amendment
in the nature of a substitute consisting of the text of Rules
Committee Print 114-45. That amendment in the nature of a
substitute shall be considered as read. All points of order
against that amendment in the nature of a substitute are
waived. No amendment to that amendment in the nature of a
substitute shall be in order except those printed in the
report of the Committee on Rules accompanying this
resolution. Each such amendment may be offered only in the
order printed in the report, may be offered only by a Member
designated in the report, shall be considered as read, shall
be debatable for the time specified in the report equally
divided and controlled by the proponent and an opponent,
shall not be subject to amendment, and shall not be subject
to a demand for division of the question in the House or in
the Committee of the Whole. All points of order against such
amendments are waived. At the conclusion of consideration of
the bill for amendment the Committee shall rise and report
the bill to the House with such amendments as may have been
adopted. Any Member may demand a separate vote in the House
on any amendment adopted in the Committee of the Whole to the
bill or to the amendment in the nature of a substitute made
in order as original text. The previous question shall be
considered as ordered on the bill and amendments thereto to
final passage without intervening motion except one motion to
recommit with or without instructions.
The SPEAKER pro tempore. The gentleman from Texas is recognized for 1
hour.
Mr. BURGESS. Mr. Speaker, for the purpose of debate only, I yield the
customary 30 minutes to the gentleman from Florida (Mr. Hastings),
pending which I yield myself such time as I may consume. During
consideration of this resolution, all time yielded is for the purpose
of debate only.
General Leave
Mr. BURGESS. Mr. Speaker, I ask unanimous consent that all Members
have 5 legislative days to revise and extend their remarks.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Texas?
There was no objection.
Mr. BURGESS. Mr. Speaker, House Resolution 632 provides for a rule to
consider a commonsense, bipartisan piece of legislation that will
address waste, fraud, and abuse within the Medicaid program.
The rule provides for 1 hour of debate, equally divided between the
majority and the minority of the Committee on Energy and Commerce. The
Committee on Rules made in order four amendments that were submitted to
the committee, three Democratic amendments and one bipartisan offering.
Finally, the rule affords the minority the customary motion to
recommit, a final opportunity to amend the legislation should the
minority choose to exercise that option.
H.R. 3716, the Ensuring Access to Quality Medicaid Providers Act,
combines two bipartisan bills that were unanimously reported out of the
Energy and Commerce Committee: H.R. 3716, the Ensuring Terminated
Providers Are Removed from Medicaid and CHIP Act that was introduced by
Dr. Larry Bucshon, a member of the committee; and H.R. 3821, the
Medicaid DOC Act authored by Representative Chris Collins, also on the
committee.
Not only is this bill bipartisan, it has received support of the
administration, and it is an important illustration of the work we are
doing in the House right now to improve health care for all Americans.
The Medicaid program continues to suffer from fraud, waste, and
abuse. These issues cause direct harm to the beneficiaries and waste
billions of taxpayer dollars.
Medicaid beneficiaries frequently end up in the emergency room, not
because they need emergency care, but because they cannot find a
physician participating in their Medicaid program. This is an
inefficient and ineffective way to access health care.
H.R. 3716 is commonsense legislation that resolves both of these
problems and improves beneficiary access to quality providers. Not only
is this bill good for patients, it is fiscally responsible.
According to the Congressional Budget Office, this package would
reduce Federal outlays by $15 million over the budget window because
the Medicaid program would no longer be paying providers who had been
terminated for reasons of fraud, integrity, or quality.
Although the Congressional Budget Office does not estimate State-
specific savings, this bill would also save State Medicaid programs
from several million dollars over the same timeframe.
The Office of Inspector General at the Department of Health and Human
Services has previously found that 12 percent of terminated providers
were participating in a State Medicaid program as of January 1, 2012,
after the same provider was terminated for reasons of integrity or
quality from another State Medicaid program.
{time} 1230
The base bill, H.R. 3716, will ensure that we put an end to this
problem.
State Medicaid and State CHIP programs will be required to report
terminated providers to the Centers for Medicare & Medicaid Services
within 21 business days. The Centers for Medicare & Medicaid Services
will then be required to include that data and Medicare provider
terminations in its Termination Notification database within 21
business days. In addition, State Medicaid and State CHIP managed care
contracts will be required to include a provision that providers
terminated for reasons of integrity or quality from Medicare, Medicaid,
or SCHIP be terminated from participation in their provider networks.
