I 

115TH CONGRESS 

1ST SESSION H. R. 1395 

To amend title XIX of the Social Security Act to improve the Medicaid 

and CHIP Payment and Access Commission (MACPAC). 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 7, 2017 

Mr. BURGESS (for himself, Mr. COLLINS of New York, Mrs. BLACKBURN, and 

Mr. MULLIN) introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

A BILL 

To amend title XIX of the Social Security Act to improve 

the Medicaid and CHIP Payment and Access Commission (MACPAC). 

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 ‘‘MACPAC Improve5 ment Act of 2017’’. 

6 SEC. 2. IMPROVEMENT OF MACPAC. 

7 (a) DUTIES.—Section 1900(b) of the Social Security 

8 Act (42 U.S.C. 1396(b)) is amended— 

9 (1) in paragraph (1)— 


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1 (A) in the heading, by inserting ‘‘, PAY2 MENT, FINANCING, AND PROGRAM INTEGRITY’’ 

3 after ‘‘ACCESS’’; 

4 (B) in subparagraph (A), by inserting ‘‘, 

5 payment, financing, or program integrity’’ after 

6 ‘‘affecting access to covered items and serv7 ices’’; 

8 (C) in subparagraph (B), by striking ‘‘ac9 cess’’; 

10 (D) in subparagraph (C), by striking ‘‘such 

11 policies’’ and inserting the following: ‘‘policies 

12 of such programs relating to financing and pro13 gram integrity, including— 

14 ‘‘(i) the implications of such policies 

15 with respect to changes in health care de16 livery in the United States; and 

17 ‘‘(ii) with respect to the market for 

18 health care items and services, the impact 

19 of such policies on the cost and spending 

20 growth under such programs;’’; and 

21 (E) in subparagraph (D), by striking ‘‘con22 taining’’ and all that follows through the period 

23 and inserting the following: ‘‘containing the re24 sults of such reviews and MACPAC’s rec25 ommendations concerning the policies of such 


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1 programs relating to access and payment, in2 cluding— 

3 ‘‘(i) the implications of such policies 

4 with respect to changes in health care de5 livery in the United States; and 

6 ‘‘(ii) with respect to the market for 

7 health care items and services, the impact 

8 of such policies on access and payment 

9 under such programs.’’; 

10 (2) in paragraph (2)— 

11 (A) in subparagraph (A)— 

12 (i) in clause (ii), by striking ‘‘and’’ at 

13 the end; 

14 (ii) in clause (iii), by striking the pe15 riod at the end and inserting ‘‘; and’’; and 

16 (iii) by adding at the end the fol17 lowing new clause: 

18 ‘‘(iv) such payment policies that may 

19 result in total payments (taking into ac20 count additional or supplemental payments 

21 or payment adjustments) under this title 

22 or title XXI that exceed the cost of pro23 viding items and services to Medicaid or 

24 CHIP beneficiaries (as applicable) and 

25 changes in such payment policies that 


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1 could improve efficiency without negatively 

2 impacting access to care for such bene3 ficiaries.’’; and 

4 (B) by adding at the end the following new 

5 subparagraph: 

6 ‘‘(I) DATA.—National and State-specific 

7 Medicaid and CHIP data.’’; 

8 (3) by amending paragraph (3) to read as fol9 lows: 

10 ‘‘(3) ANNUAL POLICY RECOMMENDATIONS.— 

11 Not less frequently than once a year, MACPAC shall 

12 make recommendations regarding Federal statutes 

13 that could be enacted or policies which the Secretary 

14 or States could implement to achieve, with respect to 

15 Medicaid and CHIP, the following goals: 

16 ‘‘(A) FEDERAL AND STATE OUTLAYS.—Re17 ducing Federal and State outlays to make such 

18 programs more sustainable. 

19 ‘‘(B) FINANCING.—Improving the trans20 parency, integrity, and sustainability of financ21 ing. 

22 ‘‘(C) STATE FLEXIBILITY AND EFFI23 CIENCY.—Improving State flexibility, predict24 ability, accountability, integrity, and efficiency 

25 in oversight and administration. 


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1 ‘‘(D) PROGRAM INTEGRITY AND REDUCE

2 WASTE, FRAUD, AND ABUSE.—Enhancing pro3 gram integrity, reducing the amount and rate 

4 of improper payments, improving internal ad5 ministrative and financial controls, and enhanc6 ing efforts to curb waste, fraud, and abuse. 

