[Congressional Record Volume 162, Number 34 (Wednesday, March 2, 2016)]
[House]
[Pages H1097-H1103]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
ENSURING REMOVAL OF TERMINATED PROVIDERS FROM MEDICAID AND CHIP ACT
General Leave
Mr. BUCSHON. Mr. Speaker, I ask unanimous consent that all Members
may have 5 legislative days to revise and extend their remarks and to
include extraneous material on H.R. 3716.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Indiana?
There was no objection.
The SPEAKER pro tempore. Pursuant to House Resolution 632 and rule
XVIII, the Chair declares the House in the Committee of the Whole House
on the state of the Union for the consideration of the bill, H.R. 3716.
The Chair appoints the gentleman from North Carolina (Mr. Holding) to
preside over the Committee of the Whole.
{time} 1302
In the Committee of the Whole
Accordingly, the House resolved itself into the Committee of the
Whole House on the state of the Union for the 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, with Mr. Holding in the chair.
The Clerk read the title of the bill.
The CHAIR. Pursuant to the rule, the bill is considered read the
first time.
The gentleman from Indiana (Mr. Bucshon) and the gentleman from New
York (Mr. Tonko) each will control 30 minutes.
The Chair recognizes the gentleman from Indiana.
Mr. BUCSHON. Mr. Chairman, I yield myself such time as I may consume.
The bipartisan bill before us today improves access to quality
healthcare providers for vulnerable Medicaid patients.
Today, State Medicaid programs too often suffer from waste, fraud,
and abuse, which can harm beneficiaries and waste taxpayer dollars. At
the same time, too many Medicaid patients may have a hard time finding
a doctor. Our bill takes an important step forward in addressing both
of these issues.
First, H.R. 3716 would ensure healthcare providers that are
terminated from Medicaid or from one State's Medicaid program for
reasons
[[Page H1098]]
of fraud, integrity, or quality are also terminated from other State
Medicaid programs. The Office of Inspector General at HHS has
previously found that 12 percent of terminated providers were
participating in a State Medicaid program after the same provider was
terminated from another State Medicaid program.
It is critical that fraudulent providers are not allowed to defraud
taxpayers or to harm patients across the board. Medicaid beneficiaries
are some of the most vulnerable patients, so our bipartisan bill will
ensure that they are better protected. This commonsense bill was
reported favorably from our Health Subcommittee and from the full
Energy and Commerce Committee last year.
The other important aspect of this legislation was authored by Chris
Collins of New York. This provision of the bill requires State Medicaid
programs to provide beneficiaries who are served under fee-for-service
or primary care case management programs an electronic directory of
physicians who are participating in the program.
Research shows that too often Medicaid patients today have a hard
time finding a doctor. The Government Accountability Office has
previously found that Medicaid patients face particular challenges in
accessing certain types of care, such as obtaining specialty care or
dental care. Additionally, the GAO has previously reported that 38
States experienced challenges in ensuring enough participating
providers.
To help empower Medicaid patients and equip them with better
information, this policy would apply requirements similar to those in
place for Medicaid managed care plans to fee-for-service and/or primary
care case management programs.
Under the bill, States would be required to list on their Web sites a
directory of physicians that would include the physician's name,
specialty, address, and telephone number. Additionally, for physicians
serving as case managers through the PCCM programs, States would be
required to include information on whether a physician is accepting new
patients as well as to list the physician's cultural and linguistic
capabilities.
In a day and age when Medicaid patients can use their phones to
search for the nearest gas station or grocery store, it makes good
sense to ensure that States are giving patients better information so
that they can readily find a doctor near them who accepts Medicaid
patients.
Finally, according to the Congressional Budget Office, H.R. 3716
would reduce Federal outlays by $15 million over a 10-year budget
window because the Medicaid program would no longer be paying providers
that were terminated for reasons of fraud, integrity, or quality. The
CBO does not estimate State-specific savings, but this bill would also
save State Medicaid programs several million dollars over the same
timeframe.
Mr. Chairman, this legislation provides commonsense reforms that help
protect Medicaid beneficiaries, that improve access to care, and that
save Federal and State dollars in the Medicaid program. I urge my
colleagues to support H.R. 3716.
I reserve the balance of my time.
Mr. TONKO. Mr. Chairman, I yield myself such time as I may consume.
I am here to express my strong support for the Ensuring Access to
Quality Medicaid Providers Act.
In particular, I am pleased that this legislation incorporates the
Medicaid Directory of Caregivers Act, also known as the Medicaid DOC
Act. This is legislation in which I joined with my colleague and friend
from New York, Representative Collins, in introducing.