Where Medicaid or CHIP payments are made to providers for services
performed more than 60 days after the provider's termination, those
States will be required to pay back the Federal portion of the Medicaid
match of those payments.
The bill will also ensure that State Medicaid agencies have a current
and complete list of providers serving Medicaid patients by requiring
providers to enroll with the State agency. To streamline reporting
requirements and eliminate duplication, the Centers for Medicare &
Medicaid Services will be required to develop uniform terminology for
terminations related to fraud, integrity, or quality.
These simple reforms will ensure that we stop paying millions of
Federal taxpayer dollars for fraudulent and wasteful care and that
beneficiaries are not receiving care from providers who have failed to
adhere to basic standards of quality or integrity.
The second key issue this bill tackles is one of access to care.
Beneficiaries in the Medicaid program have historically struggled to
find a physician who will accept Medicaid and can provide treatment.
H.R. 3716 includes H.R. 3812, introduced by Representative Chris
Collins of New York, to empower beneficiaries with better information
that will arm them with the information that they need to access care
without first going to an emergency room.
While Medicaid beneficiaries enrolled in managed care plans have a
defined network of providers, about half of States use delivery systems
other than risk-based managed care, and those served under a fee-for-
service or primary care case management program
[[Page H1096]]
include some of the most vulnerable Medicaid enrollees, such as the
elderly and disabled children. Unfortunately, these enrollees may have
limited assistance in identifying physicians who participate in the
Medicaid program.
Specifically, the policy would require State Medicaid programs to
publish an electronic directory of physicians who have billed Medicaid
in the prior year--an indication that the physician has or likely still
accepts Medicaid patients. That directory would include the physician's
name, specialty, address, telephone number, and, where relevant,
information on whether the physician is accepting new patients and
linguistic capabilities.
Medicaid is estimated to cover 83 million people this year, and it is
growing. H.R. 3716 makes two targeted but important reforms to
strengthen the integrity of the Medicaid program and to improve access
to quality care. This legislation is another example of the Energy and
Commerce Committee's record of success on bipartisan reform to improve
the state of health care in America. I encourage my colleagues to vote
for this package.
Mr. Speaker, I reserve the balance of my time.
Mr. HASTINGS. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I thank the gentleman from Texas for yielding me the
customary 30 minutes for debate.
Mr. Speaker, I rise today to debate the rule for H.R. 3716, Ensuring
Removal of Terminated Providers from Medicaid and CHIP Act. Among other
things, this bill requires State Medicaid and CHIP programs to report
providers terminated for reasons of fraud, integrity, or quality to CMS
within 21 business days.
The requirements in this legislation are straightforward and have
achieved broad bipartisan support. I find myself strangely in the
position of agreeing with all of what my colleague from Texas had to
say. I listened to him intently. So it only leaves the question: Why is
this bill being presented here today instead of under the suspension
calendar?
Rather than taking the time to debate a rule for a bill that could be
passed without the need for a special rule, would it not be a better
use of this body's valuable legislative time to debate and pass a
budget resolution and get the appropriations process started?
Mr. Speaker, I applaud Speaker Ryan's promises to end Republican
obstruction and dysfunction and return to regular order, but I cannot
see how what is unfolding now is a step in that direction.
Last fall, Republicans and Democrats came together to pass a
bipartisan budget agreement. Now Republicans, appeasing the most
extreme fringe of their party, are considering breaking that agreement.
Breaking this agreement will not be without consequences for this
Nation, including deeper cuts to seniors and working families.
Mr. Speaker, the majority's fumble on the budget has ushered in a new
level of dysfunction for this institution. My Republican friends'
inability to govern has gotten so bad that they can't even agree to
follow through on an agreement they have already agreed to and has been
signed into law.
As we debate today, it is still not clear how the majority plans to
move forward on one of this body's most basic constitutional
obligations: appropriating funds to run the country.
I told the young people working with me that I thought of a metaphor
last night about when I first learned to swim. I grew up in an area
where there were a lot of lakes, so it was automatic that all of us
would learn how to swim, and we did. In learning to swim, among the
things that the young boys taught me was there were times when you just
tread water, where you don't move forward or backward. If you are
backstroking, just tread water. Some learned to float. I didn't. But
apparently my Republican friends have learned to float and have learned
to tread water because we are not going anywhere fast in this
institution of dysfunction.
