Ensuring Access to Quality Medicaid Providers Act

Bill: 114-hr-3716
Sponsor: full_name: Rep. Bucshon, Larry [R-IN-8]
Introduced: 2015-10-08
Policy area: Health
Subjects: Child health

Government information and archives

Health care costs and insurance

Health personnel

Medicaid

Medicare

State and local government operations
Latest action: action_date: 2016-03-03
text: Received in the Senate and Read twice and referred to the Committee on Finance.

Summaries:
action_date: 2015-10-08
action_desc: Introduced in House
text: <p><b>Ensuring Terminated Providers are Removed from Medicaid and CHIP Act</b></p> <p>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 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.</p> <p>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.</p>

action_date: 2016-02-23
action_desc: Reported to House with amendment(s)
text: <p><b>Ensuring Removal of Terminated Providers from Medicaid and CHIP 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 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>

action_date: 2016-03-02
action_desc: Passed House amended
text: <p><b>Ensuring Access to Quality Medicaid Providers 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>

tv_txt: 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.

tv_txt: IB Union Calendar No. 326 114th CONGRESS 2d Session H. R. 3716 [Report No. 114–427] 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 February 23, 2016 Reported with an amendment, committed to the Committee of the Whole House on the State of the Union, and ordered to be printed Strike out all after the enacting clause and insert the part printed in italic For text of introduced bill, see copy of bill as introduced on October 8, 2015 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 Removal of Terminated Providers 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 on January 1, 2017, 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, 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 effective date of such termination specified in such 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) Reporting requirements 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) State reporting requirements for managed care entities (A) In general With respect to any contract with a managed care entity under section 1903(m) or 1905(t)(3) (as applicable), beginning on the later of the first day of the first plan year for such managed care entity that begins after the date of the enactment of this paragraph or January 1, 2017, the State shall require that such contract 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. (B) Notification of termination For the period beginning on January 1, 2017, and ending on the date on which the enrollment of providers under paragraph (6) is complete for a State, the State shall provide for a system for notifying managed care entities (as defined in subsection (a)(1)) of the termination (as described in section 1902(kk)(8)) of providers of services or persons from participation under this title, title XVIII, or title XXI. . (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 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 (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 contract with such entity that complies with the requirement 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 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 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 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 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 paragraph (1)) 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 paragraph (1)), by striking (a)(2)(C) and (h) and inserting (a)(2)(C) (relating to Indian enrollment), (d)(5) (relating to reporting requirements 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 any State child health plan under title XXI . (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.

February 23, 2016 Reported with an amendment, committed to the Committee of the Whole House on the State of the Union, and ordered to be printed

tv_txt: I 114th CONGRESS 2d Session H. R. 3716 IN THE HOUSE OF REPRESENTATIVES AN ACT 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 Access to Quality Medicaid Providers 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, 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 such subparagraph; 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 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 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 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 any State child health plan under title XXI . (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. (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 subsection (m)(3) of such section, as added by subsection (a)(4). (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). (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. 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 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 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 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.

Passed the House of Representatives March 2, 2016. Karen L. Haas, Clerk.

tv_txt: IIB 114th CONGRESS 2d Session H. R. 3716 IN THE SENATE OF THE UNITED STATES March 3, 2016 Received; read twice and referred to the Committee on Finance AN ACT 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 Access to Quality Medicaid Providers 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, 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 such subparagraph; 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 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 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 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 any State child health plan under title XXI . (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. (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 subsection (m)(3) of such section, as added by subsection (a)(4). (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). (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. 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 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 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 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.

Passed the House of Representatives March 2, 2016. Karen L. Haas, Clerk