7 ‘‘(E) PRIORITIZING THE MOST VULNER8 ABLE.—Prioritizing benefits, care, and services 

9 for the most vulnerable, low-income Medicaid 

10 and CHIP beneficiaries, such as children and 

11 pregnant women whose family income is at or 

12 below the Federal poverty line, the elderly, and 

13 individuals with disabilities. 

14 ‘‘(F) EMPOWERING BENEFICIARIES.—Im15 proving the independence, self-direction, self16 sufficiency, and empowerment of beneficiaries.’’; 

17 (4) in paragraph (4)— 

18 (A) in the heading, by striking ‘‘SYSTEM’’ 

19 and inserting ‘‘SYSTEMS’’; 

20 (B) by striking ‘‘MACPAC shall create’’ 

21 and inserting the following: 

22 ‘‘(A) SYSTEM RELATED TO ACCESS.— 

23 MACPAC shall create’’; and 

24 (C) by adding at the end the following new 

25 subparagraph: 


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1 ‘‘(B) SYSTEM RELATED TO PROGRAM

2 GROWTH.—MACPAC shall create an early3 warning system to identify challenges with sus4 taining Federal and State funding for Medicaid 

5 during the mid-term and long-term. MACPAC 

6 shall include in the annual report required 

7 under paragraph (1)(C) a description of such 

8 challenges, including challenges posed by budg9 etary pressures which could lead to increased 

10 Federal or State deficits, crowd out discre11 tionary Federal or State spending, or neces12 sitate increases in revenues, and proposed rec13 ommendations for addressing such challenges.’’; 

14 (5) in paragraph (5)— 

15 (A) in the heading, by striking ‘‘AND REG16 ULATIONS’’ and inserting ‘‘, REGULATIONS, AND

17 GUIDANCE’’; 

18 (B) in subparagraph (B), by inserting ‘‘fi19 nancing,’’ after ‘‘quality,’’; and 

20 (C) by adding at the end the following new 

21 subparagraph: 

22 ‘‘(C) CMS GUIDANCE.—MACPAC shall re23 view guidance issued to States by the Centers 

24 for Medicare & Medicaid Services with respect 

25 to Medicaid or CHIP and shall, not later than 


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1 the date that is 90 days after the date of such 

2 issuance, submit a report to the appropriate 

3 committees of Congress and the Secretary on 

4 the degree to which such guidance is projected 

5 to change Federal or State outlays for Medicaid 

6 or CHIP.’’; 

7 (6) in paragraph (7)— 

8 (A) in the heading by inserting ‘‘AND

9 WORKING DOCUMENTS’’ after ‘‘REPORTS’’; 

10 (B) by striking ‘‘MACPAC shall transmit’’ 

11 and inserting the following: 

12 ‘‘(A) REPORTS.—MACPAC shall submit’’; 

13 and 

14 (C) by adding at the end the following new 

15 subparagraph: 

16 ‘‘(B) WORKING DOCUMENTS.—MACPAC 

17 shall make available to the appropriate commit18 tees of Congress copies of draft report chapters, 

19 white papers, and other materials distributed 

20 among members of MACPAC.’’; 

21 (7) in paragraph (8), by striking ‘‘of the House 

22 of Representatives and the Committee on Finance of 

23 the Senate’’ and inserting ‘‘, the Committee on Ap24 propriations, and the Committee on Oversight and 

25 Government Reform of the House of Representatives 


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1 and the Committee on Finance, the Committee on 

2 Homeland Security and Governmental Affairs, and 

3 the Committee on Appropriations of the Senate’’; 

4 (8) in paragraph (10), by adding at the end the 

5 following: ‘‘For each recommendation that MACPAC 

6 determines would increase Federal or State outlays 

7 for Medicaid or CHIP, MACPAC shall make a rec8 ommendation regarding changes in Federal or State 

9 policy to offset such increased outlays.’’; and 

10 (9) by adding at the end the following new 

11 paragraph: 

12 ‘‘(15) ANNUAL REPORT.—Not later than three 

13 months after the end of a fiscal year, MACPAC 

14 shall prepare and make available on the MACPAC 

15 website a report with respect to such fiscal year on 

16 its activities that includes— 

17 ‘‘(A) information related to MACPAC’s ex18 penses, contracts, accomplishments, and activi19 ties for such fiscal year; and 

20 ‘‘(B) the status of MACPAC’s rec21 ommendations, including updates on Federal 

22 statutes that have been enacted or policies 

23 which the Secretary or States have implemented 

24 to effect such recommendations.’’. 


