,,ii #aadth ,,congress #b;d ,session ,s4 #bffi ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #aj1 #bjaf,mr4 ,cornyn 7for himself and ,mr4 ,carper7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend titles ,,xix and ,,xxi of the ,social ,security ,act to require ,states to provide to the ,secretary of ,health and ,human ,services certain information with respect to provider terminations1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,ensuring ,removal of ,terminated ,providers from ,medicaid and ,,chip ,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 #bjae71 or for any other reason specified by the ,secretary1 of the participation of a provider of services or any other person under the ,state plan1 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 note74 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 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 and who are enrolled with the entity1 the provider is enrolled with the ,state agency administering the ,state plan under this title4 ,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 title1 or any ,state child health plan under title ,,xxi4 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 ,act4 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#d74 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#b74 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 ,act4