#aadth ,,congress #b;d ,session ,h4 ,r4 #ebaj ,,an ,,act ,to improve access to durable medical equipment for ,medicare beneficiaries under the ,medicare program1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,patient ,access to ,durable ,medical ,equipment ,act of #bjaf or the ,,padme ,act4 #b4 ,increasing oversight of termination of ,medicaid providers 7a7 ,increased oversight and reporting 7#a7 ,state reporting requirements ,section #aijb7kk7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7kk77 is amended-- 7,a7 by redesignating paragraph 7#h7 as paragraph 7#i72 and 7,b7 by inserting after paragraph 7#g7 the following new paragraph3 7#h7 ,provider terminations 7,a7 ,in general ,beginning on ,july #a1 #bjah1 in the case of a notification under subsection 7a77#da7 with respect to a termination for a reason specified in section #dee4aja of title #db1 ,code of ,federal ,regulations 7as in effect on ,november #a1 #bjae7 or for any other reason specified by the ,secretary1 of the participation of a provider of services or any other person under the ,state plan 7or under a waiver of the plan71 the ,state1 not later than #ba business days after the effective date of such termination1 submits to the ,secretary with respect to any such provider or person1 as appropriate-- 7i7 the name of such provider or person2 7ii7 the provider type of such provider or person2 7iii7 the specialty of such provider's or person's practice2 7iv7 the date of birth1 ,social ,security number1 national provider identifier1 ,federal taxpayer identification number1 and the ,state license or certification number of such provider or person2 7v7 the reason for the termination2 7vi7 a copy of the notice of termination sent to the provider or person2 7vii7 the date on which such termination is effective1 as specified in the notice2 and 7viii7 any other information required by the ,secretary4 7,b7 ,effective date defined ,for purposes of this paragraph1 the term effective date means1 with respect to a termination described in subparagraph 7,a71 the later of-- 7i7 the date on which such termination is effective1 as specified in the notice of such termination2 or 7ii7 the date on which all appeal rights applicable to such termination have been exhausted or the timeline for any such appeal has expired4 4 7#b7 ,contract requirement for managed care entities ,section #aicb7;d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#b7;d77 is amended by adding at the end the following new paragraph3 7#e7 ,contract requirement for managed care entities ,with respect to any contract with a managed care entity under section #aijc7m7 or #aije7t77#c7 7as applicable71 no later than ,july #a1 #bjah1 such contract shall include a provision that providers of services or persons terminated 7as described in section #aijb7kk77#h77 from participation under this title1 title ,,xviii1 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 title4 4 7#c7 ,termination ,notification ,database ,section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is amended by adding at the end the following new subsection3 7ll7 ,termination notification database ,in the case of a provider of services or any other person whose participation under this title1 title ,,xviii1 or title ,,xxi is terminated 7as described in subsection 7kk77#h771 the ,secretary shall1 not later than #ba business days after the date on which the ,secretary terminates such participation under title ,,xviii or is notified of such termination under subsection 7a77#da7 7as applicable71 review such termination and1 if the ,secretary determines appropriate1 include such termination in any database or similar system developed pursuant to section #fdja7;b77#b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #acie;cc note2 ,public ,law #aaa-adh74 4 7#d7 ,no ,federal funds for items and services furnished by terminated providers ,section #aijc of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 is amended-- 7,a7 in subsection 7i77#b7-- 7i7 in subparagraph 7,a71 by striking the comma at the end and inserting a semicolon2 7ii7 in subparagraph 7,b71 by striking or at the end2 and 7iii7 by adding at the end the following new subparagraph3 7,d7 beginning not later than ,july #a1 #bjah1 under the plan by any provider of services or person whose participation in the ,state plan is terminated 7as described in section #aijb7kk77#h77 after the date that is #fj days after the date on which such termination is included in the database or other system under section #aijb7ll72 or 2 and 7,b7 in subsection 7m71 by inserting after paragraph 7#b7 the following new paragraph3 7#c7 ,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 7as defined under section #aicb7;a77#a77 under the ,state plan under this title 7or under a waiver of the