I 
114TH CONGRESS 
2D SESSION 
H. R. 6518 
To amend title XIX of the Social Security Act to improve the Medicaid 
and CHIP Payment and Access Commission (MACPAC). 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 8, 2016 
Mr. PITTS (for himself, Mr. FLORES, Mrs. BROOKS of Indiana, Mr. BUCSHON, 
Mr. COLLINS of New York, Mr. GUTHRIE, Mrs. BLACKBURN, and Mr. 
MULLIN) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce 
A BILL 
To amend title XIX of the Social Security Act to improve 
the Medicaid and CHIP Payment and Access Commis-
sion (MACPAC). 
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 ‘‘MACPAC Improve-
ment Act of 2016’’. 
SEC. 2. IMPROVEMENT OF MACPAC. 
(a) DUTIES.—Section 1900(b) of the Social Security 
Act (42 U.S.C. 1396(b)) is amended— 
(1) in paragraph (1)— 
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(A) in the heading, by inserting ‘‘, PAY-
MENT, FINANCING, AND PROGRAM INTEGRITY’’ 
after ‘‘ACCESS’’; 
(B) in subparagraph (A), by inserting ‘‘, 
payment, financing, or program integrity’’ after 
‘‘affecting access to covered items and serv-
ices’’; 
(C) in subparagraph (B), by striking ‘‘ac-
cess’’; 
(D) in subparagraph (C), by striking ‘‘such 
policies’’ and inserting the following: ‘‘policies 
of such programs relating to financing and pro-
gram integrity, including— 
‘‘(i) the implications of such policies 
with respect to changes in health care de-
livery in the United States; and 
‘‘(ii) with respect to the market for 
health care items and services, the impact 
of such policies on the cost and spending 
growth under such programs;’’; and 
(E) in subparagraph (D), by striking ‘‘con-
taining’’ and all that follows through the period 
and inserting the following: ‘‘containing the re-
sults of such reviews and MACPAC’s rec-
ommendations concerning the policies of such 
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programs relating to access and payment, in-
cluding— 
‘‘(i) the implications of such policies 
with respect to changes in health care de-
livery in the United States; and 
‘‘(ii) with respect to the market for 
health care items and services, the impact 
of such policies on access and payment 
under such programs.’’; 
(2) in paragraph (2)— 
(A) in subparagraph (A)— 
(i) in clause (ii), by striking ‘‘and’’ at 
the end; 
(ii) in clause (iii), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(iii) by adding at the end the fol-
lowing new clause: 
‘‘(iv) such payment policies that may 
result in total payments (taking into ac-
count additional or supplemental payments 
or payment adjustments) under this title 
or title XXI that exceed the cost of pro-
viding items and services to Medicaid or 
CHIP beneficiaries (as applicable) and 
changes in such payment policies that 
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could improve efficiency without negatively 
impacting access to care for such bene-
ficiaries.’’; and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(I) DATA.—National and State-specific 
Medicaid and CHIP data.’’; 
(3) by amending paragraph (3) to read as fol-
lows: 
‘‘(3) ANNUAL
POLICY
RECOMMENDATIONS.— 
Not less frequently than once a year, MACPAC shall 
make recommendations regarding Federal statutes 
that could be enacted or policies which the Secretary 
or States could implement to achieve, with respect to 
Medicaid and CHIP, the following goals: 
‘‘(A) FEDERAL AND STATE OUTLAYS.—Re-
ducing Federal and State outlays to make such 
programs more sustainable. 
‘‘(B) FINANCING.—Improving the trans-
parency, integrity, and sustainability of financ-
ing. 
‘‘(C) STATE
FLEXIBILITY
AND
EFFI-
CIENCY.—Improving State flexibility, predict-
ability, accountability, integrity, and efficiency 
in oversight and administration. 