I thank Representative Collins for his initiative in this area and
for working together on this issue in a collaborative and bipartisan
way. I also thank the Energy and Commerce Committee staffs on both
sides for providing constructive feedback and for expeditiously moving
this bill out of committee.
The impetus behind this bill is simple and straightforward: to make
it easier for Medicaid beneficiaries to find and access a doctor.
The underlying legislation would require States that operate a fee-
for-service Medicaid program to publish an online provider directory,
just like managed care plans and private insurance are already required
to do. By creating a one-stop-shop for Medicaid beneficiaries to find
information on participating providers, this commonsense legislation
will make it easier for individuals and families to access quality
health care.
The legislation details the minimum items that must be included in a
provider directory, but it also allows States to go beyond those given
standards. All consumers deserve to have access to a basic electronic
provider directory to find the best physicians for their use.
The second component of the legislation under consideration would
provide the CMS with critical tools to keep patients safe, to protect
taxpayer dollars, and to protect the integrity of our Medicaid program.
This bipartisan bill, introduced by Representatives Bucshon, Welch,
and Butterfield, implements previous OIG recommendations and builds on
authorities originally authorized under the ACA. The ACA included a
provision that prohibited disqualified providers from Medicare or a one
State Medicaid program from simply crossing State lines and receiving
payments in another State Medicaid program.
The ACA provision has been hard to implement, however, because States
don't have a consistent or a standardized way of knowing when a
specific provider has been terminated by Medicare or by another State.
All States are not currently required to report this information, and
if it is reported, it is in many differing formats, limiting the data's
usability.
This legislation would require all States to report information on
fraudulent providers to the Secretary for inclusion in a currently
existing termination database that is accessible to all States. The
legislation also requires the Secretary to develop uniform criteria for
States to use when submitting information.
The language would also require all providers in managed care to
enroll with State Medicaid agencies so that States know all providers
that are participating in the program. This legislation preserves all
existing provider appeals processes, and it changes nothing regarding
the underlying standard for fraud in this part of the program.
In closing, Mr. Chairman, I urge all Members to support this
bipartisan legislation, which makes Medicaid more consumer-friendly and
strengthens program integrity.
I reserve the balance of my time.
Mr. BUCSHON. Mr. Chairman, I yield myself such time as I may consume.
This is the type of legislation that we should be passing on the
House floor, and I will urge the Senate to pass this legislation later.
This is just good government. It corrects some obvious flaws in the
Medicaid program that will protect patients and save taxpayers money. I
am very pleased that we are able to address this today.
I reserve the balance of my time.
Mr. TONKO. As I earlier mentioned in my comments, one of the key
participants in putting this effort together was Representative Welch
from the State of Vermont.
I yield 2 minutes to the gentleman from Vermont (Mr. Welch), a good
friend and a fellow Energy and Commerce Committee member.
Mr. WELCH. I thank the gentleman from New York.
Mr. Chairman, we are lucky we have Dr. Bucshon, a good Member, a good
friend, and a great Energy and Commerce Committee person, who, with his
experience as a physician, is able to give us the benefit of this bill.
I thank the gentleman from Indiana for that.
The Medicaid program is an incredibly important program to get health
care to poor Americans who need it. The vast majority of our providers
use the Medicaid program to provide those services, but some fraudulent
providers use that program to rip off taxpayers. It has got to stop.
One of the things that Dr. Bucshon observed and brought to our
attention was that when States are aggressively monitoring for fraud
and when they identify a fraudulent provider, they write that person
off the rolls so that that provider can't keep ripping off the
taxpayers. But that information doesn't get disseminated to other
States, so that fraudulent provider simply steps across the State line,
sets
[[Page H1099]]
up another operation, and starts ripping off taxpayers all over again.
This legislation addresses that rip-off. I am glad it does because we
can debate about lots of things, but there is unity here about wanting
to make certain that any taxpayer dollar is well spent and that it is
not ripped off by a fraudulent provider. This sets up practical
mechanisms for States that have identified a fraudulent provider so
they may share that information with other States so they don't find
themselves digging the same hole.
We have bipartisan support for this. It is a money-saving bill. The
CBO estimates that it would save approximately $28 million over 10
years.
That may sound like small money; but do you want to know something?
That is real money. It is about the money, but it is also about
constant vigilance so as to make sure that the programs we design for
good intentions work.
The CHAIR. The time of the gentleman has expired.
Mr. TONKO. I yield the gentleman an additional 1 minute.
Mr. WELCH. I thank the gentleman.
Mr. Chairman, it is just what we should be doing here so we can look
at things that have good intentions, like the Medicaid program, and
find where there are holes in it and try to close them so that the
program runs better so that taxpayer money is saved and so that the
efficiency of government is enhanced.