plan7 unless the ,state-- 7,a7 beginning on ,july #a1 #bjah1 has a contract with such entity that complies with the requirement specified in section #aicb7;d77#e72 and 7,b7 beginning on ,january #a1 #bjah1 complies with the requirement specified in section #aicb7;d77#f77;,a74 4 7#e7 ,development of uniform terminology for reasons for provider termination ,not later than ,july #a1 #bjag1 the ,secretary of ,health and ,human ,services shall1 in consultation with the heads of ,state agencies administering ,state ,medicaid plans 7or waivers of such plans71 issue regulations establishing uniform terminology to be used with respect to specifying reasons under subparagraph 7,a77v7 of paragraph 7#h7 of section #aijb7kk7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7kk771 as amended by paragraph 7#a71 for the termination 7as described in such paragraph7 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 ,act4 7#f7 ,conforming amendment ,section #aijb7;a77#da7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#da77 is amended by striking provide that whenever and inserting provide1 in accordance with subsection 7kk77#h7 7as applicable71 that whenever4 7b7 ,increasing availability of ,medicaid provider information 7#a7 ,,ffs provider enrollment ,section #aijb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77 is amended by inserting after paragraph 7#gg7 the following new paragraph3 7#gh7 provide that1 not later than ,january #a1 #bjag1 in the case of a ,state plan 7or a waiver of the plan7 that provides medical assistance on a fee-for-service basis1 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 information1 including the name1 specialty1 date of birth1 ,social ,security number1 national provider identifier1 ,federal taxpayer identification number1 and the ,state license or certification number of the provider2 4 7#b7 ,managed care provider enrollment ,section #aicb7;d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#b7;d771 as amended by subsection 7a77#b71 is amended by adding at the end the following new paragraph3 7#f7 ,enrollment of participating providers 7,a7 ,in general ,beginning not later than ,january #a1 #bjah1 a ,state shall require that1 in order to participate as a provider in the network of a managed care entity that provides services to1 or orders1 prescribes1 refers1 or certifies eligibility for services for1 individuals who are eligible for medical assistance under the ,state plan under this title 7or under a waiver of the plan7 and who are enrolled with the entity1 the provider is enrolled with the ,state agency administering the ,state plan under this title 7or waiver of the plan74 ,such enrollment shall include providing to the ,state agency the provider's identifying information1 including the name1 specialty1 date of birth1 ,social ,security number1 national provider identifier1 ,federal taxpayer identification number1 and the ,state license or certification number of the provider4 7,b7 ,rule of construction ,nothing in subparagraph 7,a7 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 title4 4 7c7 ,coordination with ,,chip 7#a7 ,in general ,section #bajg7;e77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7e77#a77 is amended-- 7,a7 by redesignating subparagraphs 7,b71 7,c71 7,d71 7,e71 7,f71 7,g71 7,h71 7,i71 7,j71 7,k71 7,l71 7,m71 7,n71 and 7,o7 as subparagraphs 7,d71 7,e71 7,f71 7,g71 7,h71 7,i71 7,j71 7,k71 7,m71 7,n71 7,o71 7,p71 7,q71 and 7,r71 respectively2 7,b7 by inserting after subparagraph 7,a7 the following new subparagraphs3 7,b7 ,section #aijb7;a77#ci7 7relating to termination of participation of certain providers74 7,c7 ,section #aijb7;a77#gh7 7relating to enrollment of providers participating in ,state plans providing medical assistance on a fee-for-service basis74 2 7,c7 by inserting after subparagraph 7,k7 7as redesignated by subparagraph 7,a77 the following new subparagraph3 7,l7 ,section #aijc7m77#c7 7relating to limitation on payment with respect to managed care74 2 and 7,d7 in subparagraph 7,p7 7as redesignated by subparagraph 7,a771 by striking 7a77#b77;,c7 and 7h7 and inserting 7a77#b77;,c7 7relating to ,indian enrollment71 7d77#e7 7relating to contract requirement for managed care entities71 7d77#f7 7relating to enrollment of providers participating with a managed care entity71 and 7h7 7relating to special rules with respect to ,indian enrollees1 ,indian health care providers1 and ,indian managed care entities74 7#b7 ,excluding from ,medicaid providers excluded from ,,chip ,section #aijb7;a77#ci7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#ci77 is amended by striking title ,,xviii or any other ,state plan under this title and inserting title ,,xviii1 any other ,state plan under this title 7or waiver of the plan71 or any ,state child health plan