PADME Act

Bill: 114-hr-5210
Sponsor: full_name: Rep. Price, Tom [R-GA-6]
Introduced: 2016-05-12
Policy area: Health
Subjects: Administrative law and regulatory procedures

Child health

Congressional oversight

Department of Health and Human Services

Disability assistance

Family planning and birth control

Food assistance and relief

Government information and archives

Government liability

Government studies and investigations

Government trust funds

Health care costs and insurance

Health care coverage and access

Health personnel

Health programs administration and funding

Health technology, devices, supplies

Higher education

Licensing and registrations

Medicaid

Medicare

Poverty and welfare assistance

Public contracts and procurement

Public housing

State and local government operations

Student aid and college costs

Unemployment
Latest action: action_date: 2016-07-06
text: Received in the Senate and Read twice and referred to the Committee on Finance.

Summaries:
action_date: 2016-05-12
action_desc: Introduced in House
text: <p><strong>Patient Access to Durable Medical Equipment Act of 2016 or the PADME Act</strong></p> <p>This bill amends title XVIII (Medicare) of the Social Security Act to establish a bid ceiling for durable medical equipment (such as wheelchairs) under Medicare's competitive acquisition program, through which rates are set according to a bidding process rather than by an established fee schedule. Specifically, the bid ceiling for such an item shall not be less than the fee schedule amount that would otherwise be determined.</p> <p>Under current law, the Centers for Medicare &amp; Medicaid Services (CMS) must use payment information from competitive acquisition programs to make payment adjustments for areas outside of such programs. The bill requires CMS, in making&nbsp;these adjustments, to account for&nbsp;stakeholder input. In addition, CMS must account for a comparison of competitive acquisition areas and other areas with respect to the following factors:</p> <ul> <li>average travel distance and cost associated with furnishing items and services,</li> <li>barriers to access,</li> <li>average delivery time,</li> <li>average volume of items and services furnished by suppliers, and</li> <li>number of suppliers.</li></ul> <p>In addition, CMS shall delay by 15 months the full implementation of new Medicare payment rates for durable medical equipment.</p> <p>On a monthly basis, CMS must publish on its website the results of the monitoring of health outcomes and Medicare beneficiaries' access&nbsp;to durable medical equipment.</p>

action_date: 2016-07-05
action_desc: Passed House amended
text: <p><b>Patient Access to Durable Medical Equipment Act of 2016 or the PADME Act</b></p> <p>(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.</p> <p>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.</p> <p>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.</p> <p>The bill prohibits federal payment under a state's Medicaid or CHIP program for services provided by an MCO unless: (1) the&nbsp;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. </p> <p>HHS shall report to Congress on this bill's implementation.</p> <p>(Sec. 3) A state must publish and annually update a public directory of FFS providers participating&nbsp;under the state plan.</p> <p>(Sec. 4) HHS shall: (1)&nbsp;delay by&nbsp;three months the full implementation of new Medicare payment rates for durable medical equipment (DME), and (2) study and report on the impact of applicable payment adjustments on the availability of DME to Medicare beneficiaries.</p> <p>(Sec. 5) For purposes of eligibility determinations for federal public benefits, the bill excludes payments made under a state eugenics compensation program from classification as income or resources. A "state eugenics compensation program" is a state program intended to compensate individuals who were sterilized under the state's authority.</p> <p>(Sec. 6) The bill makes available $3 million to the Medicare Improvement Fund for services furnished during and after FY2020.</p>

