114TH CONGRESS 

2D SESSION H. R. 5210 

AN ACT 

To improve access to durable medical equipment for Medicare 

beneficiaries under the Medicare program, and for other 

purposes. 

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

2 This Act may be cited as the ‘‘Patient Access to Du3 rable Medical Equipment Act of 2016’’ or the ‘‘PADME 

4 Act’’. 

5 SEC. 2. INCREASING OVERSIGHT OF TERMINATION OF 

6 MEDICAID PROVIDERS. 

7 (a) INCREASED OVERSIGHT AND REPORTING.— 

8 (1) STATE REPORTING REQUIREMENTS.—Sec9 tion 1902(kk) of the Social Security Act (42 U.S.C. 

10 1396a(kk)) is amended— 

11 (A) by redesignating paragraph (8) as 

12 paragraph (9); and 

13 (B) by inserting after paragraph (7) the 

14 following new paragraph: 

15 ‘‘(8) PROVIDER TERMINATIONS.— 

16 ‘‘(A) IN GENERAL.—Beginning on July 1, 

17 2018, in the case of a notification under sub18 section (a)(41) with respect to a termination for 

19 a reason specified in section 455.101 of title 42, 

20 Code of Federal Regulations (as in effect on 

21 November 1, 2015) or for any other reason 

22 specified by the Secretary, of the participation 

23 of a provider of services or any other person 

24 under the State plan (or under a waiver of the 

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

26 days after the effective date of such termi-
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1 nation, submits to the Secretary with respect to 

2 any such provider or person, as appropriate— 

3 ‘‘(i) the name of such provider or per4 son; 

5 ‘‘(ii) the provider type of such pro6 vider or person; 

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

8 or person’s practice; 

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

10 number, national provider identifier, Fed11 eral taxpayer identification number, and 

12 the State license or certification number of 

13 such provider or person; 

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

15 ‘‘(vi) a copy of the notice of termi16 nation sent to the provider or person; 

17 ‘‘(vii) the date on which such termi18 nation is effective, as specified in the no19 tice; and 

20 ‘‘(viii) any other information required 

21 by the Secretary. 

22 ‘‘(B) EFFECTIVE DATE DEFINED.—For 

23 purposes of this paragraph, the term ‘effective 

24 date’ means, with respect to a termination de25 scribed 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 no3 tice 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 

7 such appeal has expired.’’. 

8 (2) CONTRACT REQUIREMENT FOR MANAGED

9 CARE ENTITIES.—Section 1932(d) of the Social Se10 curity Act (42 U.S.C. 1396u–2(d)) is amended by 

11 adding at the end the following new paragraph: 

12 ‘‘(5) CONTRACT REQUIREMENT FOR MANAGED

13 CARE ENTITIES.—With respect to any contract with 

14 a managed care entity under section 1903(m) or 

15 1905(t)(3) (as applicable), no later than July 1, 

16 2018, such contract shall include a provision that 

17 providers of services or persons terminated (as de18 scribed in section 1902(kk)(8)) from participation 

19 under this title, title XVIII, or title XXI be termi20 nated from participating under this title as a pro21 vider in any network of such entity that serves indi22 viduals eligible to receive medical assistance under 

23 this title.’’. 

24 (3) TERMINATION NOTIFICATION DATABASE.— 

25 Section 1902 of the Social Security Act (42 U.S.C. 
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1 1396a) is amended by adding at the end the fol2 lowing new subsection: 

3 ‘‘(ll) TERMINATION NOTIFICATION DATABASE.—In 

4 the case of a provider of services or any other person 

5 whose participation under this title, title XVIII, or title 

6 XXI is terminated (as described in subsection (kk)(8)), 

7 the Secretary shall, not later than 21 business days after 

8 the date on which the Secretary terminates such participa9 tion under title XVIII or is notified of such termination 

10 under subsection (a)(41) (as applicable), review such ter11 mination and, if the Secretary determines appropriate, in12 clude such termination in any database or similar system 

13 developed pursuant to section 6401(b)(2) of the Patient 

14 Protection and Affordable Care Act (42 U.S.C. 1395cc 

15 note; Public Law 111–148).’’. 

