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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5165 Introduced in House (IH)]

<DOC>

118th CONGRESS
  1st Session
                                H. R. 5165

  To amend title XIX of the Social Security Act to allow States more 
   flexibility with respect to using contractors to make eligibility 
  determinations and redeterminations on behalf of the State Medicaid 
                     plan, and for other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             August 8, 2023

Mr. Carter of Georgia (for himself and Mr. Dunn of Florida) 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 allow States more 
   flexibility with respect to using contractors to make eligibility 
  determinations and redeterminations on behalf of the State Medicaid 
                     plan, and for other purposes.

    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 ``Medicaid Staffing Flexibility and 
Protection Act of 2023''.

SEC. 2. STATE FLEXIBILITY TO USE CONTRACTORS TO MAKE ELIGIBILITY 
              DETERMINATIONS AND REDETERMINATIONS ON BEHALF OF A STATE.

    (a) Requirements With Respect to Eligibility Determinations.--
Section 1902(a)(5) of the Social Security Act (42 U.S.C. 1396a(a)(5)) 
is amended by inserting before the semicolon at the end the following: 
``, but such determinations of eligibility may be made, at the option 
of a State, under a contract with another State or local agency or a 
contractor, so long as the contract does not provide incentives for the 
agency or contractor to delay eligibility determinations or to deny 
eligibility for individuals otherwise eligible for medical 
assistance''.
    (b) Requirements With Respect to Fair Hearings.--Section 1902(a)(3) 
of the Social Security Act (42 U.S.C. 1396a(a)(3)) is amended by 
inserting before the semicolon at the end the following: ``, except 
that such fair hearing may be conducted, at the option of a State, 
under a contract with another State or local agency or a contractor, so 
long as such agency or contractor does not provide incentives to delay 
a fair hearing or to deny eligibility for an individual otherwise 
eligible for medical assistance''.

SEC. 3. PROHIBITING CONFLICTS OF INTEREST.

    A State shall not use the flexibility provided under section 2 
unless a contractor selected to conduct eligibility determinations or 
redeterminations pursuant to the amendments made by such section has no 
direct or indirect financial relationship with any Medicaid managed 
care organization (as defined in section 1903(m)(1)(A) of the Social 
Security Act (42 U.S.C. 1396b(m)(1)(A))), including the network 
providers affiliated with such organization, that provides services to 
individuals entitled to medical assistance under title XIX of such Act 
(42 U.S.C. 1396 et seq.) pursuant to a contract with such State.
                                 <all>
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