tv_txt: I 114th CONGRESS 2d Session H. R. 5210 IN THE HOUSE OF REPRESENTATIVES May 12, 2016 Mr. Tom Price of Georgia (for himself, Mr. Loebsack , Mrs. McMorris Rodgers , Mr. Welch , Mr. Collins of New York , Mr. Cramer , Mr. Flores , Mr. Harper , Mr. Luetkemeyer , Mr. Roe of Tennessee , Mr. Thompson of Pennsylvania , Mr. Tipton , Ms. Duckworth , Mr. Duncan of Tennessee , Mr. Joyce , Mr. Zinke , Mr. Kelly of Pennsylvania , Mr. Blum , Mrs. Ellmers of North Carolina , Mr. Gohmert , Mr. Long , Mr. Harris , Mr. Renacci , Mr. Tiberi , Mr. Peterson , Mr. Murphy of Pennsylvania , Mrs. Noem , Mr. Gibbs , Mr. Austin Scott of Georgia , Mr. Guthrie , Mr. DesJarlais , Ms. Jenkins of Kansas , Mr. David Scott of Georgia , Mrs. Black , Mrs. Blackburn , Mr. Smith of Missouri , Mr. Mullin , Mr. Pompeo , Mr. Byrne , Mrs. Wagner , and Mr. Boustany ) introduced the following bill; which was referred to the Committee on Energy and Commerce , and in addition to the Committee on Ways and Means , for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To improve access to durable medical equipment for Medicare beneficiaries under the Medicare program, and for other purposes.

1. Short title This Act may be cited as the Patient Access to Durable Medical Equipment Act of 2016 or the PADME Act . 2. Extension of the transition to new payment rates for durable medical equipment under the medicare program The Secretary of Health and Human Services shall extend the transition period described in clause (i) of section 414.210(g)(9) of title 42, Code of Federal Regulations, from June 30, 2016, to September 30, 2017 (with the full implementation described in clause (ii) of such section applying to items and services furnished with dates of service on or after October 1, 2017). 3. Bid ceiling for competitive acquisition for durable medical equipment under the medicare program Section 1847(b)(5) of the Social Security Act ( 42 U.S.C. 1395w–3(b)(5) ) is amended— (1) in subparagraph (A)— (A) by inserting , subject to subparagraph (E), after subsection (a)(2) ; and (B) by inserting , subject to subparagraph (E), after Based on such bids ; and (2) by adding at the end the following new subparagraph: (E) Bid ceiling for durable medical equipment (i) In general The ceiling for a bid submitted for applicable covered items may not be less than the fee schedule amount that would otherwise be determined for such items under section 1834(a), section 1834(h), or section 1842(s)(1) on January 1, 2015, updated by the covered item update for such items under section 1834(a)(14)(L), section 1834(h), or section 1842(s)(1), respectively, as appropriate for the year with respect to which the bid ceiling is established for such applicable covered item. (ii) Application to new covered items The Secretary shall establish a process for purposes of applying clause (i) with respect to applicable covered items for which no fee schedule amount would otherwise be paid under section 1834(a), section 1834(h), or section 1842(s), as appropriate, on January 1, 2015. (iii) Applicable covered items defined For purposes of this subparagraph, the term applicable covered items means competitively priced items and services described in subsection (a)(2) that are furnished with respect to rounds of competition that begin on or after January 1, 2017. . 4. Requirements in determining adjustments using information from competitive bidding programs Section 1834(a)(1)(G) of the Social Security Act ( 42 U.S.C. 1395m(a)(1)(G) ) is amended by adding at the end the following new sentence: In the case of items and services furnished on or after January 1, 2019, in making any adjustments under clause (ii) or (iii) of subparagraph (F), the Secretary shall— (i) solicit and take into account stakeholder input; and (ii) take into account the highest amount bid by a winning supplier in a competitive acquisition area and a comparison of each of the following with respect non-competitive acquisition areas and competitive acquisition areas: (I) The average travel distance and cost associated with furnishing items and services in the area. (II) Any barriers to access for items and services in the area. (III) The average delivery time in furnishing items and services in the area. (IV) The average volume of items and services furnished by suppliers in the area. (V) The number of suppliers in the area. . 5. Monthly report on the results of the monitoring of access of medicare beneficiaries to durable medical equipment and of health outcomes Not later than the first of each month (beginning with May 1, 2016, and ending with September 1, 2017), the Secretary of Health and Human Services shall publish on the Internet website of the Centers for Medicare & Medicaid Services the results of the monitoring of access of Medicare beneficiaries to durable medical equipment and of health outcomes, as described on page 66228 in the final rule published by the Center for Medicare & Medicaid Services on November 6, 2014, and entitled Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (79 Fed. Reg. 66120–66265). 6. Requiring reduction in Federal expenditures to fully offset increased expenditures from this Act It is the sense of Congress that this Act should not be enacted unless the increase in Federal expenditures under this Act is fully offset through a decrease in other Federal expenditures.