16 (4) NO FEDERAL FUNDS FOR ITEMS AND SERV17 ICES FURNISHED BY TERMINATED PROVIDERS.— 

18 Section 1903 of the Social Security Act (42 U.S.C. 

19 1396b) is amended— 

20 (A) in subsection (i)(2)— 

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

22 the comma at the end and inserting a 

23 semicolon; 

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

25 ‘‘or’’ at the end; and 
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1 (iii) by adding at the end the fol2 lowing new subparagraph: 

3 ‘‘(D) beginning not later than July 1, 

4 2018, under the plan by any provider of serv5 ices or person whose participation in the State 

6 plan is terminated (as described in section 

7 1902(kk)(8)) after the date that is 60 days 

8 after the date on which such termination is in9 cluded in the database or other system under 

10 section 1902(ll); or’’; and 

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

12 paragraph (2) the following new paragraph: 

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

14 a State with respect to expenditures incurred by the State 

15 for payment for services provided by a managed care enti16 ty (as defined under section 1932(a)(1)) under the State 

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

18 the State— 

19 ‘‘(A) beginning on July 1, 2018, has a contract 

20 with such entity that complies with the requirement 

21 specified in section 1932(d)(5); and 

22 ‘‘(B) beginning on January 1, 2018, complies 

23 with the requirement specified in section 

24 1932(d)(6)(A).’’. 
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1 (5) DEVELOPMENT OF UNIFORM TERMINOLOGY

2 FOR REASONS FOR PROVIDER TERMINATION.—Not 

3 later than July 1, 2017, the Secretary of Health and 

4 Human Services shall, in consultation with the 

5 heads of State agencies administering State Med6 icaid plans (or waivers of such plans), issue regula7 tions establishing uniform terminology to be used 

8 with respect to specifying reasons under subpara9 graph (A)(v) of paragraph (8) of section 1902(kk) 

10 of the Social Security Act (42 U.S.C. 1396a(kk)), as 

11 amended by paragraph (1), for the termination (as 

12 described in such paragraph) of the participation of 

13 certain providers in the Medicaid program under 

14 title XIX of such Act or the Children’s Health In15 surance Program under title XXI of such Act. 

16 (6) CONFORMING AMENDMENT.—Section 

17 1902(a)(41) of the Social Security Act (42 U.S.C. 

18 1396a(a)(41)) is amended by striking ‘‘provide that 

19 whenever’’ and inserting ‘‘provide, in accordance 

20 with subsection (kk)(8) (as applicable), that when21 ever’’. 

22 (b) INCREASING AVAILABILITY OF MEDICAID PRO23 VIDER INFORMATION.— 

24 (1) FFS PROVIDER ENROLLMENT.—Section 

25 1902(a) of the Social Security Act (42 U.S.C. 
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1 1396a(a)) is amended by inserting after paragraph 

2 (77) the following new paragraph: 

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

4 2017, in the case of a State plan (or a waiver of the 

5 plan) that provides medical assistance on a fee-for6 service basis, the State shall require each provider 

7 furnishing items and services to individuals eligible 

8 to receive medical assistance under such plan to en9 roll with the State agency and provide to the State 

10 agency the provider’s identifying information, includ11 ing the name, specialty, date of birth, Social Secu12 rity number, national provider identifier, Federal 

13 taxpayer identification number, and the State license 

14 or certification number of the provider;’’. 

15 (2) MANAGED CARE PROVIDER ENROLLMENT.— 

16 Section 1932(d) of the Social Security Act (42 

17 U.S.C. 1396u–2(d)), as amended by subsection 

18 (a)(2), is amended by adding at the end the fol19 lowing new paragraph: 

20 ‘‘(6) ENROLLMENT OF PARTICIPATING PRO21 VIDERS.— 

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

23 than January 1, 2018, a State shall require 

24 that, in order to participate as a provider in the 

25 network of a managed care entity that provides 
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1 services to, or orders, prescribes, refers, or cer2 tifies eligibility for services for, individuals who 

3 are eligible for medical assistance under the 

4 State plan under this title (or under a waiver 

5 of the plan) and who are enrolled with the enti6 ty, the provider is enrolled with the State agen7 cy administering the State plan under this title 

8 (or waiver of the plan). Such enrollment shall 

9 include providing to the State agency the pro10 vider’s identifying information, including the 

11 name, specialty, date of birth, Social Security 

12 number, national provider identifier, Federal 

13 taxpayer identification number, and the State 

14 license or certification number of the provider. 

15 ‘‘(B) RULE OF CONSTRUCTION.—Nothing 

16 in subparagraph (A) shall be construed as re17 quiring a provider described in such subpara18 graph to provide services to individuals who are 

19 not enrolled with a managed care entity under 

20 this title.’’. 

