,i #aaeth ,,congress #ast ,session ,h4 ,r4 #acie ,,in ,,the ,,house ,,of ,,representatives ,march #g1 #bjag,mr4 ,burgess 7for himself1 ,mr4 ,collins of ,new ,york1 ,mrs4 ,blackburn1 and ,mr4 ,mullin7 introduced the following bill2 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 7,,macpac74 #a4 ,short title ,this ,act may be cited as the ,,macpac ,improvement ,act of #bjag4 #b4 ,improvement of ,,macpac 7a7 ,duties ,section #aijj7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif7;b77 is amended-- 7#a7 in paragraph 7#a7-- 7,a7 in the heading1 by inserting 1 payment1 financing1 and program integrity after access2 7,b7 in subparagraph 7,a71 by inserting 1 payment1 financing1 or program integrity after affecting access to covered items and services2 7,c7 in subparagraph 7,b71 by striking access2 7,d7 in subparagraph 7,c71 by striking such policies and inserting the following3 policies of such programs relating to financing and program integrity1 including-- 7i7 the implications of such policies with respect to changes in health care delivery in the ,united ,states2 and 7ii7 with respect to the market for health care items and services1 the impact of such policies on the cost and spending growth under such programs2 2 and 7,e7 in subparagraph 7,d71 by striking containing and all that follows through the period and inserting the following3 containing the results of such reviews and ,,macpac's recommendations concerning the policies of such programs relating to access and payment1 including-- 7i7 the implications of such policies with respect to changes in health care delivery in the ,united ,states2 and 7ii7 with respect to the market for health care items and services1 the impact of such policies on access and payment under such programs4 2 7#b7 in paragraph 7#b7-- 7,a7 in subparagraph 7,a7-- 7i7 in clause 7ii71 by striking and at the end2 7ii7 in clause 7iii71 by striking the period at the end and inserting 2 and2 and 7iii7 by adding at the end the following new clause3 7iv7 such payment policies that may result in total payments 7taking into account additional or supplemental payments or payment adjustments7 under this title or title ,,xxi that exceed the cost of providing items and services to ,medicaid or ,,chip beneficiaries 7as applicable7 and changes in such payment policies that could improve efficiency without negatively impacting access to care for such beneficiaries4 2 and 7,b7 by adding at the end the following new subparagraph3 7,i7 ,data ,national and ,state-specific ,medicaid and ,,chip data4 2 7#c7 by amending paragraph 7#c7 to read as follows3 7#c7 ,annual policy recommendations ,not less frequently than once a year1 ,,macpac shall make recommendations regarding ,federal statutes that could be enacted or policies which the ,secretary or ,states could implement to achieve1 with respect to ,medicaid and ,,chip1 the following goals3 7,a7 ,federal and state outlays ,reducing ,federal and ,state outlays to make such programs more sustainable4 7,b7 ,financing ,improving the transparency1 integrity1 and sustainability of financing4 7,c7 ,state flexibility and efficiency ,improving ,state flexibility1 predictability1 accountability1 integrity1 and efficiency in oversight and administration4 7,d7 ,program integrity and reduce waste1 fraud1 and abuse ,enhancing program integrity1 reducing the amount and rate of improper payments1 improving internal administrative and financial controls1 and enhancing efforts to curb waste1 fraud1 and abuse4 7,e7 ,prioritizing the most vulnerable ,prioritizing benefits1 care1 and services for the most vulnerable1 low-income ,medicaid and ,,chip beneficiaries1 such as children and pregnant women whose family income is at or below the ,federal poverty line1 the elderly1 and individuals with disabilities4 7,f7 ,empowering beneficiaries ,improving the independence1 self-direction1 self-sufficiency1 and empowerment of beneficiaries4 2 7#d7 in paragraph 7#d7-- 7,a7 in the heading1 by striking system and inserting systems2 7,b7 by striking ,,macpac shall create and inserting the following3 7,a7 ,system related to access ,,macpac shall create 2 and 7,c7 by adding at the end the following new subparagraph3 7,b7 ,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-term4 ,,macpac shall include in the annual report required under paragraph 7#a77;,c7 a description of such challenges1 including challenges