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‘‘(D) PROGRAM INTEGRITY AND REDUCE 
WASTE, FRAUD, AND ABUSE.—Enhancing pro-
gram integrity, reducing the amount and rate 
of improper payments, improving internal ad-
ministrative and financial controls, and enhanc-
ing efforts to curb waste, fraud, and abuse. 
‘‘(E) PRIORITIZING
THE
MOST
VULNER-
ABLE.—Prioritizing benefits, care, and services 
for the most vulnerable, low-income Medicaid 
and CHIP beneficiaries, such as children and 
pregnant women whose family income is at or 
below the Federal poverty line, the elderly, and 
individuals with disabilities. 
‘‘(F) EMPOWERING
BENEFICIARIES.—Im-
proving the independence, self-direction, self- 
sufficiency, and empowerment of beneficiaries.’’; 
(4) in paragraph (4)— 
(A) in the heading, by striking ‘‘SYSTEM’’ 
and inserting ‘‘SYSTEMS’’; 
(B) by striking ‘‘MACPAC shall create’’ 
and inserting the following: 
‘‘(A) SYSTEM
RELATED
TO
ACCESS.— 
MACPAC shall create’’; and 
(C) by adding at the end the following new 
subparagraph: 
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‘‘(B) SYSTEM
RELATED
TO
PROGRAM 
GROWTH.—MACPAC shall create an early- 
warning system to identify challenges with sus-
taining Federal and State funding for Medicaid 
during the mid-term and long-term. MACPAC 
shall include in the annual report required 
under paragraph (1)(C) a description of such 
challenges, including challenges posed by budg-
etary pressures which could lead to increased 
Federal or State deficits, crowd out discre-
tionary Federal or State spending, or neces-
sitate increases in revenues, and proposed rec-
ommendations for addressing such challenges.’’; 
(5) in paragraph (5)— 
(A) in the heading, by striking ‘‘AND REG-
ULATIONS’’ and inserting ‘‘, REGULATIONS, AND 
GUIDANCE’’; 
(B) in subparagraph (B), by inserting ‘‘fi-
nancing,’’ after ‘‘quality,’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(C) CMS GUIDANCE.—MACPAC shall re-
view guidance issued to States by the Centers 
for Medicare & Medicaid Services with respect 
to Medicaid or CHIP and shall, not later than 
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the date that is 90 days after the date of such 
issuance, submit a report to the appropriate 
committees of Congress and the Secretary on 
the degree to which such guidance is projected 
to change Federal or State outlays for Medicaid 
or CHIP.’’; 
(6) in paragraph (7)— 
(A) in the heading by inserting ‘‘AND 
WORKING DOCUMENTS’’ after ‘‘REPORTS’’; 
(B) by striking ‘‘MACPAC shall transmit’’ 
and inserting the following: 
‘‘(A) REPORTS.—MACPAC shall submit’’; 
and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(B) WORKING
DOCUMENTS.—MACPAC 
shall make available to the appropriate commit-
tees of Congress copies of draft report chapters, 
white papers, and other materials distributed 
among members of MACPAC.’’; 
(7) in paragraph (8), by striking ‘‘of the House 
of Representatives and the Committee on Finance of 
the Senate’’ and inserting ‘‘, the Committee on Ap-
propriations, and the Committee on Oversight and 
Government Reform of the House of Representatives 
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and the Committee on Finance, the Committee on 
Homeland Security and Governmental Affairs, and 
the Committee on Appropriations of the Senate’’; 
(8) in paragraph (10), by adding at the end the 
following: ‘‘For each recommendation that MACPAC 
determines would increase Federal or State outlays 
for Medicaid or CHIP, MACPAC shall make a rec-
ommendation regarding changes in Federal or State 
policy to offset such increased outlays.’’; and 
(9) by adding at the end the following new 
paragraph: 
‘‘(15) ANNUAL REPORT.—Not later than three 
months after the end of a fiscal year, MACPAC 
shall prepare and make available on the MACPAC 
website a report with respect to such fiscal year on 
its activities that includes— 
‘‘(A) information related to MACPAC’s ex-
penses, contracts, accomplishments, and activi-
ties for such fiscal year; and 
‘‘(B) the status of MACPAC’s rec-
ommendations, including updates on Federal 
statutes that have been enacted or policies 
which the Secretary or States have implemented 
to effect such recommendations.’’. 
