Ensuring Removal of Terminated Providers From Medicaid and Chip Act

Floor Speech

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Mr. TONKO. Mr. Chairman, I yield myself such time as I may consume.

I am here to express my strong support for the Ensuring Access to Quality Medicaid Providers Act.

In particular, I am pleased that this legislation incorporates the Medicaid Directory of Caregivers Act, also known as the Medicaid DOC Act. This is legislation in which I joined with my colleague and friend from New York, Representative Collins, in introducing.

I thank Representative Collins for his initiative in this area and for working together on this issue in a collaborative and bipartisan way. I also thank the Energy and Commerce Committee staffs on both sides for providing constructive feedback and for expeditiously moving this bill out of committee.

The impetus behind this bill is simple and straightforward: to make it easier for Medicaid beneficiaries to find and access a doctor.

The underlying legislation would require States that operate a fee- for-service Medicaid program to publish an online provider directory, just like managed care plans and private insurance are already required to do. By creating a one-stop-shop for Medicaid beneficiaries to find information on participating providers, this commonsense legislation will make it easier for individuals and families to access quality health care.

The legislation details the minimum items that must be included in a provider directory, but it also allows States to go beyond those given standards. All consumers deserve to have access to a basic electronic provider directory to find the best physicians for their use.

The second component of the legislation under consideration would provide the CMS with critical tools to keep patients safe, to protect taxpayer dollars, and to protect the integrity of our Medicaid program.

This bipartisan bill, introduced by Representatives Bucshon, Welch, and Butterfield, implements previous OIG recommendations and builds on authorities originally authorized under the ACA. The ACA included a provision that prohibited disqualified providers from Medicare or a one State Medicaid program from simply crossing State lines and receiving payments in another State Medicaid program.

The ACA provision has been hard to implement, however, because States don't have a consistent or a standardized way of knowing when a specific provider has been terminated by Medicare or by another State. All States are not currently required to report this information, and if it is reported, it is in many differing formats, limiting the data's usability.

This legislation would require all States to report information on fraudulent providers to the Secretary for inclusion in a currently existing termination database that is accessible to all States. The legislation also requires the Secretary to develop uniform criteria for States to use when submitting information.

The language would also require all providers in managed care to enroll with State Medicaid agencies so that States know all providers that are participating in the program. This legislation preserves all existing provider appeals processes, and it changes nothing regarding the underlying standard for fraud in this part of the program.

In closing, Mr. Chairman, I urge all Members to support this bipartisan legislation, which makes Medicaid more consumer-friendly and strengthens program integrity.

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Mr. TONKO. As I earlier mentioned in my comments, one of the key participants in putting this effort together was Representative Welch from the State of Vermont.

I yield 2 minutes to the gentleman from Vermont (Mr. Welch), a good friend and a fellow Energy and Commerce Committee member.

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Mr. TONKO. I yield the gentleman an additional 1 minute.

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Mr. TONKO. Mr. Chair, I will continue to reserve the balance of my time.

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Mr. TONKO. Mr. Chair, I yield 3 minutes to the gentleman from New Jersey (Mr. Pallone), the ranking member of the standing Committee on Energy and Commerce, who has shown great leadership for the Democrats at the Energy and Commerce table. He is very much supportive of this effort here, and we thank him for that.

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Mr. TONKO. Mr. Chair,

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Mr. TONKO. Mr. Chair, again, I just would thank all who have been involved with the effort here--from my perspective, particularly Representative Collins, Dr. Bucshon, Representative Welch, and others who put together, I think, a good effort here to have a bipartisan, collaborative effort that speaks to sensitivity, speaks to compassion toward the patients, those requiring the access to health care, and certainly has great respect for the taxpayer and the ensuing outcomes.

With that, I would encourage my colleagues to support the legislation.

I yield back the balance of my time.

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Mr. TONKO. Mr. Chair, I rise in support of the manager's amendment.

This amendment provides a new bill name that incorporates the underlying policies from each of its component bills and reflects additional technical changes that have been outlined by the gentleman from Indiana (Mr. Bucshon), made in consultation with CMS.

This is a very targeted policy that went through extensive review through regular order in the committee. The manager's amendment reflects the final iteration of that hard work.

I would urge all my colleagues to support this simple refining amendment.

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