posed by budgetary pressures which could lead to increased ,federal or ,state deficits1 crowd out discretionary ,federal or ,state spending1 or necessitate increases in revenues1 and proposed recommendations for addressing such challenges4 2 7#e7 in paragraph 7#e7-- 7,a7 in the heading1 by striking and regulations and inserting 1 regulations1 and guidance2 7,b7 in subparagraph 7,b71 by inserting financing1 after quality12 and 7,c7 by adding at the end the following new subparagraph3 7,c7 ,,cms guidance ,,macpac shall review guidance issued to ,states by the ,centers for ,medicare ,medicaid ,services with respect to ,medicaid or ,,chip and shall1 not later than the date that is #ij days after the date of such issuance1 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 ,,chip4 2 7#f7 in paragraph 7#g7-- 7,a7 in the heading by inserting and working documents after reports2 7,b7 by striking ,,macpac shall transmit and inserting the following3 7,a7 ,reports ,,macpac shall submit 2 and 7,c7 by adding at the end the following new subparagraph3 7,b7 ,working documents ,,macpac shall make available to the appropriate committees of ,congress copies of draft report chapters1 white papers1 and other materials distributed among members of ,,macpac4 2 7#g7 in paragraph 7#h71 by striking of the ,house of ,representatives and the ,committee on ,finance of the ,senate and inserting 1 the ,committee on ,appropriations1 and the ,committee on ,oversight and ,government ,reform of the ,house of ,representatives and the ,committee on ,finance1 the ,committee on ,homeland ,security and ,governmental ,affairs1 and the ,committee on ,appropriations of the ,senate2 7#h7 in paragraph 7#aj71 by adding at the end the following3 ,for each recommendation that ,,macpac determines would increase ,federal or ,state outlays for ,medicaid or ,,chip1 ,,macpac shall make a recommendation regarding changes in ,federal or ,state policy to offset such increased outlays42 and 7#i7 by adding at the end the following new paragraph3 7#ae7 ,annual report ,not later than three months after the end of a fiscal year1 ,,macpac shall prepare and make available on the ,,macpac website a report with respect to such fiscal year on its activities that includes-- 7,a7 information related to ,,macpac's expenses1 contracts1 accomplishments1 and activities for such fiscal year2 and 7,b7 the status of ,,macpac's recommendations1 including updates on ,federal statutes that have been enacted or policies which the ,secretary or ,states have implemented to effect such recommendations4 4 7b7 ,membership ,section #aijj7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif7;c77 is amended-- 7#a7 by amending paragraph 7#b7 to read as follows3 7#b7 ,qualifications 7,a7 ,in general ,the membership of ,,macpac shall include the following3 7i7 ,at least three individuals representing health care providers1 such as physicians1 nurses1 or dentists4 7ii7 ,at least two individuals representing health plans that enroll ,medicaid or ,,chip beneficiaries1 including one or more individuals representing a ,medicaid managed care plan4 7iii7 ,at least one individual who is an actuary with expertise in health care4 7iv7 ,at least two individuals who are or have been directors of ,medicaid for a ,state1 including at least one individual who is such a director at the time of appointment to ,,macpac4 7v7 ,at least one individual who is or has been a director of ,,chip for a ,state4 7vi7 ,at least one individual with expertise in health care finance and health economics4 7vii7 ,at least two individuals who are representatives of ,medicaid and ,,chip beneficiaries1 such as children1 pregnant women1 the elderly1 and individuals with disabilities4 7viii7 ,at least one individual with expertise in long-term services and supports1 such as in the financing or delivery of long-term services and supports or managed long-term care services1 including care delivered in nursing homes or home and community-based settings4 7,b7 ,inclusion ,the membership of ,,macpac shall include individuals with expertise in-- 7i7 ,federal safety net health programs2 7ii7 developing1 negotiating1 or implementing a ,medicaid waiver based on experience working for a ,state2 7iii7 health care payment and financing reforms2 7iv7 integrated health care delivery systems1 coordinated care models1 and value-based contracting2 7v7 public health2 7vi7 program