21 (c) COORDINATION WITH CHIP.— 

22 (1) IN GENERAL.—Section 2107(e)(1) of the 

23 Social Security Act (42 U.S.C. 1397gg(e)(1)) is 

24 amended— 
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1 (A) by redesignating subparagraphs (B), 

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

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

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

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

6 (B) by inserting after subparagraph (A) 

7 the following new subparagraphs: 

8 ‘‘(B) Section 1902(a)(39) (relating to ter9 mination of participation of certain providers). 

10 ‘‘(C) Section 1902(a)(78) (relating to en11 rollment of providers participating in State 

12 plans providing medical assistance on a fee-for13 service basis).’’; 

14 (C) by inserting after subparagraph (K) 

15 (as redesignated by subparagraph (A)) the fol16 lowing new subparagraph: 

17 ‘‘(L) Section 1903(m)(3) (relating to limi18 tation on payment with respect to managed 

19 care).’’; and 

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

21 by subparagraph (A)), by striking ‘‘(a)(2)(C) 

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

23 Indian enrollment), (d)(5) (relating to contract 

24 requirement for managed care entities), (d)(6) 

25 (relating to enrollment of providers partici-
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1 pating with a managed care entity), and (h) 

2 (relating to special rules with respect to Indian 

3 enrollees, Indian health care providers, and In4 dian managed care entities)’’. 

5 (2) EXCLUDING FROM MEDICAID PROVIDERS

6 EXCLUDED FROM CHIP.—Section 1902(a)(39) of the 

7 Social Security Act (42 U.S.C. 1396a(a)(39)) is 

8 amended by striking ‘‘title XVIII or any other State 

9 plan under this title’’ and inserting ‘‘title XVIII, any 

10 other State plan under this title (or waiver of the 

11 plan), or any State child health plan under title XXI 

12 (or waiver of the plan)’’. 

13 (d) RULE OF CONSTRUCTION.—Nothing in this sec14 tion shall be construed as changing or limiting the appeal 

15 rights of providers or the process for appeals of States 

16 under the Social Security Act. 

17 (e) OIG REPORT.—Not later than March 31, 2020, 

18 the Inspector General of the Department of Health and 

19 Human Services shall submit to Congress a report on the 

20 implementation of the amendments made by this section. 

21 Such report shall include the following: 

22 (1) An assessment of the extent to which pro23 viders who are included under subsection (ll) of sec24 tion 1902 of the Social Security Act (42 U.S.C. 

25 1396a) (as added by subsection (a)(3)) in the data-
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1 base or similar system referred to in such subsection 

2 are terminated (as described in subsection (kk)(8) of 

3 such section, as added by subsection (a)(1)) from 

4 participation in all State plans under title XIX of 

5 such Act (or waivers of such plans). 

6 (2) Information on the amount of Federal fi7 nancial participation paid to States under section 

8 1903 of such Act in violation of the limitation on 

9 such payment specified in subsections (i)(2)(D) and 

10 (m)(3) of such section, as added by subsection (a)(4) 

11 of this section. 

12 (3) An assessment of the extent to which con13 tracts with managed care entities under title XIX of 

14 such Act comply with the requirement specified in 

15 section 1932(d)(5) of such Act, as added by sub16 section (a)(2) of this section. 

17 (4) An assessment of the extent to which pro18 viders have been enrolled under section 1902(a)(78) 

19 or 1932(d)(6)(A) of such Act (42 U.S.C. 

20 1396a(a)(78), 1396u–2(d)(6)(A)) with State agen21 cies administering State plans under title XIX of 

22 such Act (or waivers of such plans). 
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1 SEC. 3. REQUIRING PUBLICATION OF FEE-FOR-SERVICE 

2 PROVIDER DIRECTORY. 

3 (a) IN GENERAL.—Section 1902(a) of the Social Se4 curity Act (42 U.S.C. 1396a(a)) is amended— 

5 (1) in paragraph (80), by striking ‘‘and’’ at the 

6 end; 

7 (2) in paragraph (81), by striking the period at 

8 the end and inserting ‘‘; and’’; and 

9 (3) by inserting after paragraph (81) the fol10 lowing new paragraph: 

11 ‘‘(82) provide that, not later than January 1, 

12 2017, in the case of a State plan (or waiver of the 

13 plan) that provides medical assistance on a fee-for14 service basis or through a primary care case-man15 agement system described in section 1915(b)(1) 

16 (other than a primary care case management entity 

17 (as defined by the Secretary)), the State shall pub18 lish (and update on at least an annual basis) on the 

19 public Website of the State agency administering the 

20 State plan, a directory of the physicians described in 

21 subsection (mm) and, at State option, other pro22 viders described in such subsection that— 