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1 (b) MEMBERSHIP.—Section 1900(c) of the Social Se2 curity Act (42 U.S.C. 1396(c)) is amended— 

3 (1) by amending paragraph (2) to read as fol4 lows: 

5 ‘‘(2) QUALIFICATIONS.— 

6 ‘‘(A) IN GENERAL.—The membership of 

7 MACPAC shall include the following: 

8 ‘‘(i) At least three individuals rep9 resenting health care providers, such as 

10 physicians, nurses, or dentists. 

11 ‘‘(ii) At least two individuals rep12 resenting health plans that enroll Medicaid 

13 or CHIP beneficiaries, including one or 

14 more individuals representing a Medicaid 

15 managed care plan. 

16 ‘‘(iii) At least one individual who is an 

17 actuary with expertise in health care. 

18 ‘‘(iv) At least two individuals who are 

19 or have been directors of Medicaid for a 

20 State, including at least one individual who 

21 is such a director at the time of appoint22 ment to MACPAC. 

23 ‘‘(v) At least one individual who is or 

24 has been a director of CHIP for a State. 


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1 ‘‘(vi) At least one individual with ex2 pertise in health care finance and health 

3 economics. 

4 ‘‘(vii) At least two individuals who are 

5 representatives of Medicaid and CHIP 

6 beneficiaries, such as children, pregnant 

7 women, the elderly, and individuals with 

8 disabilities. 

9 ‘‘(viii) At least one individual with ex10 pertise in long-term services and supports, 

11 such as in the financing or delivery of 

12 long-term services and supports or man13 aged long-term care services, including 

14 care delivered in nursing homes or home 

15 and community-based settings. 

16 ‘‘(B) INCLUSION.—The membership of 

17 MACPAC shall include individuals with exper18 tise in— 

19 ‘‘(i) Federal safety net health pro20 grams; 

21 ‘‘(ii) developing, negotiating, or imple22 menting a Medicaid waiver based on expe23 rience working for a State; 

24 ‘‘(iii) health care payment and financ25 ing reforms; 


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1 ‘‘(iv) integrated health care delivery 

2 systems, coordinated care models, and 

3 value-based contracting; 

4 ‘‘(v) public health; 

5 ‘‘(vi) program integrity and fraud pre6 vention; 

7 ‘‘(vii) health information technology 

8 and telehealth; 

9 ‘‘(viii) prescription drug pricing or 

10 payment; and 

11 ‘‘(ix) operating a Medicaid program, 

12 health plan, hospital, or health care deliv13 ery system. 

14 ‘‘(C) DIVERSITY.—The membership of 

15 MACPAC shall also provide representation from 

16 a variety of different professions and geo17 graphic areas and provide for a balanced rep18 resentation among urban, suburban, and rural 

19 areas. 

20 ‘‘(D) BALANCE OF PERSPECTIVES.—The 

21 Comptroller General of the United States shall 

22 ensure members appointed for initial or subse23 quent terms to MACPAC reflect an appropriate 

24 balance of political perspectives, including by 

25 taking into account political party registration 


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1 and contributions made to political candidates 

2 and parties. 

3 ‘‘(E) MAJORITY NONPROVIDERS.— 

4 ‘‘(i) IN GENERAL.—Individuals who 

5 are directly involved in the provision, or 

6 management of the delivery, of items and 

7 services covered under Medicaid or CHIP 

8 shall not constitute a majority of the mem9 bership of MACPAC. 

10 ‘‘(ii) MEDICAID AND CHIP DIREC11 TORS.—For purposes of this subpara12 graph, Medicaid and CHIP directors shall 

13 not be considered to be directly involved in 

14 the provision, or management of the deliv15 ery, of items and services covered under 

16 Medicaid or CHIP. 

17 ‘‘(F) ETHICAL DISCLOSURE.— 

18 ‘‘(i) IN GENERAL.—The Comptroller 

19 General of the United States shall estab20 lish a system for the public disclosure of fi21 nancial, professional, political, advocacy, or 

22 other activities of members of MACPAC 

23 that may result in, or be perceived to re24 sult in, conflicts of interest relating to such 

25 members’ service on MACPAC. 