{time} 1315
And that is a mutual responsibility that we have so that people can
have confidence that the taxpayer dollars that they are spending,
whether it is for Medicaid or the Pentagon or any other program, are
spent for the intended purposes and are not wasted.
Mr. BUCSHON. Mr. Chair, I yield myself such time as I may consume.
I thank the gentleman for his comments. It is true that when you find
common ground and work together, good things happen, and this is one of
those instances.
I think there are a lot of areas in health care. I was a healthcare
provider before I was a heart surgeon. I took care of Medicaid and
Medicare patients, private insurance patients, and patients that did
not have the ability to pay. I think that we need to continue to look
for ways to improve our safety net healthcare programs, mainly continue
to look for ways to make sure that people have access to health care in
the United States regardless of their ability to pay, regardless of
their ZIP Code.
That said, we need to make sure that people have access to quality
health care, and that is why bills like this are so important. It weeds
out providers that are fraudulent and have other quality-related
problems.
As a physician--and I will speak for some of my physician friends--
this is the type of thing that we all want in our specialties. We want
to make sure that the patients that we serve have access to physicians
who are providing quality health care and are not defrauding the
system.
I reserve the balance of my time.
Mr. TONKO. Mr. Chair, I will continue to reserve the balance of my
time.
Mr. BUCSHON. Mr. Chair, I yield 2 minutes to the gentleman from New
York (Mr. Collins).
Mr. COLLINS of New York. Mr. Chair, I thank both Congressman Bucshon
and Congressman Tonko for their help on this very important bill that
we are debating today. Included in Congressman Bucshon's bill, H.R.
3716, is a bill that Mr. Tonko and I put together, H.R. 3821, the
Medicare Directory of Caregivers, or DOC, Act.
Our thought behind this bill came from the GAO report that identified
access to care as one of the key issues facing Medicaid beneficiaries.
There is nothing worse than someone saying: ``The good news is you have
got medical insurance coverage through Medicaid. The bad news is they
can't find a physician.''
So as a very good, commonsense government idea, what Representative
Tonko and I came up with was the thought that we should be publishing
on each State's Web site a list of the providers who have seen a
Medicaid patient in the last 12 months, the name of the physician, the
address, the telephone number, and their specialty, so at least these
folks navigating the system to find a doctor have somewhere to go as a
starting point: ``Here is a doctor that has seen a Medicaid patient in
the last 12 months. Let me give them a call.'' So they are not just
lost going through the phonebook, so to speak, or Google.
What our bill would do, it would require that States that operate a
fee-for-service or primary care case management program set up an
online directory of physicians who have seen these Medicaid patients.
We believe that this kind of access to caregivers will keep people out
of the emergency rooms. They will have coordinated care by a physician,
which is the best and most inexpensive way to treat them.
Representative Bucshon's bill combined with our bill, H.R. 3821, does
save $15 million over the 10-year period, as scored. The bill went
through regular order and passed out of the Energy and Commerce
subcommittee and full committee by voice vote with no objections.
We are also encouraged to know the White House has signaled that they
do support passage of this important access to care legislation.
Again, I thank Chairmen Upton and Pitts, and Ranking Members Pallone
and Green for their support. I encourage my colleagues to vote in favor
of this bipartisan legislation.
Mr. TONKO. Mr. Chair, I yield 3 minutes to the gentleman from New
Jersey (Mr. Pallone), the ranking member of the standing Committee on
Energy and Commerce, who has shown great leadership for the Democrats
at the Energy and Commerce table. He is very much supportive of this
effort here, and we thank him for that.
Mr. PALLONE. Mr. Chair, I am pleased to support H.R. 3716, the
Ensuring Access to Quality Medicaid Providers Act. This legislation is
the compilation of two bills, H.R. 3821 and H.R. 3716, which are true
efforts to improve program integrity in Medicaid in ways that will
strengthen the Medicaid program. Both bipartisan bills passed out of
the Energy and Commerce Committee through regular order and were
favorably reported by voice vote.
Part of the new compiled bill reflects H.R. 3821, the Medicaid DOC
Act. This bipartisan initiative, introduced by Representatives Collins
of New York and Tonko, would require States that participate in fee-
for-service Medicaid to publish electronic provider directories. This
is critical information for patients so they can more easily find
doctors in their area.
Currently, managed care plans in Medicaid are already required to
maintain these directories, but there is no such requirement for fee-
for-service Medicaid programs. While some States are already providing
these directories, not every State does so. This commonsense and
consumer-friendly legislation will require that all States provide
their Medicaid patients with this information, and it does so quickly,
requiring directories to be up and running in less than 1 year.
