[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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