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1 ‘‘(ii) TIMING OF DISCLOSURES.—The 

2 Comptroller General shall require that 

3 each member of MACPAC make— 

4 ‘‘(I) the disclosure described in 

5 clause (i) on an annual basis; and 

6 ‘‘(II) in the case of a significant 

7 change in any of the activities of the 

8 member described in such clause, a 

9 supplemental disclosure at the time of 

10 such significant change. 

11 ‘‘(iii) TREATMENT AS EMPLOYEES OF

12 CONGRESS.—Members of MACPAC shall 

13 be treated as employees of Congress for 

14 purposes of applying title I of the Ethics 

15 in Government Act of 1978 (Public Law 

16 95–521).’’; and 

17 (2) in paragraph (5), by adding at the end the 

18 following: ‘‘Such designation shall be based on pre19 vious management experience. The Comptroller Gen20 eral may not exclude a member from consideration 

21 for such designation based on the fact that such 

22 member is an individual employed by a State or by 

23 an entity that receives Medicaid or CHIP payments, 

24 including a local government, a health plan that enVerDate Sep 11 2014 03:32 Mar 11, 2017 Jkt 069200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H1395.IH H1395

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1 rolls Medicaid or CHIP beneficiaries, or a health 

2 care provider.’’. 

3 (c) CONFLICTS OF INTEREST.—Section 1900 of the 

4 Social Security Act (42 U.S.C. 1396) is amended by add5 ing at the end the following new subsection: 

6 ‘‘(g) CONFLICT OF INTEREST POLICY.—MACPAC 

7 shall maintain and make available on the MACPAC 

8 website a conflict of interest policy outlining requirements 

9 for members and personnel of MACPAC. Such policy shall 

10 include the following: 

11 ‘‘(1) DISCLOSURE.—Requirements for initially 

12 disclosing, and periodically updating, any substantial 

13 political activity or significant financial interests 

14 that might influence, or that might reasonably ap15 pear to influence, perspectives on issues that could 

16 come before MACPAC. 

17 ‘‘(2) LEGAL INVOLVEMENT.—With respect to 

18 any matter under adjudication before a court, ad19 ministrative law judge, or other judicial entities: 

20 ‘‘(A) A requirement of disclosure of any di21 rect or indirect involvement in any such matter 

22 related to a Federal or State health care pro23 gram (as such terms are defined in sections 

24 1128(h) and 1128B(f), respectively), including 

25 filing an amicus brief. 


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1 ‘‘(B) A prohibition on direct or indirect in2 volvement in any such matter that involves the 

3 Congress as a party, including filing an amicus 

4 brief. 

5 ‘‘(3) RECUSAL.—The criteria and circum6 stances under which a member of MACPAC shall 

7 suspend participation in MACPAC or otherwise seek 

8 recusal from MACPAC votes, including the process 

9 by which MACPAC discloses recommendations for 

10 such a recusal.’’. 

11 (d) APPLICATION.— 

12 (1) DUTIES.—The amendments made by sub13 section (a) (other than the amendments made by 

14 paragraph (5) of such subsection) shall apply with 

15 respect to reports (and recommendations included in 

16 reports) submitted on or after the date that is more 

17 than one year after the date of the enactment of this 

18 Act. 

19 (2) GUIDANCE.—The amendments made by 

20 subsection (a)(5) shall apply with respect to guid21 ance issued on or after the date of the enactment of 

22 this Act. 

23 (3) MEMBERSHIP.— 

24 (A) APPOINTMENT OF NEW MEMBERS.— 

25 The Comptroller General of the United States 


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1 shall apply the changes to the membership of 

2 the Medicaid and CHIP Payment and Access 

3 Commission required by amendments made by 

4 subsection (b) as soon as is practicable, con5 sistent with subparagraph (B), and in no event 

6 later than the date that is three years after the 

7 date of the enactment of this Act. 

8 (B) RETENTION OF CURRENT MEMBERS.— 

9 An individual who is a member of the Medicaid 

10 and CHIP Payment and Access Commission as 

11 of the date of the enactment of this Act may 

12 continue to serve until the end of the individ13 ual’s term as of such date without regard to the 

14 amendments made by subsection (b). 

15 (4) CONFLICTS OF INTEREST.—The amend16 ment made by subsection (c) shall apply beginning 

17 on the date that is 90 days after the date of the en18 actment of this Act. 

Æ 


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