23 ‘‘(A) includes— 

24 ‘‘(i) with respect to each such physi25 cian or provider— 
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1 ‘‘(I) the name of the physician or 

2 provider; 

3 ‘‘(II) the specialty of the physi4 cian or provider; 

5 ‘‘(III) the address at which the 

6 physician or provider provides serv7 ices; and 

8 ‘‘(IV) the telephone number of 

9 the physician or provider; and 

10 ‘‘(ii) with respect to any such physi11 cian or provider participating in such a 

12 primary care case-management system, in13 formation regarding— 

14 ‘‘(I) whether the physician or 

15 provider is accepting as new patients 

16 individuals who receive medical assist17 ance under this title; and 

18 ‘‘(II) the physician’s or provider’s 

19 cultural and linguistic capabilities, in20 cluding the languages spoken by the 

21 physician or provider or by the skilled 

22 medical interpreter providing interpre23 tation services at the physician’s or 

24 provider’s office; and 
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1 ‘‘(B) may include, at State option, with re2 spect to each such physician or provider— 

3 ‘‘(i) the Internet website of such phy4 sician or provider; or 

5 ‘‘(ii) whether the physician or provider 

6 is accepting as new patients individuals 

7 who receive medical assistance under this 

8 title.’’. 

9 (b) DIRECTORY PHYSICIAN OR PROVIDER DE10 SCRIBED.—Section 1902 of the Social Security Act (42 

11 U.S.C. 1396a), as amended by section 2(a)(3), is further 

12 amended by adding at the end the following new sub13 section: 

14 ‘‘(mm) DIRECTORY PHYSICIAN OR PROVIDER DE15 SCRIBED.—A physician or provider described in this sub16 section is— 

17 ‘‘(1) in the case of a physician or provider of 

18 a provider type for which the State agency, as a con19 dition on receiving payment for items and services 

20 furnished by the physician or provider to individuals 

21 eligible to receive medical assistance under the State 

22 plan, requires the enrollment of the physician or pro23 vider with the State agency, a physician or a pro24 vider that— 
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1 ‘‘(A) is enrolled with the agency as of the 

2 date on which the directory is published or up3 dated (as applicable) under subsection (a)(82); 

4 and 

5 ‘‘(B) received payment under the State 

6 plan in the 12-month period preceding such 

7 date; and 

8 ‘‘(2) in the case of a physician or provider of 

9 a provider type for which the State agency does not 

10 require such enrollment, a physician or provider that 

11 received payment under the State plan (or waiver of 

12 the plan) in the 12-month period preceding the date 

13 on which the directory is published or updated (as 

14 applicable) under subsection (a)(82).’’. 

15 (c) RULE OF CONSTRUCTION.— 

16 (1) IN GENERAL.—The amendment made by 

17 subsection (a) shall not be construed to apply in the 

18 case of a State (as defined for purposes of title XIX 

19 of the Social Security Act) in which all the individ20 uals enrolled in the State plan under such title (or 

21 under a waiver of such plan), other than individuals 

22 described in paragraph (2), are enrolled with a med23 icaid managed care organization (as defined in sec24 tion 1903(m)(1)(A) of such Act (42 U.S.C. 

25 1396b(m)(1)(A))), including prepaid inpatient health 
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1 plans and prepaid ambulatory health plans (as de2 fined by the Secretary of Health and Human Serv3 ices). 

4 (2) INDIVIDUALS DESCRIBED.—An individual 

5 described in this paragraph is an individual who is 

6 an Indian (as defined in section 4 of the Indian 

7 Health Care Improvement Act (25 U.S.C. 1603)) or 

8 an Alaska Native. 

9 (d) EXCEPTION FOR STATE LEGISLATION.—In the 

10 case of a State plan under title XIX of the Social Security 

11 Act (42 U.S.C. 1396 et seq.), which the Secretary of 

12 Health and Human Services determines requires State 

13 legislation in order for the respective plan to meet one or 

14 more additional requirements imposed by amendments 

15 made by this section, the respective plan shall not be re16 garded as failing to comply with the requirements of such 

17 title solely on the basis of its failure to meet such an addi18 tional requirement before the first day of the first calendar 

19 quarter beginning after the close of the first regular ses20 sion of the State legislature that begins after the date of 

21 enactment of this Act. For purposes of the previous sen22 tence, in the case of a State that has a 2-year legislative 

23 session, each year of the session shall be considered to be 

24 a separate regular session of the State legislature. 
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1 SEC. 4. EXTENSION OF THE TRANSITION TO NEW PAYMENT 

2 RATES FOR DURABLE MEDICAL EQUIPMENT 

3 UNDER THE MEDICARE PROGRAM. 

4 (a) IN GENERAL.—The Secretary of Health and 

5 Human Services shall extend the transition period de6 scribed in clause (i) of section 414.210(g)(9) of title 42, 

7 Code of Federal Regulations, from June 30, 2016, to Sep8 tember 30, 2016 (with the full implementation described 

9 in clause (ii) of such section applying to items and services 

10 furnished with dates of service on or after October 1, 

11 2016). 