tv_txt: IIB 114th CONGRESS 2d Session H. R. 5210 IN THE SENATE OF THE UNITED STATES July 6, 2016 Received; read twice and referred to the Committee on Finance AN ACT To improve access to durable medical equipment for Medicare beneficiaries under the Medicare program, and for other purposes.

1. Short title This Act may be cited as the Patient Access to Durable Medical Equipment Act of 2016 or the PADME 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 on July 1, 2018, in the case of a notification under subsection (a)(41) with respect to a termination for a reason specified in section 455.101 of title 42, Code of Federal Regulations (as in effect on November 1, 2015) or for any other reason specified by the Secretary, of the participation of a provider of services or any other person under the State plan (or under a waiver of the plan), the State, not later than 21 business days after the effective date of such termination, submits to the Secretary with respect to any such provider or person, as appropriate— (i) the name of such provider or person; (ii) the provider type of such provider or person; (iii) the specialty of such provider’s or person’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 provider or person; (v) the reason for the termination; (vi) a copy of the notice of termination sent to the provider or person; (vii) the date on which such termination is effective, as specified in the notice; and (viii) any other information required by the Secretary. (B) Effective date defined For purposes of this paragraph, the term effective date means, with respect to a termination described in subparagraph (A), the later of— (i) the date on which such termination is effective, as specified in the notice of such termination; or (ii) the date on which all appeal rights applicable to such termination have been exhausted or the timeline for any such appeal has expired. . (2) Contract requirement for managed care entities 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) Contract requirement for managed care entities With respect to any contract with a managed care entity under section 1903(m) or 1905(t)(3) (as applicable), no later than July 1, 2018, such contract shall include a provision that providers of services or persons terminated (as described in section 1902(kk)(8)) from participation under this title, title XVIII, or title XXI be terminated from participating under this title as a provider in any network of such entity that serves individuals eligible to receive medical assistance under this title. . (3) 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 a provider of services or any other person whose participation under this title, title XVIII, or title XXI is terminated (as described in subsection (kk)(8)), the Secretary shall, not later than 21 business days after the date on which the Secretary terminates such participation under title XVIII or is notified of such termination under subsection (a)(41) (as applicable), review such termination 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 services furnished by terminated providers Section 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 semicolon; (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 July 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 (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 July 1, 2018, has a contract with such entity that complies with the requirement specified in section 1932(d)(5); and (B) beginning on January 1, 2018, complies with the requirement specified in section 1932(d)(6)(A). . (5) Development of uniform terminology for reasons for provider termination Not later than July 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 establishing uniform terminology to be used with respect to specifying reasons under subparagraph (A)(v) of paragraph (8) of section 1902(kk) of the Social Security 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 providers 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 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 January 1, 2017, in the case of a State plan (or a waiver of the 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) ), as amended by subsection (a)(2), is amended by adding at the end the following new paragraph: (6) Enrollment of participating providers (A) In general Beginning not later than January 1, 2018, a State shall require that, in order to participate as a provider in the network of a managed care entity that provides services to, or orders, prescribes, refers, or certifies eligibility for services for, individuals who are eligible for medical assistance under the State plan under this title (or under a waiver of the plan) and who are enrolled with the entity, the provider is enrolled with the State agency administering the State plan under this title (or waiver of the plan). 