[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5210 Referred in Senate (RFS)]
<DOC>
114th CONGRESS
2d Session
H. R. 5210
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 6, 2016
Received; read twice and referred to the Committee on Finance
_______________________________________________________________________
AN ACT
To improve access to durable medical equipment for Medicare
beneficiaries under the Medicare program, and for other purposes.
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 ``Patient Access to Durable Medical
Equipment Act of 2016'' or the ``PADME Act''.
SEC. 2. INCREASING OVERSIGHT OF TERMINATION OF MEDICAID PROVIDERS.
(a) Increased Oversight and Reporting.--
(1) State reporting requirements.--Section 1902(kk) of the
Social Security Act (42 U.S.C. 1396a(kk)) is amended--
(A) by redesignating paragraph (8) as paragraph
(9); and
(B) by inserting after paragraph (7) the following
new paragraph:
``(8) Provider terminations.--
``(A) In general.--Beginning on July 1, 2018, in
the case of a notification under subsection (a)(41)
with respect to a termination for a reason specified in
section 455.101 of title 42, Code of Federal
Regulations (as in effect on November 1, 2015) or for
any other reason specified by the Secretary, of the
participation of a provider of services or any other
person under the State plan (or under a waiver of the
plan), the State, not later than 21 business days after
the effective date of such termination, submits to the
Secretary with respect to any such provider or person,
as appropriate--
``(i) the name of such provider or person;
``(ii) the provider type of such provider
or person;
``(iii) the specialty of such provider's or
person's practice;
``(iv) the date of birth, Social Security
number, national provider identifier, Federal
taxpayer identification number, and the State
license or certification number of such
provider or person;
``(v) the reason for the termination;
``(vi) a copy of the notice of termination
sent to the provider or person;
``(vii) the date on which such termination
is effective, as specified in the notice; and
``(viii) any other information required by
the Secretary.
``(B) Effective date defined.--For purposes of this
paragraph, the term `effective date' means, with
respect to a termination described in subparagraph (A),
the later of--
``(i) the date on which such termination is
effective, as specified in the notice of such
termination; or
``(ii) the date on which all appeal rights
applicable to such termination have been
exhausted or the timeline for any such appeal
has expired.''.
(2) Contract requirement for managed care entities.--
Section 1932(d) of the Social Security Act (42 U.S.C. 1396u-
2(d)) is amended by adding at the end the following new
paragraph:
``(5) Contract requirement for managed care entities.--With
respect to any contract with a managed care entity under
section 1903(m) or 1905(t)(3) (as applicable), no later than
July 1, 2018, such contract shall include a provision that
providers of services or persons terminated (as described in
section 1902(kk)(8)) from participation under this title, title
XVIII, 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
title.''.
(3) Termination notification database.--Section 1902 of the
Social Security Act (42 U.S.C. 1396a) is amended by adding at
the end the following new subsection:
``(ll) Termination Notification Database.--In the case of a
provider of services or any other person whose participation under this
title, title XVIII, or title XXI is terminated (as described in
subsection (kk)(8)), the Secretary shall, not later than 21 business
days after the date on which the Secretary terminates such
participation under title XVIII or is notified of such termination
under subsection (a)(41) (as applicable), review such termination and,
if the Secretary determines appropriate, include such termination in
any database or similar system developed pursuant to section 6401(b)(2)
of the Patient Protection and Affordable Care Act (42 U.S.C. 1395cc
note; Public Law 111-148).''.
(4) No federal funds for items and services furnished by
terminated providers.--Section 1903 of the Social Security Act
(42 U.S.C. 1396b) is amended--
(A) in subsection (i)(2)--
(i) in subparagraph (A), by striking the
comma at the end and inserting a semicolon;
(ii) in subparagraph (B), by striking
``or'' at the end; and
(iii) by adding at the end the following
new subparagraph:
``(D) beginning not later than July 1, 2018, under
the plan by any provider of services or person whose
participation in the State plan is terminated (as
described in section 1902(kk)(8)) after the date that
is 60 days after the date on which such termination is
included in the database or other system under section
1902(ll); or''; and
(B) in subsection (m), by inserting after paragraph
(2) the following new paragraph:
``(3) 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 (as defined under section 1932(a)(1))
under the State plan under this title (or under a waiver of the plan)
unless the State--
``(A) beginning on July 1, 2018, has a contract with such
entity that complies with the requirement specified in section
1932(d)(5); and
``(B) beginning on January 1, 2018, complies with the
requirement specified in section 1932(d)(6)(A).''.