Now, while the bill includes minimum items that must be included in a
provider directory, it also encourages States to go beyond these
standards. While I am hopeful that States will take the initiative to
provide other information, like whether doctors are taking new
patients, the timeline set forth in this legislation is so accelerated,
it is important that we build this foundation first before adding
additional requirements to States. I look forward to continuing to work
on this important issue with my colleagues.
The second part of the bill would provide CMS with critical tools to
keep patients safe, protect taxpayer dollars, and protect the integrity
of the Medicaid program.
This bipartisan bill, introduced by Representatives Bucshon, Welch,
and Butterfield, implements previous OIG recommendations and builds on
authorities originally authorized under the Affordable Care Act, which
prohibited disqualified providers from Medicare or one State Medicaid
program from simply crossing State lines and receiving payments in
another State Medicaid program.
But the current law has been hard to implement because States don't
have a consistent or standardized way of knowing when a specific
provider has been terminated by Medicare or another State. Since States
are not currently required to report this information or, if it is
reported, it is in many
[[Page H1100]]
differing formats, it limits the data's usability.
This legislation being considered would require all States to report
information on fraudulent providers to the Secretary for inclusion in
an existing termination database that is accessible to all States. It
also requires the Secretary to develop uniform criteria for States to
use when submitting information and ensures those providers in managed
care plans are enrolled with the State and also captured in the
database.
Finally, the bill preserves and protects all existing provider appeal
processes and changes nothing regarding the underlying standard for
fraud in this part of the program, an important protection. This is
smart policy that stakeholders and the administration agree will
improve Federal and State efforts.
I urge Members to support the bill.
Mr. BUCSHON. Mr. Chair, I yield 2 minutes to the gentleman from New
Jersey (Mr. Lance).
Mr. LANCE. Mr. Chair, this is the way Congress should work, in a
bipartisan capacity on an issue of importance to better the health of
the American Nation.
As is so often true of the House Energy and Commerce Committee, we
work in a bipartisan fashion. It is the committee of jurisdiction for
so many of the issues that reach this floor, with the support in
committee and in subcommittee of both Republicans and Democrats.
Legislation coming out of our committee, the Energy and Commerce
Committee, is legislation that passes here on the floor, goes over to
the other House, and is eventually signed into law by the President of
the United States. I am pleased that we are working closely with the
other elected branch of government in this area.
I commend Congressman Bucshon, Dr. Bucshon, for his legislation that
will so improve the issue we are discussing, and I think that Medicaid
providers is an important matter for the entire Nation. I also
compliment Congressman Collins of New York for his involvement on this
issue.
With a program as large as Medicaid, it will always be a target for
those who engage in fraud, but we can work to limit the impact of those
who engage in fraud. The Congressman's bill is a positive step in that
direction. It will save millions of dollars and send a message loud and
clear that bad actors in one State should not be allowed to participate
anywhere.
Medicaid-managed care plans already provide a network of doctors and
nurses to care for patients. The requirement in this bill ensures that
patients in fee-for-service Medicaid programs do not have to fend for
themselves.
Research has shown that access to doctors can be a problem for
Medicaid beneficiaries, so this commonsense step will help ensure
beneficiaries are empowered with better information and that this
happens across the board.
I thank Dr. Bucshon and Mr. Collins, as well as the Health
Subcommittee and its chairman, Chairman Pitts, and the full committee,
including, of course, Chairman Upton and Ranking Member Pallone. Let's
work together to ensure passage of this legislation on the floor of the
House today.
Mr. TONKO. Mr. Chair, I reserve the balance of my time.
Mr. BUCSHON. Mr. Chair, I yield 2 minutes to the gentleman from
Georgia (Mr. Carter).
Mr. CARTER of Georgia. Mr. Chair, I rise today in support of H.R.
3716, the Ensuring Access to Quality Medicaid Providers Act.
A recent report by the HHS inspector general found that more than 1
in every 10 Medicaid providers who were terminated for fraud,
integrity, or quality in one State were still participating in another
State's Medicaid program.
To ensure that Medicaid patients are receiving their care from a
qualified, licensed doctor, H.R. 3716 provides that disqualified
providers be reported within 21 days to CMS, and each Medicaid provider
must be enrolled with the State Medicaid agency.
H.R. 3716 also provides that State Medicaid programs include an
electronic directory of physicians who serve Medicaid patients. Today,
many Medicaid patients have a hard time finding a doctor and instead
rely on the emergency room. With an established directory, Medicaid
patients will be able to know which doctors are available to them and
will ultimately get better care.
