IIB 
114TH CONGRESS 
2D SESSION 
H. R. 5210 
IN THE SENATE OF THE UNITED STATES 
JULY 6, 2016 
Received; read twice and referred to the Committee on Finance 
AN ACT 
To improve access to durable medical equipment for Medicare 
beneficiaries under the Medicare program, and for other 
purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Patient Access to Du-
rable Medical Equipment Act of 2016’’ or the ‘‘PADME 
Act’’. 
SEC. 2. INCREASING OVERSIGHT OF TERMINATION OF 
MEDICAID PROVIDERS. 
(a) INCREASED OVERSIGHT AND REPORTING.— 
(1) STATE REPORTING REQUIREMENTS.—Sec-
tion 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 sub-
section (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 (or under a waiver of the 
plan), the State, not later than 21 business 
days after the effective date of such termi-
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nation, submits to the Secretary with respect to 
any such provider or person, as appropriate— 
‘‘(i) the name of such provider or per-
son; 
‘‘(ii) the provider type of such pro-
vider or person; 
‘‘(iii) the specialty of such provider’s 
or person’s practice; 
‘‘(iv) the date of birth, Social Security 
number, national provider identifier, Fed-
eral 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 termi-
nation sent to the provider or person; 
‘‘(vii) the date on which such termi-
nation is effective, as specified in the no-
tice; 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 de-
scribed in subparagraph (A), the later of— 
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‘‘(i) the date on which such termi-
nation is effective, as specified in the no-
tice 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.’’. 
(2) CONTRACT
REQUIREMENT
FOR
MANAGED 
CARE ENTITIES.—Section 1932(d) of the Social Se-
curity 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 de-
scribed in section 1902(kk)(8)) from participation 
under this title, title XVIII, or title XXI be termi-
nated from participating under this title as a pro-
vider in any network of such entity that serves indi-
viduals eligible to receive medical assistance under 
this title.’’. 
(3) TERMINATION NOTIFICATION DATABASE.— 
Section 1902 of the Social Security Act (42 U.S.C. 
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1396a) is amended by adding at the end the fol-
lowing 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 participa-
tion under title XVIII or is notified of such termination 
under subsection (a)(41) (as applicable), review such ter-
mination and, if the Secretary determines appropriate, in-
clude 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; Public Law 111–148).’’. 
(4) NO FEDERAL FUNDS FOR ITEMS AND SERV-
ICES
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 
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(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(D) beginning not later than July 1, 
2018, under the plan by any provider of serv-
ices 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 in-
cluded 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 enti-
ty (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).’’. 
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(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 Med-
icaid plans (or waivers of such plans), issue regula-
tions establishing uniform terminology to be used 
with respect to specifying reasons under subpara-
graph (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 In-
surance 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 when-
ever’’. 
(b) INCREASING AVAILABILITY OF MEDICAID PRO-
VIDER INFORMATION.— 
(1) FFS 
PROVIDER
ENROLLMENT.—Section 
1902(a) of the Social Security Act (42 U.S.C. 
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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 (or a waiver of the 
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 en-
roll with the State agency and provide to the State 
agency the provider’s identifying information, includ-
ing the name, specialty, date of birth, Social Secu-
rity 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 fol-
lowing new paragraph: 
‘‘(6) ENROLLMENT
OF
PARTICIPATING
PRO-
VIDERS.— 
‘‘(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 
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services to, or orders, prescribes, refers, or cer-
tifies eligibility for services for, individuals who 
are eligible for medical assistance under the 
State plan under this title (or under a waiver 
of the plan) and who are enrolled with the enti-
ty, the provider is enrolled with the State agen-
cy administering the State plan under this title 
(or waiver of the plan). Such enrollment shall 
include providing to the State agency the pro-
vider’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 re-
quiring a provider described in such subpara-
graph 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— 
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(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 ter-
mination of participation of certain providers). 
‘‘(C) Section 1902(a)(78) (relating to en-
rollment 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 fol-
lowing new subparagraph: 
‘‘(L) Section 1903(m)(3) (relating to limi-
tation 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 partici-
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pating with a managed care entity), and (h) 
(relating to special rules with respect to Indian 
enrollees, Indian health care providers, and In-
dian 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 waiver of the 
plan), or any State child health plan under title XXI 
(or waiver of the plan)’’. 
(d) RULE OF CONSTRUCTION.—Nothing in this sec-
tion 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 pro-
viders who are included under subsection (ll) of sec-
tion 1902 of the Social Security Act (42 U.S.C. 
