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Union Calendar No. 326 

114TH CONGRESS 

2D SESSION H. R. 3716 

[Report No. 114–427] 

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. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 8, 2015 

Mr. BUCSHON (for himself, Mr. WELCH, and Mr. BUTTERFIELD) introduced 

the following bill; which was referred to the Committee on Energy and 

Commerce 

FEBRUARY 23, 2016 

Reported with an amendment, committed to the Committee of the Whole 

House on the State of the Union, and ordered to be printed 

[Strike out all after the enacting clause and insert the part printed in italic] 

[For text of introduced bill, see copy of bill as introduced on October 8, 2015] 


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A BILL 

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. 


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1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Ensuring Removal of 

5 Terminated Providers from Medicaid and CHIP Act’’. 

6 SEC. 2. INCREASING OVERSIGHT OF TERMINATION OF MED7 ICAID PROVIDERS. 

8 (a) INCREASED OVERSIGHT AND REPORTING.— 

9 (1) STATE REPORTING REQUIREMENTS.—Section 

10 1902(kk) of the Social Security Act (42 U.S.C. 

11 1396a(kk)) is amended— 

12 (A) by redesignating paragraph (8) as 

13 paragraph (9); and 

14 (B) by inserting after paragraph (7) the fol15 lowing new paragraph: 

16 ‘‘(8) PROVIDER TERMINATIONS.— 

17 ‘‘(A) IN GENERAL.—Beginning on January 

18 1, 2017, in the case of a notification under sub19 section (a)(41) with respect to a termination for 

20 a reason specified in section 455.101 of title 42, 

21 Code of Federal Regulations (as in effect on No22 vember 1, 2015) or for any other reason specified 

23 by the Secretary, of the participation of a pro24 vider of services or any other person under the 

25 State plan, the State, not later than 21 business 


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1 days after the effective date of such termination, 

2 submits to the Secretary with respect to any such 

3 provider or person, as appropriate— 

4 ‘‘(i) the name of such provider or per5 son; 

6 ‘‘(ii) the provider type of such provider 

7 or person; 

8 ‘‘(iii) the specialty of such provider’s 

9 or person’s practice; 

10 ‘‘(iv) the date of birth, Social Security 

11 number, national provider identifier, Fed12 eral taxpayer identification number, and 

13 the State license or certification number of 

14 such provider or person; 

15 ‘‘(v) the reason for the termination; 

16 ‘‘(vi) a copy of the notice of termi17 nation sent to the provider or person; 

18 ‘‘(vii) the effective date of such termi19 nation specified in such notice; and 

20 ‘‘(viii) any other information required 

21 by the Secretary. 

22 ‘‘(B) EFFECTIVE DATE DEFINED.—For pur23 poses of this paragraph, the term ‘effective date’ 

24 means, with respect to a termination described 

25 in subparagraph (A), the later of— 


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1 ‘‘(i) the date on which such termi2 nation is effective, as specified in the notice 

3 of such termination; or 

4 ‘‘(ii) the date on which all appeal 

5 rights applicable to such termination have 

6 been exhausted or the timeline for any such 

7 appeal has expired.’’. 

8 (2) REPORTING REQUIREMENTS FOR MANAGED

9 CARE ENTITIES.—Section 1932(d) of the Social Secu10 rity Act (42 U.S.C. 1396u–2(d)) is amended by add11 ing at the end the following new paragraph: 

12 ‘‘(5) STATE REPORTING REQUIREMENTS FOR

13 MANAGED CARE ENTITIES.— 

14 ‘‘(A) IN GENERAL.—With respect to any 

15 contract with a managed care entity under sec16 tion 1903(m) or 1905(t)(3) (as applicable), be17 ginning on the later of the first day of the first 

18 plan year for such managed care entity that be19 gins after the date of the enactment of this para20 graph or January 1, 2017, the State shall re21 quire that such contract include a provision that 

22 providers of services or persons terminated (as 

23 described in section 1902(kk)(8)) from participa24 tion under this title, title XVIII, or title XXI be 

25 terminated from participating under this title as 


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1 a provider in any network of such entity that 

2 serves individuals eligible to receive medical as3 sistance under this title. 

4 ‘‘(B) NOTIFICATION OF TERMINATION.—For 

5 the period beginning on January 1, 2017, and 

6 ending on the date on which the enrollment of 

7 providers under paragraph (6) is complete for a 

8 State, the State shall provide for a system for 

9 notifying managed care entities (as defined in 

10 subsection (a)(1)) of the termination (as de11 scribed in section 1902(kk)(8)) of providers of 

12 services or persons from participation under this 

13 title, title XVIII, or title XXI.’’. 

