Ensuring Access to Quality Medicaid Providers Act

Bill: 114-hr-3716
Sponsor: Rep. Bucshon, Larry [R-IN-8]
Introduced: 2015-10-08 in the House
Policy area: Health
Subjects: Child health
Government information and archives
Health care costs and insurance
Health personnel
Medicaid
Medicare
State and local government operations

Summary:
action_date: 2015-10-08
text: 

Ensuring Terminated Providers are Removed from Medicaid and CHIP Act

 
This bill amends titles XIX (Medicaid) and XXI (Children's Health Insurance Program [CHIP]) of the Social Security Act to prohibit federal payment under Medicaid for nonemergency services furnished by providers whose participation in Medicaid, Medicare, or CHIP has been terminated.
 
Under current law, a state must exclude from Medicaid participation any provider that has been terminated under any state's Medicaid program or under Medicare. The bill maintains those requirements and further requires a state to exclude from Medicaid participation any provider that has been terminated under CHIP. Furthermore, a state must exclude from CHIP participation any provider that has been terminated under Medicaid or Medicare.
 
The bill also revises a state's reporting requirements with respect to terminating a provider under a state plan. A state shall require each Medicaid or CHIP provider, whether the provider participates on a fee-for-service basis or within the network of a managed care organization (MCO), to enroll with the state by providing specified identifying information. When notifying the Department of Health and Human Services (HHS) that a provider has been terminated under a state plan, the state must submit this information as well as information regarding the termination date and reason. HHS shall include such termination notifications in a database or similar system, as specified by the bill.
 
A state must have a system for notifying MCOs when a provider is terminated under Medicaid, Medicare, or CHIP. A contract between the state plan and an MCO must provide that such providers be excluded from participation in the MCO provider network.

action_date: 2016-02-23
text: 

Ensuring Removal of Terminated Providers from Medicaid and CHIP Act

 
(Sec. 2) This bill amends titles XIX (Medicaid) and XXI (Children's Health Insurance Program [CHIP]) of the Social Security Act to prohibit federal payment under Medicaid for nonemergency services furnished by providers whose participation in Medicaid, Medicare, or CHIP has been terminated.
 
Under current law, a state must exclude from Medicaid participation any provider that has been terminated under any state's Medicaid program or under Medicare. The bill maintains those requirements and further requires a state to exclude from Medicaid participation any provider that has been terminated under CHIP. Furthermore, a state must exclude from CHIP participation any provider that has been terminated under Medicaid or Medicare.
 
The bill also revises a state's reporting requirements with respect to terminating a provider under a state plan. A state shall require each Medicaid or CHIP provider, whether the provider participates on a fee-for-service basis or within the network of a managed care organization (MCO), to enroll with the state by providing specified identifying information. When notifying the Department of Health and Human Services (HHS) that a provider has been terminated under a state plan, the state must submit this information as well as information regarding the termination date and reason. HHS shall review such termination notifications and, if appropriate, include them in a database or similar system, as specified by the bill.
 
The bill prohibits federal payment under a state's Medicaid or CHIP program for services provided by an MCO unless: (1) the state has a system for notifying MCOs when a provider is terminated under Medicaid, Medicare, or CHIP; and (2) any contract between the state plan and an MCO provides that such providers be excluded from participation in the MCO provider network. 

action_date: 2016-03-02
text: 

Ensuring Access to Quality Medicaid Providers Act

 
(Sec. 2) This bill amends titles XIX (Medicaid) and XXI (Children's Health Insurance Program [CHIP]) of the Social Security Act to prohibit federal payment under Medicaid for nonemergency services furnished by providers whose participation in Medicaid, Medicare, or CHIP has been terminated.
 
Under current law, a state must exclude from Medicaid participation any provider that has been terminated under any state's Medicaid program or under Medicare. The bill maintains those requirements and further requires a state to exclude from Medicaid participation any provider that has been terminated under CHIP. Furthermore, a state must exclude from CHIP participation any provider that has been terminated under Medicaid or Medicare.
 
The bill also revises a state's reporting requirements with respect to terminating a provider under a state plan. A state shall require each Medicaid or CHIP provider, whether the provider participates on a fee-for-service (FFS) basis or within the network of a managed care organization (MCO), to enroll with the state by providing specified identifying information. When notifying the Department of Health and Human Services (HHS) that a provider has been terminated under a state plan, the state must submit this information as well as information regarding the termination date and reason. HHS shall review such termination notifications and, if appropriate, include them in a database or similar system, as specified by the bill.
 