integrity and fraud prevention2 7vii7 health information technology and telehealth2 7viii7 prescription drug pricing or payment2 and 7ix7 operating a ,medicaid program1 health plan1 hospital1 or health care delivery system4 7,c7 ,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 urban1 suburban1 and rural areas4 7,d7 ,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 perspectives1 including by taking into account political party registration and contributions made to political candidates and parties4 7,e7 ,majority nonproviders 7i7 ,in general ,individuals who are directly involved in the provision1 or management of the delivery1 of items and services covered under ,medicaid or ,,chip shall not constitute a majority of the membership of ,,macpac4 7ii7 ,medicaid and ,,chip directors ,for purposes of this subparagraph1 ,medicaid and ,,chip directors shall not be considered to be directly involved in the provision1 or management of the delivery1 of items and services covered under ,medicaid or ,,chip4 7,f7 ,ethical disclosure 7i7 ,in general ,the ,comptroller ,general of the ,united ,states shall establish a system for the public disclosure of financial1 professional1 political1 advocacy1 or other activities of members of ,,macpac that may result in1 or be perceived to result in1 conflicts of interest relating to such members' service on ,,macpac4 7ii7 ,timing of disclosures ,the ,comptroller ,general shall require that each member of ,,macpac make-- 7,i7 the disclosure described in clause 7i7 on an annual basis2 and 7,,ii7 in the case of a significant change in any of the activities of the member described in such clause1 a supplemental disclosure at the time of such significant change4 7iii7 ,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 #aigh 7,public ,law #ie-eba74 2 and 7#b7 in paragraph 7#e71 by adding at the end the following3 ,such designation shall be based on previous management experience4 ,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 payments1 including a local government1 a health plan that enrolls ,medicaid or ,,chip beneficiaries1 or a health care provider44 7c7 ,conflicts of interest ,section #aijj of the ,social ,security ,act 7#db ,u4,s4,c4 #acif7 is amended by adding at the end the following new subsection3 7g7 ,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 ,,macpac4 ,such policy shall include the following3 7#a7 ,disclosure ,requirements for initially disclosing1 and periodically updating1 any substantial political activity or significant financial interests that might influence1 or that might reasonably appear to influence1 perspectives on issues that could come before ,,macpac4 7#b7 ,legal involvement ,with respect to any matter under adjudication before a court1 administrative law judge1 or other judicial entities3 7,a7 ,a requirement of disclosure of any direct or indirect involvement in any such matter related to a ,federal or ,state health care program 7as such terms are defined in sections #aabh7;h7 and #aabh;,b7f71 respectively71 including filing an amicus brief4 7,b7 ,a prohibition on direct or indirect involvement in any such matter that involves the ,congress as a party1 including filing an amicus brief4 7#c7 ,recusal ,the criteria and circumstances under which a member of ,,macpac shall suspend participation in ,,macpac or otherwise seek recusal from ,,macpac votes1 including the process by which ,,macpac discloses recommendations for such a recusal4 4 7d7 ,application 7#a7 ,duties ,the amendments made by subsection 7a7 7other than the amendments made by paragraph 7#e7 of such subsection7 shall apply with respect to reports 7and recommendations included in reports7 submitted on or after the date that is more than one year after the date of the enactment of this ,act4 7#b7 ,guidance ,the amendments made by subsection 7a77#e7 shall apply with respect to guidance issued on or after the date of the enactment of this ,act4 7#c7 ,membership 7,a7 ,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 7b7 as soon as is practicable1 consistent with subparagraph 7,b71 and in no event later than the date that is three years after the date of the enactment of this ,act4 7,b7 ,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 7b74 7#d7 ,conflicts of interest ,the amendment made by subsection 7c7 shall apply beginning on the date that is #ij days after the date of the enactment of this ,act4