14 (3) TERMINATION NOTIFICATION DATABASE.— 

15 Section 1902 of the Social Security Act (42 U.S.C. 

16 1396a) is amended by adding at the end the following 

17 new subsection: 

18 ‘‘(ll) TERMINATION NOTIFICATION DATABASE.—In the 

19 case of a provider of services or any other person whose 

20 participation under this title, title XVIII, or title XXI is 

21 terminated (as described in subsection (kk)(8)), the Sec22 retary shall, not later than 21 business days after the date 

23 on which the Secretary terminates such participation under 

24 title XVIII or is notified of such termination under sub25 section (a)(41) (as applicable), review such termination 


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1 and, if the Secretary determines appropriate, include such 

2 termination in any database or similar system developed 

3 pursuant to section 6401(b)(2) of the Patient Protection 

4 and Affordable Care Act (42 U.S.C. 1395cc note; Public 

5 Law 111–148).’’. 

6 (4) NO FEDERAL FUNDS FOR ITEMS AND SERV7 ICES FURNISHED BY TERMINATED PROVIDERS.—Sec8 tion 1903 of the Social Security Act (42 U.S.C. 

9 1396b) is amended— 

10 (A) in subsection (i)(2)— 

11 (i) in subparagraph (A), by striking 

12 the comma at the end and inserting a semi13 colon; 

14 (ii) in subparagraph (B), by striking 

15 ‘‘or’’ at the end; and 

16 (iii) by adding at the end the following 

17 new subparagraph: 

18 ‘‘(D) beginning not later than January 1, 

19 2018, under the plan by any provider of services 

20 or person whose participation in the State plan 

21 is terminated (as described in section 

22 1902(kk)(8)) after the date that is 60 days after 

23 the date on which such termination is included 

24 in the database or other system under section 

25 1902(ll); or’’; and 


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1 (B) in subsection (m), by inserting after 

2 paragraph (2) the following new paragraph: 

3 ‘‘(3) No payment shall be made under this title to a 

4 State with respect to expenditures incurred by the State for 

5 payment for services provided by a managed care entity 

6 (as defined under section 1932(a)(1)) under the State plan 

7 under this title (or under a waiver of the plan) unless the 

8 State— 

9 ‘‘(A) beginning on the applicable date specified 

10 in subparagraph (A) of section 1932(d)(5), has a con11 tract with such entity that complies with the require12 ment specified in such subparagraph; and 

13 ‘‘(B)(i) for the period specified in subparagraph 

14 (B) of such section, has a system in effect that meets 

15 the requirement specified in such subparagraph; and 

16 ‘‘(ii) after such period, complies with section 

17 1932(d)(6).’’. 

18 (5) DEVELOPMENT OF UNIFORM TERMINOLOGY

19 FOR REASONS FOR PROVIDER TERMINATION.—Not 

20 later than January 1, 2017, the Secretary of Health 

21 and Human Services shall, in consultation with the 

22 heads of State agencies administering State Medicaid 

23 plans (or waivers of such plans), issue regulations es24 tablishing uniform terminology to be used with re25 spect to specifying reasons under subparagraph (A)(v) 


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1 of paragraph (8) of section 1902(kk) of the Social Se2 curity Act (42 U.S.C. 1396a(kk)), as amended by 

3 paragraph (1), for the termination (as described in 

4 such paragraph) of the participation of certain pro5 viders in the Medicaid program under title XIX of 

6 such Act or the Children’s Health Insurance Program 

7 under title XXI of such Act. 

8 (6) CONFORMING AMENDMENT.—Section 

9 1902(a)(41) of the Social Security Act (42 U.S.C. 

10 1396a(a)(41)) is amended by striking ‘‘provide that 

11 whenever’’ and inserting ‘‘provide, in accordance with 

12 subsection (kk)(8) (as applicable), that whenever’’. 

13 (b) INCREASING AVAILABILITY OF MEDICAID PRO14 VIDER INFORMATION.— 

15 (1) FFS PROVIDER ENROLLMENT.—Section 

16 1902(a) of the Social Security Act (42 U.S.C. 

17 1396a(a)) is amended by inserting after paragraph 

18 (77) the following new paragraph: 

19 ‘‘(78) provide that, not later than January 1, 

20 2017, in the case of a State plan that provides med21 ical assistance on a fee-for-service basis, the State 

22 shall require each provider furnishing items and serv23 ices to individuals eligible to receive medical assist24 ance under such plan to enroll with the State agency 

25 and provide to the State agency the provider’s identiVerDate Sep 11 2014 21:34 Feb 23, 2016 Jkt 059200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6203 E:\BILLS\H3716.RH H3716

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1 fying information, including the name, specialty, date 

2 of birth, Social Security number, national provider 

3 identifier, Federal taxpayer identification number, 

4 and the State license or certification number of the 

5 provider;’’. 