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(b) MEMBERSHIP.—Section 1900(c) of the Social Se-
curity Act (42 U.S.C. 1396(c)) is amended— 
(1) by amending paragraph (2) to read as fol-
lows: 
‘‘(2) QUALIFICATIONS.— 
‘‘(A) IN
GENERAL.—The membership of 
MACPAC shall include the following: 
‘‘(i) At least three individuals rep-
resenting health care providers, such as 
physicians, nurses, or dentists. 
‘‘(ii) At least two individuals rep-
resenting health plans that enroll Medicaid 
or CHIP beneficiaries, including one or 
more individuals representing a Medicaid 
managed care plan. 
‘‘(iii) At least one individual who is an 
actuary with expertise in health care. 
‘‘(iv) At least two individuals who are 
or have been directors of Medicaid for a 
State, including at least one individual who 
is such a director at the time of appoint-
ment to MACPAC. 
‘‘(v) At least one individual who is or 
has been a director of CHIP for a State. 
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‘‘(vi) At least one individual with ex-
pertise in health care finance and health 
economics. 
‘‘(vii) At least two individuals who are 
representatives of Medicaid and CHIP 
beneficiaries, such as children, pregnant 
women, the elderly, and individuals with 
disabilities. 
‘‘(viii) At least one individual with ex-
pertise in long-term services and supports, 
such as in the financing or delivery of 
long-term services and supports or man-
aged long-term care services, including 
care delivered in nursing homes or home 
and community-based settings. 
‘‘(B) INCLUSION.—The membership of 
MACPAC shall include individuals with exper-
tise in— 
‘‘(i) Federal safety net health pro-
grams; 
‘‘(ii) developing, negotiating, or imple-
menting a Medicaid waiver based on expe-
rience working for a State; 
‘‘(iii) health care payment and financ-
ing reforms; 
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‘‘(iv) integrated health care delivery 
systems, coordinated care models, and 
value-based contracting; 
‘‘(v) public health; 
‘‘(vi) program integrity and fraud pre-
vention; 
‘‘(vii) health information technology 
and telehealth; 
‘‘(viii) prescription drug pricing or 
payment; and 
‘‘(ix) operating a Medicaid program, 
health plan, hospital, or health care deliv-
ery system. 
‘‘(C) DIVERSITY.—The membership of 
MACPAC shall also provide representation from 
a variety of different professions and geo-
graphic areas and provide for a balanced rep-
resentation among urban, suburban, and rural 
areas. 
‘‘(D) BALANCE
OF
PERSPECTIVES.—The 
Comptroller General of the United States shall 
ensure members appointed for initial or subse-
quent terms to MACPAC reflect an appropriate 
balance of political perspectives, including by 
taking into account political party registration 
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and contributions made to political candidates 
and parties. 
‘‘(E) MAJORITY NONPROVIDERS.— 
‘‘(i) IN
GENERAL.—Individuals who 
are directly involved in the provision, or 
management of the delivery, of items and 
services covered under Medicaid or CHIP 
shall not constitute a majority of the mem-
bership of MACPAC. 
‘‘(ii) MEDICAID
AND
CHIP
DIREC-
TORS.—For purposes of this subpara-
graph, Medicaid and CHIP directors shall 
not be considered to be directly involved in 
the provision, or management of the deliv-
ery, of items and services covered under 
Medicaid or CHIP. 
‘‘(F) ETHICAL DISCLOSURE.— 
‘‘(i) IN
GENERAL.—The Comptroller 
General of the United States shall estab-
lish a system for the public disclosure of fi-
nancial, professional, political, advocacy, or 
other activities of members of MACPAC 
that may result in, or be perceived to re-
sult in, conflicts of interest relating to such 
members’ service on MACPAC. 
