[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1395 Introduced in House (IH)]
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115th CONGRESS
1st Session
H. R. 1395
To amend title XIX of the Social Security Act to improve the Medicaid
and CHIP Payment and Access Commission (MACPAC).
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 7, 2017
Mr. Burgess (for himself, Mr. Collins of New York, Mrs. Blackburn, and
Mr. Mullin) 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 improve the Medicaid
and CHIP Payment and Access Commission (MACPAC).
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 ``MACPAC Improvement Act of 2017''.
SEC. 2. IMPROVEMENT OF MACPAC.
(a) Duties.--Section 1900(b) of the Social Security Act (42 U.S.C.
1396(b)) is amended--
(1) in paragraph (1)--
(A) in the heading, by inserting ``, payment,
financing, and program integrity'' after ``access'';
(B) in subparagraph (A), by inserting ``, payment,
financing, or program integrity'' after ``affecting
access to covered items and services'';
(C) in subparagraph (B), by striking ``access'';
(D) in subparagraph (C), by striking ``such
policies'' and inserting the following: ``policies of
such programs relating to financing and program
integrity, including--
``(i) the implications of such policies
with respect to changes in health care delivery
in the United States; and
``(ii) with respect to the market for
health care items and services, the impact of
such policies on the cost and spending growth
under such programs;''; and
(E) in subparagraph (D), by striking ``containing''
and all that follows through the period and inserting
the following: ``containing the results of such reviews
and MACPAC's recommendations concerning the policies of
such programs relating to access and payment,
including--
``(i) the implications of such policies
with respect to changes in health care delivery
in the United States; and
``(ii) with respect to the market for
health care items and services, the impact of
such policies on access and payment under such
programs.'';
(2) in paragraph (2)--
(A) in subparagraph (A)--
(i) in clause (ii), by striking ``and'' at
the end;
(ii) in clause (iii), by striking the
period at the end and inserting ``; and''; and
(iii) by adding at the end the following
new clause:
``(iv) such payment policies that may
result in total payments (taking into account
additional or supplemental payments or payment
adjustments) under this title or title XXI that
exceed the cost of providing items and services
to Medicaid or CHIP beneficiaries (as
applicable) and changes in such payment
policies that could improve efficiency without
negatively impacting access to care for such
beneficiaries.''; and
(B) by adding at the end the following new
subparagraph:
``(I) Data.--National and State-specific Medicaid
and CHIP data.'';
(3) by amending paragraph (3) to read as follows:
``(3) Annual policy recommendations.--Not less frequently
than once a year, MACPAC shall make recommendations regarding
Federal statutes that could be enacted or policies which the
Secretary or States could implement to achieve, with respect to
Medicaid and CHIP, the following goals:
``(A) Federal and state outlays.--Reducing Federal
and State outlays to make such programs more
sustainable.
``(B) Financing.--Improving the transparency,
integrity, and sustainability of financing.
``(C) State flexibility and efficiency.--Improving
State flexibility, predictability, accountability,
integrity, and efficiency in oversight and
administration.
``(D) Program integrity and reduce waste, fraud,
and abuse.--Enhancing program integrity, reducing the
amount and rate of improper payments, improving
internal administrative and financial controls, and
enhancing efforts to curb waste, fraud, and abuse.
``(E) Prioritizing the most vulnerable.--
Prioritizing benefits, care, and services for the most
vulnerable, low-income Medicaid and CHIP beneficiaries,
such as children and pregnant women whose family income
is at or below the Federal poverty line, the elderly,
and individuals with disabilities.