6 (2) MANAGED CARE PROVIDER ENROLLMENT.— 

7 Section 1932(d) of the Social Security Act (42 U.S.C. 

8 1396u–2(d)), as amended by subsection (a)(2), is 

9 amended by adding at the end the following new 

10 paragraph: 

11 ‘‘(6) ENROLLMENT OF PARTICIPATING PRO12 VIDERS.— 

13 ‘‘(A) IN GENERAL.—Beginning not later 

14 than January 1, 2018, a State shall require that, 

15 in order to participate as a provider in the net16 work of a managed care entity that provides 

17 services to, or orders, prescribes, refers, or cer18 tifies eligibility for services for, individuals who 

19 are eligible for medical assistance under the 

20 State plan under this title and who are enrolled 

21 with the entity, the provider is enrolled with the 

22 State agency administering the State plan under 

23 this title. Such enrollment shall include pro24 viding to the State agency the provider’s identi25 fying information, including the name, specialty, 


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1 date of birth, Social Security number, national 

2 provider identifier, Federal taxpayer identifica3 tion number, and the State license or certifi4 cation number of the provider. 

5 ‘‘(B) RULE OF CONSTRUCTION.—Nothing in 

6 subparagraph (A) shall be construed as requiring 

7 a provider described in such subparagraph to 

8 provide services to individuals who are not en9 rolled with a managed care entity under this 

10 title.’’. 

11 (c) COORDINATION WITH CHIP.— 

12 (1) IN GENERAL.—Section 2107(e)(1) of the So13 cial Security Act (42 U.S.C. 1397gg(e)(1)) is amend14 ed— 

15 (A) by redesignating subparagraphs (B), 

16 (C), (D), (E), (F), (G), (H), (I), (J), (K), (L), 

17 (M), (N), and (O) as subparagraphs (D), (E), 

18 (F), (G), (H), (I), (J), (K), (M), (N), (O), (P), 

19 (Q), and (R), respectively; 

20 (B) by inserting after subparagraph (A) the 

21 following new subparagraphs: 

22 ‘‘(B) Section 1902(a)(39) (relating to termi23 nation of participation of certain providers). 

24 ‘‘(C) Section 1902(a)(78) (relating to enroll25 ment of providers participating in State plans 


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1 providing medical assistance on a fee-for-service 

2 basis).’’; 

3 (C) by inserting after subparagraph (K) (as 

4 redesignated by paragraph (1)) the following 

5 new subparagraph: 

6 ‘‘(L) Section 1903(m)(3) (relating to limi7 tation on payment with respect to managed 

8 care).’’; and 

9 (D) in subparagraph (P) (as redesignated 

10 by paragraph (1)), by striking ‘‘(a)(2)(C) and 

11 (h)’’ and inserting ‘‘(a)(2)(C) (relating to Indian 

12 enrollment), (d)(5) (relating to reporting require13 ments for managed care entities), (d)(6) (relat14 ing to enrollment of providers participating with 

15 a managed care entity), and (h) (relating to spe16 cial rules with respect to Indian enrollees, In17 dian health care providers, and Indian managed 

18 care entities)’’. 

19 (2) EXCLUDING FROM MEDICAID PROVIDERS EX20 CLUDED FROM CHIP.—Section 1902(a)(39) of the So21 cial Security Act (42 U.S.C. 1396a(a)(39)) is amend22 ed by striking ‘‘title XVIII or any other State plan 

23 under this title’’ and inserting ‘‘title XVIII, any other 

24 State plan under this title, or any State child health 

25 plan under title XXI’’. 


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1 (d) RULE OF CONSTRUCTION.—Nothing in this section 

2 shall be construed as changing or limiting the appeal rights 

3 of providers or the process for appeals of States under the 

4 Social Security Act. 


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Union Calendar No. 326 

114TH CONGRESS 

2D SESSION H. R. 3716 

[Report No. 114–427] 

A BILL 

To amend title XIX of the Social Security Act to 

other purposes. with respect to provider terminations, and for Health and Human Services certain information require States to provide to the Secretary of 

FEBRUARY 23, 2016 

Reported with an amendment, committed to the Comand ordered to be printed mittee of the Whole House on the State of the Union, 


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