I encourage my colleagues to support the reforms in H.R. 3716 so we
can make sure that Medicaid patients are receiving the care and
attention they deserve.
Mr. TONKO. Mr. Chair, again, I just would thank all who have been
involved with the effort here--from my perspective, particularly
Representative Collins, Dr. Bucshon, Representative Welch, and others
who put together, I think, a good effort here to have a bipartisan,
collaborative effort that speaks to sensitivity, speaks to compassion
toward the patients, those requiring the access to health care, and
certainly has great respect for the taxpayer and the ensuing outcomes.
With that, I would encourage my colleagues to support the
legislation.
I yield back the balance of my time.
Mr. BUCSHON. Mr. Chair, I would just like to echo the words of Mr.
Tonko. This is good legislation. It improves the Medicaid program. It
ensures access to quality providers for our Medicaid recipients in all
of our States. Also, it helps our States to determine when people have
been kicked off the program as a provider in another State and,
therefore, helps them protect the patients in their own States.
I urge all of my colleagues to support this legislation.
I yield back the balance of my time.
Mr. UPTON. Mr. Chair, today we are making a difference for the
nation's most vulnerable. Republicans and Democrats working to
strengthen Medicaid, and the White House has officially given its seal
of approval to these commonsense reforms.
Today is an important day and underscores what we can accomplish when
we work together.
Medicaid is an important lifeline for so many in Michigan and across
the country. It is estimated the program will expand to cover 83
million people this year--to put that into perspective, that's one in
four Americans. Given its rapidly growing size, it is imperative the
program is working as it is intended--providing care for folks who need
it most.
The Ensuring Access to Quality Medicaid Providers Act we are
considering is the product of two bills authored by committee members
Dr. Larry Bucshon and Rep. Chris Collins that unanimously cleared both
the Health Subcommittee and full committee last fall.
Dr. Bucshon led the effort to help cut down on fraud by eliminating
bad actors. The bipartisan legislation ensures that providers
terminated from Medicare or a state Medicaid program for reasons of
fraud, integrity, or quality are terminated across the board from all
other state Medicaid programs.
With a program as large as Medicaid, it will always be a target for
fraudsters, but we can work to limit their impact, and this bill is an
positive step that will save millions of dollars and send the message
loud and clear that bad actors in one state should not be allowed to
participate anywhere, period.
In addition to reducing fraud, we are helping increase access for
those most in need. Finding a doctor is often a difficult task, and Mr.
Collins led this effort to increase access to care beyond the emergency
room. If a state is using a fee-for-service or primary case management
system to deliver care to Medicaid patients, this bill requires they
provide those patients with a directory of physicians.
Medicaid managed care plans already provide a network of doctors and
nurses to care for patients. This requirement ensures that patients in
fee-for-service Medicaid programs don't have to fend for themselves.
Research has shown that access to doctors can be a problem for
Medicaid beneficiaries, so this commonsense step will help ensure
beneficiaries are empowered with better information that is more
readily available. And that's a good thing.
This bill doesn't solve all our problems, but it is a significant
bipartisan step forward. And yesterday, the Office of Management and
Budget announced the administration ``supports House passage of H.R.
3716 because it improves program integrity for Medicaid and the
Children's Health Insurance Program.''
We've got Republicans, Democrats, and the White House all in lockstep
supporting meaningful, 21st century reforms for Medicaid. This bill
shows that it's possible to work together on Medicaid.
I'd like to once again thank Dr. Bucshon and Mr. Collins, as well as
Helath Subcommittee Chairman Pitts and full committee Ranking Member
Pallone. Together, we are building upon the committee's proud
bipartisan record of success. Let's keep the momentum going to help our
most vulnerable folks.
[[Page H1101]]
The CHAIR. All time for general debate has expired.
Pursuant to the rule, the bill shall be considered for amendment
under the 5-minute rule.
In lieu of the amendment in the nature of a substitute recommended by
the Committee on Energy and Commerce, printed in the bill, it shall be
in order to consider as an original bill for the purpose of amendment
under the 5-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.
The text of the amendment in the nature of a substitute is as
follows:
H.R. 3716
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
[[Page H1102]]
(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.
SEC. 3. REQUIRING PUBLICATION OF FEE-FOR-SERVICE PROVIDER
DIRECTORY.
