,i  #aahth ,,congress  #b;d ,session    
,h4 ,r4 #haac  ,,in ,,the ,,house ,,of  
,,representatives  ,april #bc1 #bjbd,mr4
 ,griffith 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 require       
reporting on certain directed payments  
under the ,medicaid program4  #a4 ,short
 title ,this ,act may be cited as the   
,transparency into ,state ,directed     
,payments ,act of #bjbd4  #b4 ,state    
directed payment reporting requirements 
,section #aijc of the ,social ,security 
,act 7#db ,u4,s4,c4 #acif;b7 is amended 
by adding at the end the following new  
subsection3  7cc7 ,state directed       
payment reporting requirements  7#a7    
,collection and availability of directed
 payment data  7,a7 ,in general ,not    
later than ,january #a1 #bjbf1 the      
,secretary shall establish a system for 
each ,state to submit a report1 at      
intervals as determined appropriate by  

the ,secretary1 on directed payment     
data1 as a requirement for a ,state plan
 or a ,state plan amendment that would  
provide for a directed payment          
arrangement4  7,b7 ,requirements ,each  
report submitted by a ,state in         
accordance with the requirement         
established under subparagraph 7,a7     
shall include the following3 7i7 ,an    
explanation of how directed payments    
made under the ,state plan or a ,state  
plan amendment will result in payments  
that are consistent with section        
#aijb7;a77#cj77;,a71 including standards
 with respect to efficiency1 economy1   
quality of care1 and access1 along with 
the stated purpose and intended effects 
of the directed payment4  7ii7 ,the     
criteria used to determine which        
providers are eligible to receive the   
directed payment4  7iii7 ,a             
comprehensive description of the        
methodology used to calculate the amount
 of1 and distribute1 the directed       
payment to each eligible provider1      

including-- 7,i7 data on the amount of  
the directed payment made to each       
eligible provider1 if known1 or1 if the 
total amount is distributed using a     
formula based on data from #a or more   
fiscal years1 data on the total amount  
of the directed payments for the fiscal 
year or years available to all providers
 eligible to receive a directed payment2
  7,,ii7 if applicable1 the specific    
criteria with respect to ,medicaid      
service1 utilization1 or cost data to be
 used as the basis for calculations     
regarding the amount or distribution of 
the directed payment2 and  7,,iii7 the  
timing of the directed payment made to  
each eligible provider4  7iv7 ,an       
analysis of how total ,medicaid payments
 made to an eligible provider1 including
 the directed payment1 compare relative 
to the upper payment limit for such     
provider and the average commercial rate
 for the services to which the payment  
relates4  7v7 ,the net payment rate to a
 provider receiving a directed payment  

that is inclusive of base payment rates1
 supplemental payments 7as defined in   
subsection 7bb771 and any such directed 
payments4  7,c7 ,public availability    
,the ,secretary shall make all reports  
and related data submitted under this   
paragraph publicly available on the     
website of the ,centers for ,medicare   
,medicaid ,services on a timely basis4  
7#b7 ,definitions ,in this subsection3  
7,a7 ,directed payment arrangement ,the 
term directed payment arrangement means 
a contract arrangement between a ,state 
and a managed care organization1 prepaid
 ambulatory health plan1 or prepaid     
inpatient health plan that directs the  
expenditures of such managed care       
organization1 prepaid ambulatory health 
plan1 or prepaid inpatient health plan  
in a manner allowable under section     
#dch4f of title #db1 ,code of ,federal  
,regulations 7or any successor          
regulation74  7,b7 ,directed payment    
,the term directed payment means a      
payment to a provider made pursuant to a

 directed payment arrangement4  7,c7    
,prepaid ambulatory health plan2 prepaid
 inpatient health plan ,the terms       
prepaid ambulatory health plan and      
prepaid inpatient health plan have the  
meaning given each such term in section 
#dch4b of title #db1 ,code of ,federal  
,regulations 7or any successor          
regulation74  4