12 (b) STUDY AND REPORT.— 

13 (1) STUDY.— 

14 (A) IN GENERAL.—The Secretary of 

15 Health and Human Services shall conduct a 

16 study that examines the impact of applicable 

17 payment adjustments upon— 

18 (i) the number of suppliers of durable 

19 medical equipment that, on a date that is 

20 not before January 1, 2016, and not later 

21 than September 1, 2016, ceased to conduct 

22 business as such suppliers; and 

23 (ii) the availability of durable medical 

24 equipment, during the period beginning on 

25 January 1, 2016, and ending on Sep26 tember 1, 2016, to individuals entitled to 
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1 benefits under part A of title XVIII of the 

2 Social Security Act (42 U.S.C. 1395 et 

3 seq.) or enrolled under part B of such title. 

4 (B) DEFINITIONS.—For purposes of this 

5 subsection, the following definitions apply: 

6 (i) SUPPLIER; DURABLE MEDICAL

7 EQUIPMENT.—The terms ‘‘supplier’’ and 

8 ‘‘durable medical equipment’’ have the 

9 meanings given such terms by section 1861 

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

11 1395x). 

12 (ii) APPLICABLE PAYMENT ADJUST13 MENT.—The term ‘‘applicable payment ad14 justment’’ means a payment adjustment 

15 described in section 414.210(g) of title 42, 

16 Code of Federal Regulations, that is 

17 phased in by paragraph (9)(i) of such sec18 tion. For purposes of the preceding sen19 tence, a payment adjustment that is 

20 phased in pursuant to the extension under 

21 subsection (a) shall be considered a pay22 ment adjustment that is phased in by such 

23 paragraph (9)(i). 

24 (2) REPORT.—The Secretary of Health and 

25 Human Services shall, not later than September 10, 
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1 2016, submit to the Committees on Ways and 

2 Means and on Energy and Commerce of the House 

3 of Representatives, and to the Committee on Fi4 nance of the Senate, a report on the findings of the 

5 study conducted under paragraph (1). 

6 SEC. 5. EXCLUSION OF PAYMENTS FROM STATE EUGENICS 

7 COMPENSATION PROGRAMS FROM CONSID8 ERATION IN DETERMINING ELIGIBILITY FOR, 

9 OR THE AMOUNT OF, FEDERAL PUBLIC BENE10 FITS. 

11 (a) IN GENERAL.—Notwithstanding any other provi12 sion of law, payments made under a State eugenics com13 pensation program shall not be considered as income or 

14 resources in determining eligibility for, or the amount of, 

15 any Federal public benefit. 

16 (b) DEFINITIONS.—For purposes of this section: 

17 (1) FEDERAL PUBLIC BENEFIT.—The term 

18 ‘‘Federal public benefit’’ means— 

19 (A) any grant, contract, loan, professional 

20 license, or commercial license provided by an 

21 agency of the United States or by appropriated 

22 funds of the United States; and 

23 (B) any retirement, welfare, health, dis24 ability, public or assisted housing, postsec25 ondary education, food assistance, unemploy-
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1 ment benefit, or any other similar benefit for 

2 which payments or assistance are provided to 

3 an individual, household, or family eligibility 

4 unit by an agency of the United States or by 

5 appropriated funds of the United States. 

6 (2) STATE EUGENICS COMPENSATION PRO7 GRAM.—The term ‘‘State eugenics compensation 

8 program’’ means a program established by State law 

9 that is intended to compensate individuals who were 

10 sterilized under the authority of the State. 

11 SEC. 6. DEPOSIT OF SAVINGS INTO MEDICARE IMPROVE12 MENT FUND. 

13 Section 1898(b)(1) of the Social Security Act (42 

14 U.S.C. 1395iii(b)(1)) is amended by striking ‘‘$0’’ and in15 serting ‘‘$3,000,000’’. 

Passed the House of Representatives July 5, 2016. 

Attest: 

Clerk. 
114TH CONGRESS 

2D SESSION H. R. 5210 

AN ACT 

To improve access to durable medical equipment for 

gram, and for other purposes. Medicare beneficiaries under the Medicare pro-