(a) In General.--Section 1902(a) of the Social Security Act
(42 U.S.C. 1396a(a)) is amended--
(1) in paragraph (80), by striking ``and'' at the end;
(2) in paragraph (81), by striking the period at the end
and inserting ``; and''; and
(3) by inserting after paragraph (81) the following new
paragraph:
``(82) 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 or through a primary care case-management system
described in section 1915(b)(1) (other than a primary care
case management entity (as defined by the Secretary)), the
State shall publish (and update on at least an annual basis)
on the public Website of the State agency administering the
State plan, a directory of the providers (including, at a
minimum, primary and specialty care physicians) described in
subsection (mm) that includes--
``(A) with respect to each such provider--
``(i) the name of the provider;
``(ii) the specialty of the provider;
``(iii) the address of the provider; and
``(iv) the telephone number of the provider; and
``(B) with respect to any such provider participating in
such a primary care case-management system, information
regarding--
``(i) whether the provider is accepting as new patients
individuals who receive medical assistance under this title;
and
``(ii) the provider's cultural and linguistic capabilities,
including the languages spoken by the provider or by the
skilled medical interpreter providing interpretation services
at the provider's office.''.
(b) Directory Providers Described.--Section 1902 of the
Social Security Act (42 U.S.C. 1396a), as amended by section
2(a)(3), is amended by adding at the end the following new
subsection:
``(mm) Directory Providers Described.--A provider described
in this subsection is--
``(1) in the case of a provider of a provider type for
which the State agency, as a condition on receiving payment
for items and services furnished by the provider to
individuals eligible to receive medical assistance under the
State plan, requires the enrollment of the provider with the
State agency, a provider that--
``(A) is enrolled with the agency as of the date on which
the directory is published or updated (as applicable) under
subsection (a)(82); and
``(B) received payment under the State plan in the 12-month
period preceding such date; and
``(2) in the case of a provider of a provider type for
which the State agency does not require such enrollment, a
provider that received payment under the State plan in the
12-month period preceding the date on which the directory is
published or updated (as applicable) under subsection
(a)(82).''.
(c) Rule of Construction.--
(1) In general.--The amendment made by subsection (a) shall
not be construed to apply in the case of a State in which all
the individuals enrolled in the State plan under title XIX of
the Social Security Act (or under a waiver of such plan),
other than individuals described in paragraph (2), are
enrolled with a medicaid managed care organization (as
defined in section 1903(m)(1)(A) of such Act (42 U.S.C.
1396b(m)(1)(A))), including prepaid inpatient health plans
and prepaid ambulatory health plans (as defined by the
Secretary of Health and Human Services).
(2) Individuals described.--An individual described in this
paragraph is an individual who is an Indian (as defined in
section 4 of the Indian Health Care Improvement Act (25
U.S.C. 1603)) or an Alaska Native.
(d) Exception for State Legislation.--In the case of a
State plan under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.), which the Secretary determines requires
State legislation in order for the respective plan to meet
one or more additional requirements imposed by amendments
made by this section, the respective plan shall not be
regarded as failing to comply with the requirements of such
title solely on the basis of its failure to meet such an
additional requirement before the first day of the first
calendar quarter beginning after the close of the first
regular session of the State legislature that begins after
the date of enactment of this section. For purposes of the
previous sentence, in the case of a State that has a 2-year
legislative session, each year of the session shall be
considered to be a separate regular session of the State
legislature.
The CHAIR. No amendment to the amendment in the nature of a
substitute shall be in order except those printed in House Report 114-
440. Each such amendment may be offered only in the order printed in
the report, by a Member designated in the report, shall be considered
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.
{time} 1330
Amendment No. 1 Offered by Mr. Bucshon
The CHAIR. It is now in order to consider amendment No. 1 printed in
House Report 114-440.
Mr. BUCSHON. Mr. Chairman, I have an amendment at the desk.
The CHAIR. The Clerk will designate the amendment.
The text of the amendment is as follows:
Page 1, lines 2 and 3, strike ``Ensuring Removal of
Terminated Providers from Medicaid and CHIP Act'' and insert
``Ensuring Access to Quality Medicaid Providers Act''.
Page 1, lines 15 and 16, strike ``January 1, 2017'' and
insert ``July 1, 2018''.
Page 3, lines 1 and 2, strike ``the effective date of such
termination specified in such notice'' and insert ``the date
on which such termination is effective, as specified in the
notice''.
Page 3, line 16, strike ``Reporting requirements'' and
insert ``Contract requirement''.
Page 3, line 20, strike ``State reporting requirements for
managed care entities'' and insert ``Contract requirement for
managed care entities''.
Page 3, line 22, strike ``(A)'' and all that follows
through ``With respect'' and insert ``With respect''.
Page 3, beginning on line 24, strike ``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'' and insert
``applicable), no later than July 1, 2018, such contract
shall''.
Page 4, strike lines 12 through 21.
Page 6, line 1, strike ``January 1, 2018'' and insert
``July 1, 2018''.