The inability to fulfill this obligation is truly astounding and
reveals a Republican majority that may wish upon every star in the sky
to return to regular order but has no earthly idea of how to do so.
Indeed, the only regularity we see coming out of today's Republican
leadership is one dedicated to disorder.
The inability to even begin a fruitful discussion of a budget process
is but one among many pieces of evidence that prove that the Republican
hopes of regular order are as elusive as is their ability to put forth
a plan that will benefit working class Americans, strengthen our
infrastructure, and provide for the least among us. It would be comical
if it were not so dire.
Let's recap how we have arrived at this point of Republican inability
to govern. For the first time in 40 years, Republicans refuse to even
invite a representative from the administration to testify on the
President's budget proposal. Then, Republican leaders failed to hold a
committee markup on a budget resolution last week and fumbled their
plans to present their conference with a promised budget blueprint.
Now, in order to appease the insatiable radical fringe of his party,
Speaker Ryan is threatening to break the terms of the bipartisan budget
agreement passed into law last year--totally unbelievable.
Mr. Speaker, the American people deserve better. They want us to work
together to fund their government and solve the problems of this
country. This whole Republican budget process has shown that the
majority and the radical fringe rightwing of their party are simply not
up to that task.
I might add that I read last night that the majority leader in the
other body has made it very clear that he is not going to play along
with House Republican functionaries who would send stuff to the Senate
that is not going to pass. I predict that we will one day have the
usual omnibus at the end of this process, and that is tragic.
Mr. Speaker, I reserve the balance of my time.
Mr. BURGESS. Mr. Speaker, I have no further speakers, so pending Mr.
Hastings' conclusion, I will reserve the balance of my time.
Mr. HASTINGS. Mr. Speaker, I have no further speakers as well, and I
am prepared to close.
I yield myself the balance of my time.
Mr. Speaker, if we defeat the previous question, I am going to offer
an amendment to the rule to bring up a resolution that would require
the Republican majority to stop its partisan games and finally hold
hearings on the President's budget proposal.
Mr. Speaker, I ask unanimous consent to insert the text of the
amendment in the Record, along with extraneous material, immediately
prior to the vote on the previous question.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Florida?
There was no objection.
Mr. HASTINGS. Mr. Speaker, I urge my colleagues to vote ``no'' and
defeat the previous question.
Mr. Speaker, the bill underlying this rule institutes a number of
proposals that have broad bipartisan support. So again I ask: Why are
we here debating a rule for such a bill? Quite obviously, it is because
Republicans have no choice but to tread water. In doing so, they have
called a time-out on helping the American people; they have called a
time-out on doing their job.
They have done so so that they may make haste in putting Humpty
Dumpty back together again.
Good luck, my friends. Truly, truly, I wish you good luck.
In the meantime, rest assured that those of us on this side of the
aisle stand ready in getting to the people's business once you can pull
yourselves together and put forth a budget plan. I am, of course,
suspect of whether our friends on the other side of the aisle will be
able to do so.
Mr. Speaker, I yield back the balance of my time.
Mr. BURGESS. Mr. Speaker, I yield myself the balance of my time.
Mr. Speaker, I do want to point out today is March 2, significant for
many of us in Texas because that is Texas Independence Day, a date that
is recognized across the Nation as one that brought independence to the
State of Texas.
I would point out it seems like oftentimes, in my role here
presenting the Republican case for the rule from the Rules Committee,
it also becomes my duty to provide some historical perspective for the
House of Representatives, and today is no exception.
March 2, today, the first year that the Democrats had the majority in
recent memory was calendar year 2007.
[[Page H1097]]
When was a budget passed in calendar year 2007? It was passed on March
29. I would point out that the only thing bipartisan about that budget
resolution was the opposition.
Calendar 2008, a bit better, the budget passed on March 13, the
middle of the month, about 2 weeks from where we are today. Once again,
on that budget, 212 yeas and 207 nays. But the nays were bipartisan.
The yeas, of course, were of a single party.
Calendar year 2009, the budget didn't pass until the month of April,
and, once again, the only thing bipartisan about the budget that year
was its opposition.
Then, finally, I would point out that the following calendar year,
2010, there was no budget submitted.