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), (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 termination of participation of certain providers). (C) Section 1902(a)(78) (relating to enrollment of providers participating in State plans providing medical assistance on a fee-for-service basis). ; (C) by inserting after subparagraph (K) (as redesignated by subparagraph (A)) the following new subparagraph: (L) Section 1903(m)(3) (relating to limitation on payment with respect to managed care). ; and (D) in subparagraph (P) (as redesignated by subparagraph (A)), by striking (a)(2)(C) and (h) and inserting (a)(2)(C) (relating to Indian enrollment), (d)(5) (relating to contract requirement for managed care entities), (d)(6) (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 waiver of the plan), or any State child health plan under title XXI (or waiver of the plan) . (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. (e) OIG report Not later than March 31, 2020, the Inspector General of the Department of Health and Human Services shall submit to Congress a report on the implementation of the amendments made by this section. Such report shall include the following: (1) An assessment of the extent to which providers who are included under subsection (ll) of section 1902 of the Social Security Act ( 42 U.S.C. 1396a ) (as added by subsection (a)(3)) in the database or similar system referred to in such subsection are terminated (as described in subsection (kk)(8) of such section, as added by subsection (a)(1)) from participation in all State plans under title XIX of such Act (or waivers of such plans). (2) Information on the amount of Federal financial participation paid to States under section 1903 of such Act in violation of the limitation on such payment specified in subsections (i)(2)(D) and (m)(3) of such section, as added by subsection (a)(4) of this section. (3) An assessment of the extent to which contracts with managed care entities under title XIX of such Act comply with the requirement specified in section 1932(d)(5) of such Act, as added by subsection (a)(2) of this section. (4) An assessment of the extent to which providers have been enrolled under section 1902(a)(78) or 1932(d)(6)(A) of such Act ( 42 U.S.C. 1396a(a)(78) , 1396u–2(d)(6)(A)) with State agencies administering State plans under title XIX of such Act (or waivers of such plans). 3. Requiring publication of fee-for-service provider directory (a) In general Section 1902(a) of the Social Security Act ( 42 U.S.C. 1396a(a) ) is amended— (1) in paragraph (80), by striking and at the end; (2) in paragraph (81), by striking the period at the end and inserting ; and ; and (3) by inserting after paragraph (81) the following new paragraph: (82) provide that, not later than January 1, 2017, in the case of a State plan (or waiver of the plan) that provides medical assistance on a fee-for-service basis or through a primary care case-management system described in section 1915(b)(1) (other than a primary care case management entity (as defined by the Secretary)), the State shall publish (and update on at least an annual basis) on the public Website of the State agency administering the State plan, a directory of the physicians described in subsection (mm) and, at State option, other providers described in such subsection that— (A) includes— (i) with respect to each such physician or provider— (I) the name of the physician or provider; (II) the specialty of the physician or provider; (III) the address at which the physician or provider provides services; and (IV) the telephone number of the physician or provider; and (ii) with respect to any such physician or provider participating in such a primary care case-management system, information regarding— (I) whether the physician or provider is accepting as new patients individuals who receive medical assistance under this title; and (II) the physician’s or provider’s cultural and linguistic capabilities, including the languages spoken by the physician or provider or by the skilled medical interpreter providing interpretation services at the physician’s or provider’s office; and (B) may include, at State option, with respect to each such physician or provider— (i) the Internet website of such physician or provider; or (ii) whether the physician or provider is accepting as new patients individuals who receive medical assistance under this title. . (b) Directory physician or provider described Section 1902 of the Social Security Act ( 42 U.S.C. 1396a ), as amended by section 2(a)(3), is further amended by adding at the end the following new subsection: (mm) Directory physician or provider described A physician or provider described in this subsection is— (1) in the case of a physician or provider of a provider type for which the State agency, as a condition on receiving payment for items and services furnished by the physician or provider to individuals eligible to receive medical assistance under the State plan, requires the enrollment of the physician or provider with the State agency, a physician or a provider that— (A) is enrolled with the agency as of the date on which the directory is published or updated (as applicable) under subsection (a)(82); and (B) received payment under the State plan in the 12-month period preceding such date; and (2) in the case of a physician or provider of a provider type for which the State agency does not require such enrollment, a physician or provider that received payment