``(F) Empowering beneficiaries.--Improving the
independence, self-direction, self-sufficiency, and
empowerment of beneficiaries.'';
(4) in paragraph (4)--
(A) in the heading, by striking ``system'' and
inserting ``systems'';
(B) by striking ``MACPAC shall create'' and
inserting the following:
``(A) System related to access.--MACPAC shall
create''; and
(C) by adding at the end the following new
subparagraph:
``(B) System related to program growth.--MACPAC
shall create an early-warning system to identify
challenges with sustaining Federal and State funding
for Medicaid during the mid-term and long-term. MACPAC
shall include in the annual report required under
paragraph (1)(C) a description of such challenges,
including challenges posed by budgetary pressures which
could lead to increased Federal or State deficits,
crowd out discretionary Federal or State spending, or
necessitate increases in revenues, and proposed
recommendations for addressing such challenges.'';
(5) in paragraph (5)--
(A) in the heading, by striking ``and regulations''
and inserting ``, regulations, and guidance'';
(B) in subparagraph (B), by inserting
``financing,'' after ``quality,''; and
(C) by adding at the end the following new
subparagraph:
``(C) CMS guidance.--MACPAC shall review guidance
issued to States by the Centers for Medicare & Medicaid
Services with respect to Medicaid or CHIP and shall,
not later than the date that is 90 days after the date
of such issuance, submit a report to the appropriate
committees of Congress and the Secretary on the degree
to which such guidance is projected to change Federal
or State outlays for Medicaid or CHIP.'';
(6) in paragraph (7)--
(A) in the heading by inserting ``and working
documents'' after ``reports'';
(B) by striking ``MACPAC shall transmit'' and
inserting the following:
``(A) Reports.--MACPAC shall submit''; and
(C) by adding at the end the following new
subparagraph:
``(B) Working documents.--MACPAC shall make
available to the appropriate committees of Congress
copies of draft report chapters, white papers, and
other materials distributed among members of MACPAC.'';
(7) in paragraph (8), by striking ``of the House of
Representatives and the Committee on Finance of the Senate''
and inserting ``, the Committee on Appropriations, and the
Committee on Oversight and Government Reform of the House of
Representatives and the Committee on Finance, the Committee on
Homeland Security and Governmental Affairs, and the Committee
on Appropriations of the Senate'';
(8) in paragraph (10), by adding at the end the following:
``For each recommendation that MACPAC determines would increase
Federal or State outlays for Medicaid or CHIP, MACPAC shall
make a recommendation regarding changes in Federal or State
policy to offset such increased outlays.''; and
(9) by adding at the end the following new paragraph:
``(15) Annual report.--Not later than three months after
the end of a fiscal year, MACPAC shall prepare and make
available on the MACPAC website a report with respect to such
fiscal year on its activities that includes--
``(A) information related to MACPAC's expenses,
contracts, accomplishments, and activities for such
fiscal year; and
``(B) the status of MACPAC's recommendations,
including updates on Federal statutes that have been
enacted or policies which the Secretary or States have
implemented to effect such recommendations.''.
(b) Membership.--Section 1900(c) of the Social Security Act (42
U.S.C. 1396(c)) is amended--
(1) by amending paragraph (2) to read as follows:
``(2) Qualifications.--
``(A) In general.--The membership of MACPAC shall
include the following:
``(i) At least three individuals
representing health care providers, such as
physicians, nurses, or dentists.
``(ii) At least two individuals
representing health plans that enroll Medicaid
or CHIP beneficiaries, including one or more
individuals representing a Medicaid managed
care plan.
``(iii) At least one individual who is an
actuary with expertise in health care.
``(iv) At least two individuals who are or
have been directors of Medicaid for a State,
including at least one individual who is such a
director at the time of appointment to MACPAC.
``(v) At least one individual who is or has
been a director of CHIP for a State.
``(vi) At least one individual with
expertise in health care finance and health
economics.
``(vii) At least two individuals who are
representatives of Medicaid and CHIP
beneficiaries, such as children, pregnant
women, the elderly, and individuals with
disabilities.
``(viii) At least one individual with
expertise in long-term services and supports,
such as in the financing or delivery of long-
term services and supports or managed long-term
care services, including care delivered in
nursing homes or home and community-based
settings.
``(B) Inclusion.--The membership of MACPAC shall
include individuals with expertise in--
``(i) Federal safety net health programs;
``(ii) developing, negotiating, or
implementing a Medicaid waiver based on
experience working for a State;
``(iii) health care payment and financing
reforms;
``(iv) integrated health care delivery
systems, coordinated care models, and value-
based contracting;
``(v) public health;
``(vi) program integrity and fraud
prevention;
``(vii) health information technology and
telehealth;
``(viii) prescription drug pricing or
payment; and
``(ix) operating a Medicaid program, health
plan, hospital, or health care delivery system.
``(C) Diversity.--The membership of MACPAC shall
also provide representation from a variety of different
professions and geographic areas and provide for a
balanced representation among urban, suburban, and
rural areas.