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‘‘(ii) TIMING OF DISCLOSURES.—The 
Comptroller General shall require that 
each member of MACPAC make— 
‘‘(I) the disclosure described in 
clause (i) on an annual basis; and 
‘‘(II) in the case of a significant 
change in any of the activities of the 
member described in such clause, a 
supplemental disclosure at the time of 
such significant change. 
‘‘(iii) TREATMENT AS EMPLOYEES OF 
CONGRESS.—Members of MACPAC shall 
be treated as employees of Congress for 
purposes of applying title I of the Ethics 
in Government Act of 1978 (Public Law 
95–521).’’; and 
(2) in paragraph (5), by adding at the end the 
following: ‘‘Such designation shall be based on pre-
vious management experience. The Comptroller Gen-
eral may not exclude a member from consideration 
for such designation based on the fact that such 
member is an individual employed by a State or by 
an entity that receives Medicaid or CHIP payments, 
including a local government, a health plan that en-
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rolls Medicaid or CHIP beneficiaries, or a health 
care provider.’’. 
(c) CONFLICTS OF INTEREST.—Section 1900 of the 
Social Security Act (42 U.S.C. 1396) is amended by add-
ing at the end the following new subsection: 
‘‘(g) CONFLICT OF INTEREST POLICY.—MACPAC 
shall maintain and make available on the MACPAC 
website a conflict of interest policy outlining requirements 
for members and personnel of MACPAC. Such policy shall 
include the following: 
‘‘(1) DISCLOSURE.—Requirements for initially 
disclosing, and periodically updating, any substantial 
political activity or significant financial interests 
that might influence, or that might reasonably ap-
pear to influence, perspectives on issues that could 
come before MACPAC. 
‘‘(2) LEGAL
INVOLVEMENT.—With respect to 
any matter under adjudication before a court, ad-
ministrative law judge, or other judicial entities: 
‘‘(A) A requirement of disclosure of any di-
rect or indirect involvement in any such matter 
related to a Federal or State health care pro-
gram (as such terms are defined in sections 
1128(h) and 1128B(f), respectively), including 
filing an amicus brief. 
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‘‘(B) A prohibition on direct or indirect in-
volvement in any such matter that involves the 
Congress as a party, including filing an amicus 
brief. 
‘‘(3) 
RECUSAL.—The 
criteria 
and 
cir-
cumstances under which a member of MACPAC 
shall suspend participation in MACPAC or otherwise 
seek recusal from MACPAC votes, including the 
process by which MACPAC discloses recommenda-
tions for such a recusal.’’. 
(d) APPLICATION.— 
(1) DUTIES.—The amendments made by sub-
section (a) shall apply with respect to reports (and 
recommendations included in reports) submitted on 
or after the date that is more than one year after 
the date of the enactment of this Act. 
(2) GUIDANCE.—The amendments made by 
subsection (b)(5) shall apply with respect to guid-
ance issued on or after the date of the enactment of 
this Act. 
(3) MEMBERSHIP.— 
(A) APPOINTMENT OF NEW MEMBERS.— 
The Comptroller General of the United States 
shall apply the changes to the membership of 
the Medicaid and CHIP Payment and Access 
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Commission required by amendments made by 
subsection (b) as soon as is practicable, con-
sistent with subparagraph (B), and in no event 
later than the date that is three years after the 
date of the enactment of this Act. 
(B) RETENTION OF CURRENT MEMBERS.— 
An individual who is a member of the Medicaid 
and CHIP Payment and Access Commission as 
of the date of the enactment of this Act may 
continue to serve until the end of the individ-
ual’s term as of such date without regard to the 
amendments made by subsection (b). 
(4) CONFLICTS
OF
INTEREST.—The amend-
ment made by subsection (c) shall apply beginning 
on the date that is 90 days after the date of the en-
actment of this Act. 
Æ 
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