under the State plan (or waiver of the plan) in the 12-month period preceding the date on which the directory is published or updated (as applicable) under subsection (a)(82). . (c) Rule of construction (1) In general The amendment made by subsection (a) shall not be construed to apply in the case of a State (as defined for purposes of title XIX of the Social Security Act) in which all the individuals enrolled in the State plan under such title (or under a waiver of such plan), other than individuals described in paragraph (2), are enrolled with a medicaid managed care organization (as defined in section 1903(m)(1)(A) of such Act ( 42 U.S.C. 1396b(m)(1)(A) )), including prepaid inpatient health plans and prepaid ambulatory health plans (as defined by the Secretary of Health and Human Services). (2) Individuals described An individual described in this paragraph is an individual who is an Indian (as defined in section 4 of the Indian Health Care Improvement Act ( 25 U.S.C. 1603 )) or an Alaska Native. (d) Exception for State legislation In the case of a State plan under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ), which the Secretary of Health and Human Services determines requires State legislation in order for the respective plan to meet one or more additional requirements imposed by amendments made by this section, the respective plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such an additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session shall be considered to be a separate regular session of the State legislature. 4. Extension of the transition to new payment rates for durable medical equipment under the medicare program (a) In general The Secretary of Health and Human Services shall extend the transition period described in clause (i) of section 414.210(g)(9) of title 42, Code of Federal Regulations, from June 30, 2016, to September 30, 2016 (with the full implementation described in clause (ii) of such section applying to items and services furnished with dates of service on or after October 1, 2016). (b) Study and report (1) Study (A) In general The Secretary of Health and Human Services shall conduct a study that examines the impact of applicable payment adjustments upon— (i) the number of suppliers of durable medical equipment that, on a date that is not before January 1, 2016, and not later than September 1, 2016, ceased to conduct business as such suppliers; and (ii) the availability of durable medical equipment, during the period beginning on January 1, 2016, and ending on September 1, 2016, to individuals entitled to benefits under part A of title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ) or enrolled under part B of such title. (B) Definitions For purposes of this subsection, the following definitions apply: (i) Supplier; durable medical equipment The terms supplier and durable medical equipment have the meanings given such terms by section 1861 of the Social Security Act ( 42 U.S.C. 1395x ). (ii) Applicable payment adjustment The term applicable payment adjustment means a payment adjustment described in section 414.210(g) of title 42, Code of Federal Regulations, that is phased in by paragraph (9)(i) of such section. For purposes of the preceding sentence, a payment adjustment that is phased in pursuant to the extension under subsection (a) shall be considered a payment adjustment that is phased in by such paragraph (9)(i). (2) Report The Secretary of Health and Human Services shall, not later than September 10, 2016, submit to the Committees on Ways and Means and on Energy and Commerce of the House of Representatives, and to the Committee on Finance of the Senate, a report on the findings of the study conducted under paragraph (1). 5. Exclusion of payments from State eugenics compensation programs from consideration in determining eligibility for, or the amount of, Federal public benefits (a) In general Notwithstanding any other provision of law, payments made under a State eugenics compensation program shall not be considered as income or resources in determining eligibility for, or the amount of, any Federal public benefit. (b) Definitions For purposes of this section: (1) Federal public benefit The term Federal public benefit means— (A) any grant, contract, loan, professional license, or commercial license provided by an agency of the United States or by appropriated funds of the United States; and (B) any retirement, welfare, health, disability, public or assisted housing, postsecondary education, food assistance, unemployment benefit, or any other similar benefit for which payments or assistance are provided to an individual, household, or family eligibility unit by an agency of the United States or by appropriated funds of the United States. (2) State eugenics compensation program The term State eugenics compensation program means a program established by State law that is intended to compensate individuals who were sterilized under the authority of the State. 6. Deposit of savings into Medicare Improvement Fund Section 1898(b)(1) of the Social Security Act ( 42 U.S.C. 1395iii(b)(1) ) is amended by striking $0 and inserting $3,000,000 .