Page 6, line 17, strike ``the applicable date specified in
subparagraph (A) of section 1932(d)(5)'' and insert ``July 1,
2018''.
Page 6, line 21, strike ``(i)''.
Page 6, line 21, strike ``for the period specified in
subparagraph (B) of such section, has a system in effect that
meets'' and insert ``beginning on January 1, 2018, complies
with''.
Page 6, line 23, strike ``such subparagraph; and'' and all
that follows through page 7, line 2 and insert ``section
1932(d)(6)(A).''.
Page 7, line 5, strike ``January 1, 2017'' and insert
``July 1, 2017''.
Page 10, line 15, strike ``paragraph (1)'' and insert
``subparagraph (A)''.
Page 10, line 21, strike ``paragraph (1)'' and insert
``subparagraph (A)''.
Page 10, lines 23 and 24, strike ``reporting requirements''
and insert ``contract requirement''.
Page 11, after line 15, insert the following:
(e) OIG Report.--Not later than March 31, 2020, the
Inspector General of the Department of Health and Human
Services shall submit to Congress a report on the
implementation of the amendments made by this section. Such
report shall include the following:
(1) An assessment of the extent to which providers who are
included under subsection (ll) of section 1902 of the Social
Security Act (42 U.S.C. 1396a) (as added by subsection
(a)(3)) in the database or similar system referred to in such
subsection are terminated (as described in subsection (kk)(8)
of such section, as added by subsection (a)(1)) from
participation in all State plans under title XIX of such Act.
(2) Information on the amount of Federal financial
participation paid to States under section 1903 of such Act
in violation of the limitation on such payment specified in
subsections (i)(2)(D) and subsection (m)(3) of such section,
as added by subsection (a)(4).
(3) An assessment of the extent to which contracts with
managed care entities under title XIX of such Act comply with
the requirement specified in section 1932(d)(5) of such Act,
as added by subsection (a)(2).
(4) An assessment of the extent to which providers have
been enrolled under section 1902(a)(78) or 1932(d)(6)(A) of
such Act (42 U.S.C. 1396a(a)(78), 1396u-2(d)(6)(A)) with
State agencies administering State plans under title XIX of
such Act.
Page 12, lines 1 and 2, strike ``180 days after the date of
the enactment of this paragraph'' and insert ``January 1,
2017''.
Page 12, line 10, strike ``a directory'' and all that
follows through line 13 and insert the following: ``a
directory of the physicians described in subsection (mm) and,
at State option, other providers described in such subsection
that--''
Page 12, after line 13, insert the following:
``(A) includes--''.
Page 12, line 14, strike ``(A)'' and insert ``(i)''.
Page 12, line 14, insert ``physician or'' before
``provider''.
Page 12, line 15, strike ``(i)'' and insert ``(I)''.
Page 12, line 15, insert ``physician or'' before
``provider''.
Page 12, line 16, strike ``(ii)'' and insert ``(II)''.
[[Page H1103]]
Page 12, line 16, insert ``physician or'' before
``provider''.
Page 12, line 17, strike ``(iii)'' and insert ``(III)''.
Page 12, line 17, strike ``of the provider'' and insert
``at which the physician or provider provides services''.
Page 12, line 18, strike ``(iv)'' and insert ``(IV)''.
Page 12, line 18, insert ``physician or'' before
``provider''.
Page 12, line 20, strike ``(B)'' and insert ``(ii)''.
Page 12, line 20, insert ``physician or'' before
``provider''.
Page 12, line 23, strike ``(i)'' and insert ``(I)''.
Page 12, line 23, insert ``physician or'' before
``provider''.
Page 13, line 1, strike ``(ii)'' and insert ``(II)''.
Page 13, line 1, insert ``the physician's'' before
``provider's''.
Page 13, line 3, insert ``physician or'' before
``provider''.
Page 13, line 5, strike ``provider's office.'' and insert
``physician's or provider's office; and''.
Page 13, after line 5, insert the following:
``(B) may include, at State option, with respect to each
such physician or provider--
``(i) the Internet website of such physician or provider;
or
``(ii) whether the physician or provider is accepting as
new patients individuals who receive medical assistance under
this title.''.
Page 13, line 6, strike ``Providers'' and insert
``Physician or Provider''.
Page 13, line 10, strike ``Providers'' and insert
``Physician or Provider''.
Page 13, line 10, strike ``A'' and insert ``A physician
or''.
Page 13, line 12, insert ``physician or'' before ``provider
of''.
Page 13, line 15, insert ``physician or'' before
``provider''.
Page 13, line 17, strike ``provider with the State agency,
a'' and insert ``physician or provider with the State agency,
a physician or''.