(5) Development of uniform terminology for reasons for
provider termination.--Not later than July 1, 2017, the
Secretary of Health and Human Services shall, in consultation
with the heads of State agencies administering State Medicaid
plans (or waivers of such plans), issue regulations
establishing uniform terminology to be used with respect to
specifying reasons under subparagraph (A)(v) of paragraph (8)
of section 1902(kk) of the Social Security Act (42 U.S.C.
1396a(kk)), as amended by paragraph (1), for the termination
(as described in such paragraph) 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 Act.
(6) Conforming amendment.--Section 1902(a)(41) of the
Social Security Act (42 U.S.C. 1396a(a)(41)) is amended by
striking ``provide that whenever'' and inserting ``provide, in
accordance with subsection (kk)(8) (as applicable), that
whenever''.
(b) Increasing Availability of Medicaid Provider Information.--
(1) FFS provider enrollment.--Section 1902(a) of the Social
Security Act (42 U.S.C. 1396a(a)) is amended by inserting after
paragraph (77) the following new paragraph:
``(78) provide that, not later than January 1, 2017, in the
case of a State plan (or a waiver of the plan) that provides
medical assistance on a fee-for-service basis, 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 information, including the
name, specialty, date of birth, Social Security number,
national provider identifier, Federal taxpayer identification
number, and the State license or certification number of the
provider;''.
(2) Managed care provider enrollment.--Section 1932(d) of
the Social Security Act (42 U.S.C. 1396u-2(d)), as amended by
subsection (a)(2), is amended by adding at the end the
following new paragraph:
``(6) Enrollment of participating providers.--
``(A) In general.--Beginning not later than January
1, 2018, a State shall require that, in order to
participate as a provider in the network of a managed
care entity that provides services to, or orders,
prescribes, refers, or certifies eligibility for
services for, individuals who are eligible for medical
assistance under the State plan under this title (or
under a waiver of the plan) and who are enrolled with
the entity, the provider is enrolled with the State
agency administering the State plan under this title
(or waiver of the plan). Such enrollment shall include
providing to the State agency the provider's
identifying information, including the name, specialty,
date of birth, Social Security number, national
provider identifier, Federal taxpayer identification
number, and the State license or certification number
of the provider.
``(B) Rule of construction.--Nothing in
subparagraph (A) 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 title.''.
(c) Coordination With CHIP.--
(1) In general.--Section 2107(e)(1) of the Social Security
Act (42 U.S.C. 1397gg(e)(1)) is amended--
(A) by redesignating subparagraphs (B), (C), (D),
(E), (F), (G), (H), (I), (J), (K), (L), (M), (N), and
(O) as subparagraphs (D), (E), (F), (G), (H), (I), (J),
(K), (M), (N), (O), (P), (Q), and (R), respectively;
(B) by inserting after subparagraph (A) the
following new subparagraphs:
``(B) Section 1902(a)(39) (relating to termination
of participation of certain providers).
``(C) Section 1902(a)(78) (relating to enrollment
of providers participating in State plans providing
medical assistance on a fee-for-service basis).'';
(C) by inserting after subparagraph (K) (as
redesignated by subparagraph (A)) the following new
subparagraph:
``(L) Section 1903(m)(3) (relating to limitation on
payment with respect to managed care).''; and
(D) in subparagraph (P) (as redesignated by
subparagraph (A)), by striking ``(a)(2)(C) and (h)''
and inserting ``(a)(2)(C) (relating to Indian
enrollment), (d)(5) (relating to contract requirement
for managed care entities), (d)(6) (relating to
enrollment of providers participating with a managed
care entity), and (h) (relating to special rules with
respect to Indian enrollees, Indian health care
providers, and Indian managed care entities)''.
(2) Excluding from medicaid providers excluded from chip.--
Section 1902(a)(39) of the Social Security Act (42 U.S.C.