Passed the House of Representatives July 5, 2016. Karen L. Haas, Clerk

tv_txt: I 114th CONGRESS 2d Session H. R. 5210 IN THE HOUSE OF REPRESENTATIVES AN ACT To improve access to durable medical equipment for Medicare beneficiaries under the Medicare program, and for other purposes.

1. Short title This Act may be cited as the Patient Access to Durable Medical Equipment Act of 2016 or the PADME 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 on July 1, 2018, in the case of a notification under subsection (a)(41) with respect to a termination for a reason specified in section 455.101 of title 42, Code of Federal Regulations (as in effect on November 1, 2015) or for any other reason specified by the Secretary, of the participation of a provider of services or any other person under the State plan (or under a waiver of the plan), the State, not later than 21 business days after the effective date of such termination, submits to the Secretary with respect to any such provider or person, as appropriate— (i) the name of such provider or person; (ii) the provider type of such provider or person; (iii) the specialty of such provider’s or person’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 provider or person; (v) the reason for the termination; (vi) a copy of the notice of termination sent to the provider or person; (vii) the date on which such termination is effective, as specified in the notice; and (viii) any other information required by the Secretary. (B) Effective date defined For purposes of this paragraph, the term effective date means, with respect to a termination described in subparagraph (A), the later of— (i) the date on which such termination is effective, as specified in the notice of such termination; or (ii) the date on which all appeal rights applicable to such termination have been exhausted or the timeline for any such appeal has expired. . (2) Contract requirement for managed care entities 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) Contract requirement for managed care entities With respect to any contract with a managed care entity under section 1903(m) or 1905(t)(3) (as applicable), no later than July 1, 2018, such contract shall include a provision that providers of services or persons terminated (as described in section 1902(kk)(8)) from participation under this title, title XVIII, or title XXI be terminated from participating under this title as a provider in any network of such entity that serves individuals eligible to receive medical assistance under this title. . (3) 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 a provider of services or any other person whose participation under this title, title XVIII, or title XXI is terminated (as described in subsection (kk)(8)), the Secretary shall, not later than 21 business days after the date on which the Secretary terminates such participation under title XVIII or is notified of such termination under subsection (a)(41) (as applicable), review such termination 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 services furnished by terminated providers Section 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 semicolon; (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 July 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 (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 July 1, 2018, has a contract with such entity that complies with the requirement specified in section 1932(d)(5); and (B) beginning on January 1, 2018, complies with the requirement specified in section 1932(d)(6)(A). . (5) Development of uniform terminology for reasons for provider termination Not later than July 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 establishing uniform terminology to be used with respect to specifying reasons under subparagraph (A)(v) of paragraph (8) of section 1902(kk) of the Social Security 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 providers 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 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 January 1, 2017, in the case of a State plan (or a waiver of the 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) ), as amended by subsection (a)(2), is amended by adding at the end the following new paragraph: (6) Enrollment of participating providers (A) In general Beginning not later than January 1, 2018, a State shall require that, in order to participate as a provider in the network of a managed care entity that provides services to, or orders, prescribes, refers, or certifies eligibility for services for, individuals who are eligible for medical assistance under the State plan under this title (or under a waiver of the plan) and who are enrolled with the entity, the provider is enrolled with the State agency administering the State plan under this title (or waiver of the plan). 