I 114th CONGRESS 1st Session H. R. 3716 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 terminations, and for other purposes.

1. Short title This Act may be cited as the Ensuring Terminated Providers are Removed from Medicaid and CHIP Act . 2. Increasing oversight of termination of Medicaid providers (a) Increased oversight and reporting (1) State reporting requirements Section 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 paragraph, in the case of a notification under subsection (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 termination, 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 individual or entity; (iii) the specialty of such individual’s or entity’s practice; (iv) the date of birth, Social Security number, national provider identifier, Federal 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 termination; and (vii) a copy of the notice of termination sent to the individual or entity. (B) Managed care entities (i) In general With respect to managed care entities (as defined in section 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 enactment, the State requires that any contract the State plan has with any such entity includes a provision that individuals terminated for cause from participation under the program under title XVIII, this title, or title XXI be terminated from participation in the provider networks of managed care entities under this title that serve individuals eligible to receive medical assistance under this title. (ii) Notification of termination 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 providers under section 1932(d)(5) is complete for the State, the State provides for a system for notifying managed care entities (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 following 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 Secretary shall, not later than 14 business days after the date on which the Secretary is notified of such termination 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 services 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 participation 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 section; or . (4) Development of uniform terminology for reasons for provider termination Not 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 providers in the Medicaid program under title XIX of such Act or the Children’s Health Insurance Program 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 whenever . (b) Increasing availability of Medicaid provider 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 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 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 providers (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 eligible for medical assistance under the State plan under this title and who are enrolled with 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 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 requiring a provider described in such subparagraph 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: (B) Section 1902(a)(39) (relating to termination 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 Indian 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 section shall be construed as changing the appeal rights of providers or the process for appeals of States under the Social Security Act.