under title ,,xxi 7or waiver of the plan74 7d7 ,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 ,act4 7e7 ,,oig report ,not later than ,march #ca1 #bjbj1 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 section4 ,such report shall include the following3 7#a7 ,an assessment of the extent to which providers who are included under subsection 7ll7 of section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 7as added by subsection 7a77#c77 in the database or similar system referred to in such subsection are terminated 7as described in subsection 7kk77#h7 of such section1 as added by subsection 7a77#a77 from participation in all ,state plans under title ,,xix of such ,act 7or waivers of such plans74 7#b7 ,information on the amount of ,federal financial participation paid to ,states under section #aijc of such ,act in violation of the limitation on such payment specified in subsections 7i77#b77;,d7 and 7m77#c7 of such section1 as added by subsection 7a77#d7 of this section4 7#c7 ,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 #aicb7;d77#e7 of such ,act1 as added by subsection 7a77#b7 of this section4 7#d7 ,an assessment of the extent to which providers have been enrolled under section #aijb7;a77#gh7 or #aicb7;d77#f77;,a7 of such ,act 7#db ,u4,s4,c4 #acif;a7a77#gh71 #acifu-#b7;d77#f77;,a77 with ,state agencies administering ,state plans under title ,,xix of such ,act 7or waivers of such plans74 #c4 ,requiring publication of fee-for-service provider directory 7a7 ,in general ,section #aijb7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77 is amended-- 7#a7 in paragraph 7#hj71 by striking and at the end2 7#b7 in paragraph 7#ha71 by striking the period at the end and inserting 2 and2 and 7#c7 by inserting after paragraph 7#ha7 the following new paragraph3 7#hb7 provide that1 not later than ,january #a1 #bjag1 in the case of a ,state plan 7or waiver of the plan7 that provides medical assistance on a fee-for-service basis or through a primary care case-management system described in section #aiae7;b77#a7 7other than a primary care case management entity 7as defined by the ,secretary771 the ,state shall publish 7and update on at least an annual basis7 on the public ,website of the ,state agency administering the ,state plan1 a directory of the physicians described in subsection 7mm7 and1 at ,state option1 other providers described in such subsection that-- 7,a7 includes-- 7i7 with respect to each such physician or provider-- 7,i7 the name of the physician or provider2 7,,ii7 the specialty of the physician or provider2 7,,iii7 the address at which the physician or provider provides services2 and 7,,iv7 the telephone number of the physician or provider2 and 7ii7 with respect to any such physician or provider participating in such a primary care case-management system1 information regarding-- 7,i7 whether the physician or provider is accepting as new patients individuals who receive medical assistance under this title2 and 7,,ii7 the physician's or provider's cultural and linguistic capabilities1 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 office2 and 7,b7 may include1 at ,state option1 with respect to each such physician or provider-- 7i7 the ,internet website of such physician or provider2 or 7ii7 whether the physician or provider is accepting as new patients individuals who receive medical assistance under this title4 4 7b7 ,directory physician or provider described ,section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a71 as amended by section #b7;a77#c71 is further amended by adding at the end the following new subsection3 7mm7 ,directory physician or provider described ,a physician or provider described in this subsection is-- 7#a7 in the case of a physician or provider of a provider type for which the ,state agency1 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 plan1 requires the enrollment of the physician or provider with the ,state agency1 a physician or a provider that-- 7,a7 is enrolled with the agency as of the date on which the directory is published or updated 7as applicable7 under subsection 7a77#hb72 and 7,b7 received payment under the ,state plan in the #ab-month period preceding such date2 and 7#b7 in the case of a physician or provider of a provider type for which the ,state agency does not require such enrollment1 a physician or provider that received payment under the ,state plan 7or waiver of the plan7 in the #ab-month period preceding the date on which the directory is published or updated 7as applicable7 under subsection 7a77#hb74 4 7c7 ,rule of construction 7#a7 ,in general ,the amendment made by subsection 7a7 shall not be construed to apply in the case of a ,state 7as defined for purposes of title ,,xix of the ,social ,security ,act7 in which all the individuals