1396a(a)(39)) is amended by striking ``title XVIII or any other
State plan under this title'' and inserting ``title XVIII, any
other State plan under this title (or waiver of the plan), or
any State child health plan under title XXI (or waiver of the
plan)''.
(d) 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 Act.
(e) OIG Report.--Not later than March 31, 2020, 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
section. Such report shall include the following:
(1) An assessment of the extent to which providers who are
included under subsection (ll) of section 1902 of the Social
Security Act (42 U.S.C. 1396a) (as added by subsection (a)(3))
in the database or similar system referred to in such
subsection are terminated (as described in subsection (kk)(8)
of such section, as added by subsection (a)(1)) from
participation in all State plans under title XIX of such Act
(or waivers of such plans).
(2) Information on the amount of Federal financial
participation paid to States under section 1903 of such Act in
violation of the limitation on such payment specified in
subsections (i)(2)(D) and (m)(3) of such section, as added by
subsection (a)(4) of this section.
(3) 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 1932(d)(5) of such Act, as
added by subsection (a)(2) of this section.
(4) An assessment of the extent to which providers have
been enrolled under section 1902(a)(78) or 1932(d)(6)(A) of
such Act (42 U.S.C. 1396a(a)(78), 1396u-2(d)(6)(A)) with State
agencies administering State plans under title XIX of such Act
(or waivers of such plans).
SEC. 3. REQUIRING PUBLICATION OF FEE-FOR-SERVICE PROVIDER DIRECTORY.
(a) In General.--Section 1902(a) of the Social Security Act (42
U.S.C. 1396a(a)) is amended--
(1) in paragraph (80), by striking ``and'' at the end;
(2) in paragraph (81), by striking the period at the end
and inserting ``; and''; and
(3) by inserting after paragraph (81) the following new
paragraph:
``(82) provide that, not later than January 1, 2017, in the
case of a State plan (or waiver of the plan) that provides
medical assistance on a fee-for-service basis or through a
primary care case-management system described in section
1915(b)(1) (other than a primary care case management entity
(as defined by the Secretary)), the State shall publish (and
update on at least an annual basis) on the public Website of
the State agency administering the State plan, a directory of
the physicians described in subsection (mm) and, at State
option, other providers described in such subsection that--
``(A) includes--
``(i) with respect to each such physician
or provider--
``(I) the name of the physician or
provider;
``(II) the specialty of the
physician or provider;
``(III) the address at which the
physician or provider provides
services; and
``(IV) the telephone number of the
physician or provider; and
``(ii) with respect to any such physician
or provider participating in such a primary
care case-management system, information
regarding--
``(I) whether the physician or
provider is accepting as new patients
individuals who receive medical
assistance under this title; and
``(II) the physician's or
provider's cultural and linguistic
capabilities, 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 office;
and
``(B) may include, at State option, with respect to
each such physician or provider--
``(i) the Internet website of such
physician or provider; or
``(ii) whether the physician or provider is
accepting as new patients individuals who
receive medical assistance under this title.''.
(b) Directory Physician or Provider Described.--Section 1902 of the
Social Security Act (42 U.S.C. 1396a), as amended by section 2(a)(3),
is further amended by adding at the end the following new subsection:
``(mm) Directory Physician or Provider Described.--A physician or
provider described in this subsection is--
``(1) in the case of a physician or provider of a provider
type for which the State agency, 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 plan, requires the enrollment of the physician
or provider with the State agency, a physician or a provider
that--
``(A) is enrolled with the agency as of the date on
which the directory is published or updated (as
applicable) under subsection (a)(82); and
``(B) received payment under the State plan in the
12-month period preceding such date; and
``(2) in the case of a physician or provider of a provider
type for which the State agency does not require such
enrollment, a physician or provider that received payment under
the State plan (or waiver of the plan) in the 12-month period
preceding the date on which the directory is published or
updated (as applicable) under subsection (a)(82).''.
(c) Rule of Construction.--
(1) In general.--The amendment made by subsection (a) shall
not be construed to apply in the case of a State (as defined
for purposes of title XIX of the Social Security Act) in which
all the individuals enrolled in the State plan under such title
(or under a waiver of such plan), other than individuals
described in paragraph (2), are enrolled with a medicaid
managed care organization (as defined in section 1903(m)(1)(A)
of such Act (42 U.S.C. 1396b(m)(1)(A))), including prepaid
inpatient health plans and prepaid ambulatory health plans (as
defined by the Secretary of Health and Human Services).
