I 
114TH CONGRESS 
1ST SESSION H. R. 3716 
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 
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 ter-
minations, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Ensuring Terminated 
Providers are Removed from Medicaid and CHIP Act’’. 
SEC. 2. INCREASING OVERSIGHT OF TERMINATION OF 
MEDICAID PROVIDERS. 
(a) INCREASED OVERSIGHT AND REPORTING.— 
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(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 180 days 
after the date of the enactment of this para-
graph, in the case of a notification under sub-
section (a)(41) with respect to a termination for 
cause of the participation of any individual or 
entity under the State plan under subsection 
(a)(39), the State, not later than 14 business 
days after the effective date of such termi-
nation, submits to the Secretary with respect to 
any such individual or entity— 
‘‘(i) the name of such individual or 
entity; 
‘‘(ii) the provider type of such indi-
vidual or entity; 
‘‘(iii) the specialty of such individual’s 
or entity’s practice; 
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‘‘(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 individual or entity; 
‘‘(v) the reason for the termination; 
‘‘(vi) the effective date of such termi-
nation; and 
‘‘(vii) a copy of the notice of termi-
nation sent to the individual or entity. 
‘‘(B) MANAGED CARE ENTITIES.— 
‘‘(i) IN
GENERAL.—With respect to 
managed care entities (as defined in sec-
tion 1932(a)(1)), beginning on the later of 
the date that is 180 days after the date of 
the enactment of this paragraph or the 
first day of the first plan year for such an 
entity that begins after such date of enact-
ment, the State requires that any contract 
the State plan has with any such entity in-
cludes a provision that individuals termi-
nated for cause from participation under 
the program under title XVIII, this title, 
or title XXI be terminated from participa-
tion in the provider networks of managed 
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care entities under this title that serve in-
dividuals eligible to receive medical assist-
ance under this title. 
‘‘(ii) 
NOTIFICATION
OF
TERMI-
NATION.—For the period beginning on the 
date that is 180 days after the date of the 
enactment of this paragraph and ending on 
the date on which the enrollment of pro-
viders under section 1932(d)(5) is com-
plete for the State, the State provides for 
a system for notifying managed care enti-
ties (as defined in section 1932(a)(1)) of 
the termination of individuals or entities 
from participation under the program 
under title XVIII, this title, or title XXI.’’. 
(2) TERMINATION NOTIFICATION DATABASE.— 
Section 1902 of the Social Security Act (42 U.S.C. 
1396a) is amended by adding at the end the fol-
lowing new subsection: 
‘‘(ll) TERMINATION NOTIFICATION DATABASE.—In 
the case of an individual or entity whose participation in 
the program under title XVIII, this title, or title XXI is 
terminated for cause under subsection (a)(39), the Sec-
retary shall, not later than 14 business days after the date 
on which the Secretary is notified of such termination 
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under subsection (a)(41), include 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).’’. 
(3) NO FEDERAL FUNDS FOR ITEMS AND SERV-
ICES
FURNISHED
BY
TERMINATED
PROVIDERS.— 
Section 1903(i)(2) of the Social Security Act (42 
U.S.C. 1396b(i)(2)) is amended— 
(A) in subparagraph (A), by striking the 
comma at the end and inserting a semicolon; 
(B) in subparagraph (B), by striking ‘‘or’’ 
at the end; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(D) beginning 2 years after the date of 
the enactment of this subparagraph, under the 
plan by any individual or entity whose partici-
pation in the State plan is terminated for cause 
under subsection (a)(39) of section 1902 after 
the date that is 60 days after the date on which 
such termination is included in the database or 
other system under subsection (ll) of such sec-
tion; or’’. 
(4) DEVELOPMENT OF UNIFORM TERMINOLOGY 
FOR REASONS FOR PROVIDER TERMINATION.—Not 
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later than 180 days after the date of the enactment 
of this Act, the Secretary of Health and Human 
Services shall issue regulations establishing uniform 
terminology to be used with respect to specifying 
reasons under paragraph (8)(A) of section 1902(kk) 
of the Social Security Act (42 U.S.C. 1396a(kk)) for 
the termination of the participation of certain pro-
viders in the Medicaid program under title XIX of 
such Act or the Children’s Health Insurance Pro-
gram under title XXI of such Act. 
(5) 
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. 
1396a(a)) is amended by inserting after paragraph 
(77) the following new paragraph: 
‘‘(78) provide that, not later than 180 days 
after the date of the enactment of this paragraph, 
in the case of a State plan that provides medical as-
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sistance on a fee-for-service basis, the State shall re-
quire each provider furnishing items and services to 
individuals eligible to receive medical assistance 
under such plan to enroll with the State agency and 
provide to the State agency the provider’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;’’. 
(2) MANAGED CARE PROVIDER ENROLLMENT.— 
Section 1932(d) of the Social Security Act (42 
U.S.C. 1396u–2(d)) is amended by adding at the 
end the following new paragraph: 
‘‘(5) ENROLLMENT
OF
PARTICIPATING
PRO-
VIDERS.— 
‘‘(A) IN
GENERAL.—Beginning not later 
than one year after the date of the enactment 
of this paragraph, a State shall require that, as 
a condition on the participation in the provider 
network of a managed care entity of a provider 
that provides services to, or orders or provides 
referrals for services for, individuals who are el-
igible for medical assistance under the State 
plan under this title and who are enrolled with 
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the entity, the provider enrolls with the State 
agency administering the State plan under this 
title. Such enrollment shall include providing to 
the State agency the provider’s identifying in-
formation, including the name, specialty, date 
of birth, Social Security number, national pro-
vider 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— 
(A) by redesignating subparagraphs (B) 
through (O) as subparagraphs (D) through (Q), 
respectively; 
(B) by inserting after subparagraph (A) 
the following new subparagraphs: 
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‘‘(B) Section 1902(a)(39) (relating to ter-
mination of participation of certain providers). 
‘‘(C) Section 1902(a)(78) (relating to the 
enrollment of providers participating in State 
plans providing medical assistance on a fee-for- 
service basis).’’; and 
(C) in subparagraph (O) (as redesignated 
by paragraph (1)), by striking ‘‘(a)(2)(C) and 
(h)’’ and inserting ‘‘(a)(2)(C) (relating to In-
dian enrollment), (d)(5) (relating to enrollment 
of providers participating with a managed care 
entity), and (h) (relating to special rules with 
respect to Indian enrollees, Indian health care 
providers, and Indian 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 any State child 
health plan under title XXI’’. 
(d) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed as changing the appeal rights of 
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providers or the process for appeals of States under the 
Social Security Act. 
Æ 
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