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), (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 termination of participation of certain providers). (C) Section 1902(a)(78) (relating to enrollment of providers participating in State plans providing medical assistance on a fee-for-service basis). ; (C) by inserting after subparagraph (K) (as redesignated by subparagraph (A)) the following new subparagraph: (L) Section 1903(m)(3) (relating to limitation on payment with respect to managed care). ; and (D) in subparagraph (P) (as redesignated by subparagraph (A)), by striking (a)(2)(C) and (h) and inserting (a)(2)(C) (relating to Indian enrollment), (d)(5) (relating to contract requirement for managed care entities), (d)(6) (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 waiver of the plan), or any State child health plan under title XXI (or waiver of the plan) . (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. (e) OIG report Not later than March 31, 2020, the Inspector General of the Department of Health and Human Services shall submit to Congress a report on the implementation of the amendments made by this section. Such report shall include the following: (1) An assessment of the extent to which providers who are included under subsection (ll) of section 1902 of the Social Security Act ( 42 U.S.C. 1396a ) (as added by subsection (a)(3)) in the database or similar system referred to in such subsection are terminated (as described in subsection (kk)(8) of such section, as added by subsection (a)(1)) from participation in all State plans under title XIX of such Act (or waivers of such plans). (2) Information on the amount of Federal financial participation paid to States under section 1903 of such Act in violation of the limitation on such payment specified in subsections (i)(2)(D) and (m)(3) of such section, as added by subsection (a)(4) of this section. (3) An assessment of the extent to which contracts with managed care entities under title XIX of such Act comply with the requirement specified in section 1932(d)(5) of such Act, as added by subsection (a)(2) of this section. (4) An assessment of the extent to which providers have been enrolled under section 1902(a)(78) or 1932(d)(6)(A) of such Act ( 42 U.S.C. 1396a(a)(78) , 1396u–2(d)(6)(A)) with State agencies administering State plans under title XIX of such Act (or waivers of such plans). 3. Requiring publication of fee-for-service provider directory (a) In general Section 1902(a) of the Social Security Act ( 42 U.S.C. 1396a(a) ) is amended— (1) in paragraph (80), by striking and at the end; (2) in paragraph (81), by striking the period at the end and inserting ; and ; and (3) by inserting after paragraph (81) the following new paragraph: (82) provide that, not later than January 1, 2017, in the case of a State plan (or waiver of the plan) that provides medical assistance on a fee-for-service basis or through a primary care case-management system described in section 1915(b)(1) (other than a primary care case management entity (as defined by the Secretary)), the State shall publish (and update on at least an annual basis) on the public Website of the State agency administering the State plan, a directory of the physicians described in subsection (mm) and, at State option, other providers described in such subsection that— (A) includes— (i) with respect to each such physician or provider— (I) the name of the physician or provider; (II) the specialty of the physician or provider; (III) the address at which the physician or provider provides services; and (IV) the telephone number of the physician or provider; and (ii) with respect to any such physician or provider participating in such a primary care case-management system, information regarding— (I) whether the physician or provider is accepting as new patients individuals who receive medical assistance under this title; and (II) the physician’s or provider’s cultural and linguistic capabilities, including the languages spoken by the physician or provider or by the skilled medical interpreter providing interpretation services at the physician’s or provider’s office; and (B) may include, at State option, with respect to each such physician or provider— (i) the Internet website of such physician or provider; or (ii) whether the physician or provider is accepting as new patients individuals who receive medical assistance under this title. . (b) Directory physician or provider described Section 1902 of the Social Security Act ( 42 U.S.C. 1396a ), as amended by section 2(a)(3), is further amended by adding at the end the following new subsection: (mm) Directory physician or provider described A physician or provider described in this subsection is— (1) in the case of a physician or provider of a provider type for which the State agency, as a condition on receiving payment for items and services furnished by the physician or provider to individuals eligible to receive medical assistance under the State plan, requires the enrollment of the physician or provider with the State agency, a physician or a provider that— (A) is enrolled with the agency as of the date on which the directory is published or updated (as applicable) under subsection (a)(82); and (B) received payment under the State plan in the 12-month period preceding such date; and (2) in the case of a physician or provider of a provider type for which the State agency does not require such enrollment, a physician or provider that received payment under the State plan (or waiver of the plan) in