and, if the Secretary determines appropriate, 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).’’. 
(4) NO FEDERAL FUNDS FOR ITEMS AND SERV-
ICES FURNISHED BY TERMINATED PROVIDERS.—Sec-
tion 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 semi-
colon; 
(ii) in subparagraph (B), by striking 
‘‘or’’ at the end; and 
(iii) by adding at the end the following 
new subparagraph: 
‘‘(D) beginning not later than January 1, 
2018, under the plan by any provider of services 
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 included 
in the database or other system under section 
1902(ll); or’’; and 
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(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 entity 
(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 the applicable date specified 
in subparagraph (A) of section 1932(d)(5), has a con-
tract with such entity that complies with the require-
ment specified in such subparagraph; and 
‘‘(B)(i) for the period specified in subparagraph 
(B) of such section, has a system in effect that meets 
the requirement specified in such subparagraph; and 
‘‘(ii) after such period, complies with section 
1932(d)(6).’’. 
(5) DEVELOPMENT OF UNIFORM TERMINOLOGY 
FOR
REASONS
FOR
PROVIDER
TERMINATION.—Not 
later than January 1, 2017, the Secretary of Health 
and Human Services shall, in consultation with the 
heads of State agencies administering State Medicaid 
plans (or waivers of such plans), issue regulations es-
tablishing uniform terminology to be used with re-
spect to specifying reasons under subparagraph (A)(v) 
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of paragraph (8) of section 1902(kk) of the Social Se-
curity 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 pro-
viders in the Medicaid program under title XIX of 
such Act or the Children’s Health Insurance 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 whenever’’. 
(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 January 1, 
2017, in the case of a State plan that provides med-
ical assistance on a fee-for-service basis, the State 
shall require each provider furnishing items and serv-
ices to individuals eligible to receive medical assist-
ance under such plan to enroll with the State agency 
and provide to the State agency the provider’s identi-
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fying 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)), as amended by subsection (a)(2), is 
amended by adding at the end the following 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 net-
work of a managed care entity that provides 
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 and who are enrolled 
with the entity, the provider is enrolled with the 
State agency administering the State plan under 
this title. Such enrollment shall include pro-
viding to the State agency the provider’s identi-
fying information, including the name, specialty, 
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date of birth, Social Security number, national 
provider identifier, Federal taxpayer identifica-
tion number, and the State license or certifi-
cation number of the provider. 
‘‘(B) RULE OF CONSTRUCTION.—Nothing in 
subparagraph (A) shall be construed as requiring 
a provider described in such subparagraph to 
provide services to individuals who are not en-
rolled with a managed care entity under this 
title.’’. 
(c) COORDINATION WITH CHIP.— 
(1) IN GENERAL.—Section 2107(e)(1) of the So-
cial Security Act (42 U.S.C. 1397gg(e)(1)) is amend-
ed— 
(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 termi-
nation of participation of certain providers). 
‘‘(C) Section 1902(a)(78) (relating to enroll-
ment of providers participating in State plans 
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providing medical assistance on a fee-for-service 
basis).’’; 
(C) by inserting after subparagraph (K) (as 
redesignated by paragraph (1)) the following 
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 paragraph (1)), by striking ‘‘(a)(2)(C) and 
(h)’’ and inserting ‘‘(a)(2)(C) (relating to Indian 
enrollment), (d)(5) (relating to reporting require-
ments for managed care entities), (d)(6) (relat-
ing to enrollment of providers participating with 
a managed care entity), and (h) (relating to spe-
cial rules with respect to Indian enrollees, In-
dian health care providers, and Indian managed 
care entities)’’. 
(2) EXCLUDING FROM MEDICAID PROVIDERS EX-
CLUDED FROM CHIP.—Section 1902(a)(39) of the So-
cial Security Act (42 U.S.C. 1396a(a)(39)) is amend-
ed 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’’. 
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(d) RULE OF CONSTRUCTION.—Nothing in this section 
shall be construed as changing or limiting the appeal rights 
of providers or the process for appeals of States under the 
Social Security Act. 
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Union Calendar No. 326 
114TH CONGRESS 
2D SESSION 
H. R. 3716 
[Report No. 114–427] 
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 terminations, and for 
other purposes. 
FEBRUARY 23, 2016 
Reported with an amendment, committed to the Com-
mittee of the Whole House on the State of the Union, 
and ordered to be printed 
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