Page 14, line 1, insert ``physician or'' before ``provider
of''.
Page 14, line 3, insert ``physician or'' before
``provider''.
Page 14, beginning on line 10, strike ``in which all the
individuals enrolled in the State plan under title XIX of the
Social Security Act'' and insert ``(as defined for purposes
of title XIX of the Social Security Act) in which all the
individuals enrolled in the State plan under such title''.
Page 15, line 3, insert ``of Health and Human Services''
after ``Secretary''.
Page 15, line 12, strike ``section'' and insert ``Act''.
The CHAIR. Pursuant to House Resolution 632, the gentleman from
Indiana (Mr. Bucshon) and a Member opposed each will control 5 minutes.
The Chair recognizes the gentleman from Indiana.
Mr. BUCSHON. Mr. Chairman, I yield myself such time as I may consume.
This bipartisan amendment makes a few technical changes to the bill.
First, this amendment modifies the short title to better reflect the
policies of both sections of the bill.
Second, this amendment updates the effective dates throughout the
bill to ensure that States and HHS have the time necessary to correctly
implement the provisions.
Next, it includes a requirement that the Office of the Inspector
General at HHS review the implementation of the requirements in this
bill regarding terminated providers and report back to Congress on what
they find. This is an important feedback loop to ensure appropriate
oversight.
Finally, the amendment clarifies that the fee-for-service provider
directory is required to include physicians and, at a State's option,
other providers. The amendment also clarifies the information that
could be included in the directory.
Modification to Amendment No. 1 Offered by Mr. Bucshon
Mr. BUCSHON. Mr. Chair, I ask unanimous consent to modify the second
instruction relating to page 13, line 1, as provided at the desk.
The CHAIR. The Clerk will report the modification.
The Clerk read as follows:
Modification to amendment No. 1 offered by Mr. Bucshon:
Page 13, line 1, insert ``physician's or'' before
``provider's''.
The CHAIR. Is there objection to the request of the gentleman from
Indiana?
There was no objection.
The CHAIR. The amendment is modified.
The Chair recognizes the gentleman from Indiana.
Mr. BUCSHON. Mr. Chairman, I urge my colleagues to support this
bipartisan amendment to H.R. 3716.
I yield back the balance of my time.
The CHAIR. Does any Member seek time in opposition to the amendment?
Mr. BUCSHON. Mr. Chairman, I ask unanimous consent to reclaim my
time.
The CHAIR. Is there objection to the request of the gentleman from
Indiana?
There was no objection.
The CHAIR. The gentleman from Indiana is recognized.
Mr. BUCSHON. Mr. Chairman, I yield to the gentleman from New York
(Mr. Tonko).
Mr. TONKO. Mr. Chair, I rise in support of the manager's amendment.
This amendment provides a new bill name that incorporates the
underlying policies from each of its component bills and reflects
additional technical changes that have been outlined by the gentleman
from Indiana (Mr. Bucshon), made in consultation with CMS.
This is a very targeted policy that went through extensive review
through regular order in the committee. The manager's amendment
reflects the final iteration of that hard work.
I would urge all my colleagues to support this simple refining
amendment.
Mr. BUCSHON. Mr. Chairman, I yield back the balance of my time.
The CHAIR. The question is on the amendment, as modified, offered by
the gentleman from Indiana (Mr. Bucshon).
The amendment, as modified, was agreed to.
The CHAIR. It is now in order to consider amendment No. 2 printed in
House Report 114-440.
It is now in order to consider amendment No. 3 printed in House
Report 114-440.
It is now in order to consider amendment No. 4 printed in House
Report 114-440.
The question is on the amendment in the nature of a substitute, as
amended.
The amendment was agreed to.
The CHAIR. Under the rule, the Committee rises.
Accordingly, the Committee rose; and the Speaker pro tempore (Mr.
Smith of Nebraska) having assumed the chair, Mr. Holding, Chair of the
Committee of the Whole House on the state of the Union, reported that
that Committee, having had under consideration 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, and, pursuant
to House Resolution 632, he reported the bill back to the House with an
amendment adopted in the Committee of the Whole.
The SPEAKER pro tempore. Under the rule, the previous question is
ordered.
Is a separate vote demanded on any amendment to the amendment
reported from the Committee of the Whole?
If not, the question is on the amendment in the nature of a
substitute, as amended.
The amendment was agreed to.
The SPEAKER pro tempore. The question is on the engrossment and third
reading of the bill.
The bill was ordered to be engrossed and read a third time, and was
read the third time.
The SPEAKER pro tempore. The question is on the passage of the bill.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Mr. BUCSHON. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further
proceedings on this question will be postponed.
____________________