enrolled in the ,state plan under such title 7or under a waiver of such plan71 other than individuals described in paragraph 7#b71 are enrolled with a medicaid managed care organization 7as defined in section #aijc7m77#a77;,a7 of such ,act 7#db ,u4,s4,c4 #acif;b7m77#a77;,a7771 including prepaid inpatient health plans and prepaid ambulatory health plans 7as defined by the ,secretary of ,health and ,human ,services74 7#b7 ,individuals described ,an individual described in this paragraph is an individual who is an ,indian 7as defined in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc77 or an ,alaska ,native4 7d7 ,exception for ,state legislation ,in the case of a ,state plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 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 section1 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 ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of the session shall be considered to be a separate regular session of the ,state legislature4 #d4 ,extension of the transition to new payment rates for durable medical equipment under the medicare program 7a7 ,in general ,the ,secretary of ,health and ,human ,services shall extend the transition period described in clause 7i7 of section #dad4baj7;g77#i7 of title #db1 ,code of ,federal ,regulations1 from ,june #cj1 #bjaf1 to ,september #cj1 #bjaf 7with the full implementation described in clause 7ii7 of such section applying to items and services furnished with dates of service on or after ,october #a1 #bjaf74 7b7 ,study and report 7#a7 ,study 7,a7 ,in general ,the ,secretary of ,health and ,human ,services shall conduct a study that examines the impact of applicable payment adjustments upon-- 7i7 the number of suppliers of durable medical equipment that1 on a date that is not before ,january #a1 #bjaf1 and not later than ,september #a1 #bjaf1 ceased to conduct business as such suppliers2 and 7ii7 the availability of durable medical equipment1 during the period beginning on ,january #a1 #bjaf1 and ending on ,september #a1 #bjaf1 to individuals entitled to benefits under part ,a of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 or enrolled under part ,b of such title4 7,b7 ,definitions ,for purposes of this subsection1 the following definitions apply3 7i7 ,supplier2 durable medical equipment ,the terms supplier and durable medical equipment have the meanings given such terms by section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex74 7ii7 ,applicable payment adjustment ,the term applicable payment adjustment means a payment adjustment described in section #dad4baj7;g7 of title #db1 ,code of ,federal ,regulations1 that is phased in by paragraph 7#i77;i7 of such section4 ,for purposes of the preceding sentence1 a payment adjustment that is phased in pursuant to the extension under subsection 7a7 shall be considered a payment adjustment that is phased in by such paragraph 7#i77;i74 7#b7 ,report ,the ,secretary of ,health and ,human ,services shall1 not later than ,september #aj1 #bjaf1 submit to the ,committees on ,ways and ,means and on ,energy and ,commerce of the ,house of ,representatives1 and to the ,committee on ,finance of the ,senate1 a report on the findings of the study conducted under paragraph 7#a74 #e4 ,exclusion of payments from ,state eugenics compensation programs from consideration in determining eligibility for1 or the amount of1 ,federal public benefits 7a7 ,in general ,notwithstanding any other provision of law1 payments made under a ,state eugenics compensation program shall not be considered as income or resources in determining eligibility for1 or the amount of1 any ,federal public benefit4 7b7 ,definitions ,for purposes of this section3 7#a7 ,federal public benefit ,the term ,federal public benefit means-- 7,a7 any grant1 contract1 loan1 professional license1 or commercial license provided by an agency of the ,united ,states or by appropriated funds of the ,united ,states2 and 7,b7 any retirement1 welfare1 health1 disability1 public or assisted housing1 postsecondary education1 food assistance1 unemployment benefit1 or any other similar benefit for which payments or assistance are provided to an individual1 household1 or family eligibility unit by an agency of the ,united ,states or by appropriated funds of the ,united ,states4 7#b7 ,state eugenics compensation program ,the term ,state eugenics compensation program means a program established by ,state law that is intended to compensate individuals who were sterilized under the authority of the ,state4 #f4 ,deposit of savings into ,medicare ,improvement ,fund ,section #ahih7;b77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;iii7b77#a77 is amended by striking #j and inserting #c1jjj1jjj4 ,passed the ,house of ,representatives ,july #e1 #bjaf4;,clerk4