(2) Individuals described.--An individual described in this
paragraph is an individual who is an Indian (as defined in
section 4 of the Indian Health Care Improvement Act (25 U.S.C.
1603)) or an Alaska Native.
(d) Exception for State Legislation.--In the case of a State plan
under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.),
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 section, 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 Act. For purposes of the previous sentence, in the case of a State
that has a 2-year legislative session, each year of the session shall
be considered to be a separate regular session of the State
legislature.
SEC. 4. EXTENSION OF THE TRANSITION TO NEW PAYMENT RATES FOR DURABLE
MEDICAL EQUIPMENT UNDER THE MEDICARE PROGRAM.
(a) In General.--The Secretary of Health and Human Services shall
extend the transition period described in clause (i) of section
414.210(g)(9) of title 42, Code of Federal Regulations, from June 30,
2016, to September 30, 2016 (with the full implementation described in
clause (ii) of such section applying to items and services furnished
with dates of service on or after October 1, 2016).
(b) Study and Report.--
(1) Study.--
(A) In general.--The Secretary of Health and Human
Services shall conduct a study that examines the impact
of applicable payment adjustments upon--
(i) the number of suppliers of durable
medical equipment that, on a date that is not
before January 1, 2016, and not later than
September 1, 2016, ceased to conduct business
as such suppliers; and
(ii) the availability of durable medical
equipment, during the period beginning on
January 1, 2016, and ending on September 1,
2016, to individuals entitled to benefits under
part A of title XVIII of the Social Security
Act (42 U.S.C. 1395 et seq.) or enrolled under
part B of such title.
(B) Definitions.--For purposes of this subsection,
the following definitions apply:
(i) Supplier; durable medical equipment.--
The terms ``supplier'' and ``durable medical
equipment'' have the meanings given such terms
by section 1861 of the Social Security Act (42
U.S.C. 1395x).
(ii) Applicable payment adjustment.--The
term ``applicable payment adjustment'' means a
payment adjustment described in section
414.210(g) of title 42, Code of Federal
Regulations, that is phased in by paragraph
(9)(i) of such section. For purposes of the
preceding sentence, a payment adjustment that
is phased in pursuant to the extension under
subsection (a) shall be considered a payment
adjustment that is phased in by such paragraph
(9)(i).
(2) Report.--The Secretary of Health and Human Services
shall, not later than September 10, 2016, submit to the
Committees on Ways and Means and on Energy and Commerce of the
House of Representatives, and to the Committee on Finance of
the Senate, a report on the findings of the study conducted
under paragraph (1).
SEC. 5. EXCLUSION OF PAYMENTS FROM STATE EUGENICS COMPENSATION PROGRAMS
FROM CONSIDERATION IN DETERMINING ELIGIBILITY FOR, OR THE
AMOUNT OF, FEDERAL PUBLIC BENEFITS.
(a) In General.--Notwithstanding any other provision of law,
payments made under a State eugenics compensation program shall not be
considered as income or resources in determining eligibility for, or
the amount of, any Federal public benefit.
(b) Definitions.--For purposes of this section:
(1) Federal public benefit.--The term ``Federal public
benefit'' means--
(A) any grant, contract, loan, professional
license, or commercial license provided by an agency of
the United States or by appropriated funds of the
United States; and
(B) any retirement, welfare, health, disability,
public or assisted housing, postsecondary education,
food assistance, unemployment benefit, or any other
similar benefit for which payments or assistance are
provided to an individual, household, or family
eligibility unit by an agency of the United States or
by appropriated funds of the United States.
(2) 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 State.
SEC. 6. DEPOSIT OF SAVINGS INTO MEDICARE IMPROVEMENT FUND.
Section 1898(b)(1) of the Social Security Act (42 U.S.C.
1395iii(b)(1)) is amended by striking ``$0'' and inserting
``$3,000,000''.
Passed the House of Representatives July 5, 2016.
Attest:
KAREN L. HAAS,
Clerk.