The bill prohibits federal payment under a state's Medicaid or CHIP program for services provided by an MCO unless: (1) the state has a system for notifying MCOs when a provider is terminated under Medicaid, Medicare, or CHIP; and (2) any contract between the state plan and an MCO provides that such providers be excluded from participation in the MCO provider network. 
 
HHS shall report to Congress on this bill's implementation.
 
(Sec. 3) A state must publish and annually update a public directory of FFS providers participating under the state plan.


Legislative actions:
action_date: 2016-03-03
text: Received in the Senate and Read twice and referred to the Committee on Finance.
action_date: 2016-03-02
text: Motion to reconsider laid on the table Agreed to without objection.
action_date: 2016-03-02
text: On passage Passed by the Yeas and Nays: 406 - 0 (Roll no. 105).
action_date: 2016-03-02
text: Passed/agreed to in House: On passage Passed by the Yeas and Nays: 406 - 0 (Roll no. 105).
action_date: 2016-03-02
text: Considered as unfinished business. (consideration: CR H1104)
action_date: 2016-03-02
text: UNFINISHED BUSINESS - The Chair announced that the unfinished business was the question of passage of H.R. 3716 which had been debated earlier and on which further proceedings had been postponed.
action_date: 2016-03-02
text: POSTPONED PROCEEDINGS - The Chair put the question on passage of H.R. 3716 and by voice vote, announced that the ayes had prevailed. Mr. Bucshon demanded the yeas and nays and the Chair postponed further proceedings on the question of passage of the bill until a time to be announced.
action_date: 2016-03-02
text: The House adopted the amendment in the nature of a substitute as agreed to by the Committee of the Whole House on the state of the Union.
action_date: 2016-03-02
text: The previous question was ordered pursuant to the rule. (consideration: CR H1103)
action_date: 2016-03-02
text: The House rose from the Committee of the Whole House on the state of the Union to report H.R. 3716.
action_date: 2016-03-02
text: DEBATE - Pursuant to the provisions of H.Res. 632, the Committee of the Whole proceeded with 10 minutes of debate on the Bucshon amendment No. 1, as modified.
action_date: 2016-03-02
text: GENERAL DEBATE - The Committee of the Whole proceeded with one hour of general debate on H.R. 3716.
action_date: 2016-03-02
text: The Speaker designated the Honorable George Holding to act as Chairman of the Committee.
action_date: 2016-03-02
text: House resolved itself into the Committee of the Whole House on the state of the Union pursuant to H. Res. 632 and Rule XVIII.
action_date: 2016-03-02
text: Rule provides for consideration of H.R. 3716 with 1 hour of general debate. Previous question shall be considered as ordered without intervening motions except motion to recommit with or without instructions. Measure will be considered read. Specified amendments are in order. It shall be in order to consider as an original bill for the purpose of amendment under the five-minute rule an amendment in the nature of a subsitute consisting of the text of Rules Committee Print 114-45.
action_date: 2016-03-02
text: Considered under the provisions of rule H. Res. 632. (consideration: CR H1097-1103; text of amendment in the nature of a substitute: CR H1101-1102)
action_date: 2016-03-02
text: Rule H. Res. 632 passed House.
action_date: 2016-03-01
text: Rules Committee Resolution H. Res. 632 Reported to House. Rule provides for consideration of H.R. 3716 with 1 hour of general debate. Previous question shall be considered as ordered without intervening motions except motion to recommit with or without instructions. Measure will be considered read. Specified amendments are in order. It shall be in order to consider as an original bill for the purpose of amendment under the five-minute rule an amendment in the nature of a subsitute consisting of the text of Rules Committee Print 114-45.
action_date: 2016-02-23
text: Placed on the Union Calendar, Calendar No. 326.
action_date: 2016-02-23
text: Reported (Amended) by the Committee on Energy and Commerce. H. Rept. 114-427.
action_date: 2016-02-23
text: Reported (Amended) by the Committee on Energy and Commerce. H. Rept. 114-427.
action_date: 2015-11-18
text: Ordered to be Reported (Amended) by Voice Vote.
action_date: 2015-11-18
text: Committee Consideration and Mark-up Session Held.
action_date: 2015-11-17
text: Committee Consideration and Mark-up Session Held.
action_date: 2015-11-04
text: Forwarded by Subcommittee to Full Committee (Amended) by Voice Vote .
action_date: 2015-11-04
text: Subcommittee Consideration and Mark-up Session Held.
action_date: 2015-11-03
text: Subcommittee Consideration and Mark-up Session Held.
action_date: 2015-10-09
text: Referred to the Subcommittee on Health.
action_date: 2015-10-08
text: Referred to the House Committee on Energy and Commerce.
action_date: 2015-10-08
text: Introduced in House
action_date: 2015-10-08
text: Introduced in House