[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3716 Engrossed in House (EH)]
<DOC>
114th CONGRESS
2d Session
H. R. 3716
_______________________________________________________________________
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.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Ensuring Access to Quality Medicaid
Providers Act''.
SEC. 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.
SEC. 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.
Attest:
Clerk.
114th CONGRESS
2d Session
H. R. 3716
_______________________________________________________________________
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.