the 12-month period preceding the date on which the directory is published or updated (as applicable) under subsection (a)(82). . (c) Rule of construction (1) In general The amendment made by subsection (a) shall not be construed to apply in the case of a State (as defined for purposes of title XIX of the Social Security Act) in which all the individuals enrolled in the State plan under such title (or under a waiver of such plan), other than individuals described in paragraph (2), are enrolled with a medicaid managed care organization (as defined in section 1903(m)(1)(A) of such Act ( 42 U.S.C. 1396b(m)(1)(A) )), including prepaid inpatient health plans and prepaid ambulatory health plans (as defined by the Secretary of Health and Human Services). (2) Individuals described An individual described in this paragraph is an individual who is an Indian (as defined in section 4 of the Indian Health Care Improvement Act ( 25 U.S.C. 1603 )) or an Alaska Native. (d) Exception for State legislation In the case of a State plan under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ), which the Secretary of Health and Human Services determines requires State legislation in order for the respective plan to meet one or more additional requirements imposed by amendments made by this section, the respective plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such an additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session shall be considered to be a separate regular session of the State legislature. 4. Extension of the transition to new payment rates for durable medical equipment under the medicare program (a) In general The Secretary of Health and Human Services shall extend the transition period described in clause (i) of section 414.210(g)(9) of title 42, Code of Federal Regulations, from June 30, 2016, to September 30, 2016 (with the full implementation described in clause (ii) of such section applying to items and services furnished with dates of service on or after October 1, 2016). (b) Study and report (1) Study (A) In general The Secretary of Health and Human Services shall conduct a study that examines the impact of applicable payment adjustments upon— (i) the number of suppliers of durable medical equipment that, on a date that is not before January 1, 2016, and not later than September 1, 2016, ceased to conduct business as such suppliers; and (ii) the availability of durable medical equipment, during the period beginning on January 1, 2016, and ending on September 1, 2016, to individuals entitled to benefits under part A of title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ) or enrolled under part B of such title. (B) Definitions For purposes of this subsection, the following definitions apply: (i) Supplier; durable medical equipment The terms supplier and durable medical equipment have the meanings given such terms by section 1861 of the Social Security Act ( 42 U.S.C. 1395x ). (ii) Applicable payment adjustment The term applicable payment adjustment means a payment adjustment described in section 414.210(g) of title 42, Code of Federal Regulations, that is phased in by paragraph (9)(i) of such section. For purposes of the preceding sentence, a payment adjustment that is phased in pursuant to the extension under subsection (a) shall be considered a payment adjustment that is phased in by such paragraph (9)(i). (2) Report The Secretary of Health and Human Services shall, not later than September 10, 2016, submit to the Committees on Ways and Means and on Energy and Commerce of the House of Representatives, and to the Committee on Finance of the Senate, a report on the findings of the study conducted under paragraph (1). 5. Exclusion of payments from State eugenics compensation programs from consideration in determining eligibility for, or the amount of, Federal public benefits (a) In general Notwithstanding any other provision of law, payments made under a State eugenics compensation program shall not be considered as income or resources in determining eligibility for, or the amount of, any Federal public benefit. (b) Definitions For purposes of this section: (1) Federal public benefit The term Federal public benefit means— (A) any grant, contract, loan, professional license, or commercial license provided by an agency of the United States or by appropriated funds of the United States; and (B) any retirement, welfare, health, disability, public or assisted housing, postsecondary education, food assistance, unemployment benefit, or any other similar benefit for which payments or assistance are provided to an individual, household, or family eligibility unit by an agency of the United States or by appropriated funds of the United States. (2) State eugenics compensation program The term State eugenics compensation program means a program established by State law that is intended to compensate individuals who were sterilized under the authority of the State. 6. Deposit of savings into Medicare Improvement Fund Section 1898(b)(1) of the Social Security Act ( 42 U.S.C. 1395iii(b)(1) ) is amended by striking $0 and inserting $3,000,000 .

Passed the House of Representatives July 5, 2016. Karen L. Haas, Clerk.