So, Mr. Speaker, my understanding from the chairman of the Budget
Committee is they are actively working on the budget. I wish them
Godspeed. I am thankful that I don't have to be in the room while it is
being done, but I have every confidence that they will produce a budget
document that the House will then consider. But today--today--Mr.
Speaker, today's rule provides for consideration of an important fix to
the Nation's Medicaid program.
I certainly want to thank Dr. Larry Bucshon and Mr. Collins of New
York--both, of the Energy and Commerce Committee, two important members
of the Committee on Energy and Commerce--for their work on this
legislation.
Mr. Speaker, I urge my colleagues to vote ``yes'' on the rule and
``yes'' on the underlying bill.
The material previously referred to by Mr. Hastings is as follows:
An amendment to H. Res. 632 Offered by Mr. Hastings of Florida
At the end of the resolution, add the following new
sections:
Sec. 2. Immediately upon the adoption of this resolution it
shall be in order without intervention of any point of order
to consider in the House the resolution (H. Res. 624)
Directing the Committee on the Budget to hold a public
hearing on the President's fiscal year 2017 budget request
with the Director of the Office of Management and Budget as a
witness. The resolution shall be considered as read. The
previous question shall be considered as ordered on the
resolution and preamble to adoption without intervening
motion or demand for division of the question except one hour
of debate equally divided and controlled by the chair and
ranking minority member of the Committee on the Budget.
Sec. 3. Clause 1(c) of rule XIX shall not apply to the
consideration of H. Res. 624.
____
The Vote on the Previous Question: What It Really Means
This vote, the vote on whether to order the previous
question on a special rule, is not merely a procedural vote.
A vote against ordering the previous question is a vote
against the Republican majority agenda and a vote to allow
the Democratic minority to offer an alternative plan. It is a
vote about what the House should be debating.
Mr. Clarence Cannon's Precedents of the House of
Representatives (VI, 308-311), describes the vote on the
previous question on the rule as ``a motion to direct or
control the consideration of the subject before the House
being made by the Member in charge.'' To defeat the previous
question is to give the opposition a chance to decide the
subject before the House. Cannon cites the Speaker's ruling
of January 13, 1920, to the effect that ``the refusal of the
House to sustain the demand for the previous question passes
the control of the resolution to the opposition'' in order to
offer an amendment. On March 15, 1909, a member of the
majority party offered a rule resolution. The House defeated
the previous question and a member of the opposition rose to
a parliamentary inquiry, asking who was entitled to
recognition. Speaker Joseph G. Cannon (R-Illinois) said:
``The previous question having been refused, the gentleman
from New York, Mr. Fitzgerald, who had asked the gentleman to
yield to him for an amendment, is entitled to the first
recognition.''
The Republican majority may say ``the vote on the previous
question is simply a vote on whether to proceed to an
immediate vote on adopting the resolution. . . . [and] has no
substantive legislative or policy implications whatsoever.''
But that is not what they have always said. Listen to the
Republican Leadership Manual on the Legislative Process in
the United States House of Representatives, (6th edition,
page 135). Here's how the Republicans describe the previous
question vote in their own manual: ``Although it is generally
not possible to amend the rule because the majority Member
controlling the time will not yield for the purpose of
offering an amendment, the same result may be achieved by
voting down the previous question on the rule. . . . When the
motion for the previous question is defeated, control of the
time passes to the Member who led the opposition to ordering
the previous question. That Member, because he then controls
the time, may offer an amendment to the rule, or yield for
the purpose of amendment.''
In Deschler's Procedure in the U.S. House of
Representatives, the subchapter titled ``Amending Special
Rules'' states: ``a refusal to order the previous question on
such a rule [a special rule reported from the Committee on
Rules] opens the resolution to amendment and further
debate.'' (Chapter 21, section 21.2) Section 21.3 continues:
``Upon rejection of the motion for the previous question on a
resolution reported from the Committee on Rules, control
shifts to the Member leading the opposition to the previous
question, who may offer a proper amendment or motion and who
controls the time for debate thereon.''
Clearly, the vote on the previous question on a rule does
have substantive policy implications. It is one of the only
available tools for those who oppose the Republican
majority's agenda and allows those with alternative views the
opportunity to offer an alternative plan.
Mr. BURGESS. Mr. Speaker, I yield back the balance of my time, and I
move the previous question on the resolution.
The previous question was ordered.
The resolution was agreed to.
A motion to reconsider was laid on the table.
____________________