1396a) (as added by subsection (a)(3)) in the data-
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base 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 (or waivers of such plans). 
(2) Information on the amount of Federal fi-
nancial 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 
(m)(3) of such section, as added by subsection (a)(4) 
of this section. 
(3) An assessment of the extent to which con-
tracts 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 sub-
section (a)(2) of this section. 
(4) An assessment of the extent to which pro-
viders 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 agen-
cies administering State plans under title XIX of 
such Act (or waivers of such plans). 
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SEC. 3. REQUIRING PUBLICATION OF FEE-FOR-SERVICE 
PROVIDER DIRECTORY. 
(a) IN GENERAL.—Section 1902(a) of the Social Se-
curity Act (42 U.S.C. 1396a(a)) is amended— 
(1) in paragraph (80), by striking ‘‘and’’ at the 
end; 
(2) in paragraph (81), by striking the period at 
the end and inserting ‘‘; and’’; and 
(3) by inserting after paragraph (81) the fol-
lowing new paragraph: 
‘‘(82) provide that, not later than January 1, 
2017, in the case of a State plan (or waiver of the 
plan) that provides medical assistance on a fee-for- 
service basis or through a primary care case-man-
agement system described in section 1915(b)(1) 
(other than a primary care case management entity 
(as defined by the Secretary)), the State shall pub-
lish (and update on at least an annual basis) on the 
public Website of the State agency administering the 
State plan, a directory of the physicians described in 
subsection (mm) and, at State option, other pro-
viders described in such subsection that— 
‘‘(A) includes— 
‘‘(i) with respect to each such physi-
cian or provider— 
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‘‘(I) the name of the physician or 
provider; 
‘‘(II) the specialty of the physi-
cian or provider; 
‘‘(III) the address at which the 
physician or provider provides serv-
ices; and 
‘‘(IV) the telephone number of 
the physician or provider; and 
‘‘(ii) with respect to any such physi-
cian or provider participating in such a 
primary care case-management system, in-
formation regarding— 
‘‘(I) whether the physician or 
provider is accepting as new patients 
individuals who receive medical assist-
ance under this title; and 
‘‘(II) the physician’s or provider’s 
cultural and linguistic capabilities, in-
cluding the languages spoken by the 
physician or provider or by the skilled 
medical interpreter providing interpre-
tation services at the physician’s or 
provider’s office; and 
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‘‘(B) may include, at State option, with re-
spect to each such physician or provider— 
‘‘(i) the Internet website of such phy-
sician or provider; or 
‘‘(ii) whether the physician or provider 
is accepting as new patients individuals 
who receive medical assistance under this 
title.’’. 
(b) DIRECTORY
PHYSICIAN
OR
PROVIDER
DE-
SCRIBED.—Section 1902 of the Social Security Act (42 
U.S.C. 1396a), as amended by section 2(a)(3), is further 
amended by adding at the end the following new sub-
section: 
‘‘(mm) DIRECTORY PHYSICIAN OR PROVIDER DE-
SCRIBED.—A physician or provider described in this sub-
section is— 
‘‘(1) in the case of a physician or provider of 
a provider type for which the State agency, as a con-
dition on receiving payment for items and services 
furnished by the physician or provider to individuals 
eligible to receive medical assistance under the State 
plan, requires the enrollment of the physician or pro-
vider with the State agency, a physician or a pro-
vider that— 
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‘‘(A) is enrolled with the agency as of the 
date on which the directory is published or up-
dated (as applicable) under subsection (a)(82); 
and 
‘‘(B) received payment under the State 
plan in the 12-month period preceding such 
date; and 
‘‘(2) in the case of a physician or provider of 
a provider type for which the State agency does not 
require such enrollment, a physician or provider that 
received payment under the State plan (or waiver of 
the plan) in the 12-month period preceding the date 
on which the directory is published or updated (as 
applicable) under subsection (a)(82).’’. 
(c) RULE OF CONSTRUCTION.— 
(1) IN
GENERAL.—The amendment made by 
subsection (a) shall not be construed to apply in the 
case of a State (as defined for purposes of title XIX 
of the Social Security Act) in which all the individ-
uals enrolled in the State plan under such title (or 
under a waiver of such plan), other than individuals 
described in paragraph (2), are enrolled with a med-
icaid managed care organization (as defined in sec-
tion 1903(m)(1)(A) of such Act (42 U.S.C. 
1396b(m)(1)(A))), including prepaid inpatient health 
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