[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.

                          ____________________