``(D) Balance of perspectives.--The Comptroller
General of the United States shall ensure members
appointed for initial or subsequent terms to MACPAC
reflect an appropriate balance of political
perspectives, including by taking into account
political party registration and contributions made to
political candidates and parties.
``(E) Majority nonproviders.--
``(i) In general.--Individuals who are
directly involved in the provision, or
management of the delivery, of items and
services covered under Medicaid or CHIP shall
not constitute a majority of the membership of
MACPAC.
``(ii) Medicaid and chip directors.--For
purposes of this subparagraph, Medicaid and
CHIP directors shall not be considered to be
directly involved in the provision, or
management of the delivery, of items and
services covered under Medicaid or CHIP.
``(F) Ethical disclosure.--
``(i) In general.--The Comptroller General
of the United States shall establish a system
for the public disclosure of financial,
professional, political, advocacy, or other
activities of members of MACPAC that may result
in, or be perceived to result in, conflicts of
interest relating to such members' service on
MACPAC.
``(ii) Timing of disclosures.--The
Comptroller General shall require that each
member of MACPAC make--
``(I) the disclosure described in
clause (i) on an annual basis; and
``(II) in the case of a significant
change in any of the activities of the
member described in such clause, a
supplemental disclosure at the time of
such significant change.
``(iii) Treatment as employees of
congress.--Members of MACPAC shall be treated
as employees of Congress for purposes of
applying title I of the Ethics in Government
Act of 1978 (Public Law 95-521).''; and
(2) in paragraph (5), by adding at the end the following:
``Such designation shall be based on previous management
experience. The Comptroller General may not exclude a member
from consideration for such designation based on the fact that
such member is an individual employed by a State or by an
entity that receives Medicaid or CHIP payments, including a
local government, a health plan that enrolls Medicaid or CHIP
beneficiaries, or a health care provider.''.
(c) Conflicts of Interest.--Section 1900 of the Social Security Act
(42 U.S.C. 1396) is amended by adding at the end the following new
subsection:
``(g) Conflict of Interest Policy.--MACPAC shall maintain and make
available on the MACPAC website a conflict of interest policy outlining
requirements for members and personnel of MACPAC. Such policy shall
include the following:
``(1) Disclosure.--Requirements for initially disclosing,
and periodically updating, any substantial political activity
or significant financial interests that might influence, or
that might reasonably appear to influence, perspectives on
issues that could come before MACPAC.
``(2) Legal involvement.--With respect to any matter under
adjudication before a court, administrative law judge, or other
judicial entities:
``(A) A requirement of disclosure of any direct or
indirect involvement in any such matter related to a
Federal or State health care program (as such terms are
defined in sections 1128(h) and 1128B(f),
respectively), including filing an amicus brief.
``(B) A prohibition on direct or indirect
involvement in any such matter that involves the
Congress as a party, including filing an amicus brief.
``(3) Recusal.--The criteria and circumstances under which
a member of MACPAC shall suspend participation in MACPAC or
otherwise seek recusal from MACPAC votes, including the process
by which MACPAC discloses recommendations for such a
recusal.''.
(d) Application.--
(1) Duties.--The amendments made by subsection (a) (other
than the amendments made by paragraph (5) of such subsection)
shall apply with respect to reports (and recommendations
included in reports) submitted on or after the date that is
more than one year after the date of the enactment of this Act.
(2) Guidance.--The amendments made by subsection (a)(5)
shall apply with respect to guidance issued on or after the
date of the enactment of this Act.
(3) Membership.--
(A) Appointment of new members.--The Comptroller
General of the United States shall apply the changes to
the membership of the Medicaid and CHIP Payment and
Access Commission required by amendments made by
subsection (b) as soon as is practicable, consistent
with subparagraph (B), and in no event later than the
date that is three years after the date of the
enactment of this Act.
(B) Retention of current members.--An individual
who is a member of the Medicaid and CHIP Payment and
Access Commission as of the date of the enactment of
this Act may continue to serve until the end of the
individual's term as of such date without regard to the
amendments made by subsection (b).
(4) Conflicts of interest.--The amendment made by
subsection (c) shall apply beginning on the date that is 90
days after the date of the enactment of this Act.
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