[Congressional Record Volume 162, Number 39 (Thursday, March 10, 2016)]
[Senate]
[Pages S1441-S1442]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CORNYN (for himself and Mr. Carper):
  S. 2669. A bill to amend titles XIX and XXI 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; to the Committee on Finance.
  Mr. CORNYN. Mr. President, I ask unanimous consent that the text of 
the bill be printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 2669

       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 July 1, 2018, 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 date on which such termination is effective, as 
     specified in the 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.''.

[[Page S1442]]

       (2) Contract requirement 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) Contract requirement for managed care entities.--With 
     respect to any contract with a managed care entity under 
     section 1903(m) or 1905(t)(3) (as applicable), no later than 
     July 1, 2018, such contract shall 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.''.
       (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).''.
       (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 July 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 July 1, 2018, has a contract with such 
     entity that complies with the requirement specified in 
     section 1932(d)(5); and
       ``(B) beginning on January 1, 2018, complies with the 
     requirement specified in section 1932(d)(6)(A).''.
       (5) Development of uniform terminology for reasons for 
     provider termination.--Not later than July 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 
     subparagraph (A)) the following new subparagraph:
       ``(L) Section 1903(m)(3) (relating to limitation on payment 
     with respect to managed care).''; and
       (D) in subparagraph (P) (as redesignated by subparagraph 
     (A)), by striking ``(a)(2)(C) and (h)'' and inserting 
     ``(a)(2)(C) (relating to Indian enrollment), (d)(5) (relating 
     to contract requirement 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.
       (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.

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