Ensuring Removal of Terminated Providers From Medicaid and Chip Act

Floor Speech

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Mr. PALLONE. Mr. Chair, I am pleased to support H.R. 3716, the Ensuring Access to Quality Medicaid Providers Act. This legislation is the compilation of two bills, H.R. 3821 and H.R. 3716, which are true efforts to improve program integrity in Medicaid in ways that will strengthen the Medicaid program. Both bipartisan bills passed out of the Energy and Commerce Committee through regular order and were favorably reported by voice vote.

Part of the new compiled bill reflects H.R. 3821, the Medicaid DOC Act. This bipartisan initiative, introduced by Representatives Collins of New York and Tonko, would require States that participate in fee- for-service Medicaid to publish electronic provider directories. This is critical information for patients so they can more easily find doctors in their area.

Currently, managed care plans in Medicaid are already required to maintain these directories, but there is no such requirement for fee- for-service Medicaid programs. While some States are already providing these directories, not every State does so. This commonsense and consumer-friendly legislation will require that all States provide their Medicaid patients with this information, and it does so quickly, requiring directories to be up and running in less than 1 year.

Now, while the bill includes minimum items that must be included in a provider directory, it also encourages States to go beyond these standards. While I am hopeful that States will take the initiative to provide other information, like whether doctors are taking new patients, the timeline set forth in this legislation is so accelerated, it is important that we build this foundation first before adding additional requirements to States. I look forward to continuing to work on this important issue with my colleagues.

The second part of the bill would provide CMS with critical tools to keep patients safe, protect taxpayer dollars, and protect the integrity of the Medicaid program.

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

But the current law has been hard to implement because States don't have a consistent or standardized way of knowing when a specific provider has been terminated by Medicare or another State. Since States are not currently required to report this information or, if it is reported, it is in many differing formats, it limits the data's usability.

This legislation being considered would require all States to report information on fraudulent providers to the Secretary for inclusion in an existing termination database that is accessible to all States. It also requires the Secretary to develop uniform criteria for States to use when submitting information and ensures those providers in managed care plans are enrolled with the State and also captured in the database.

Finally, the bill preserves and protects all existing provider appeal processes and changes nothing regarding the underlying standard for fraud in this part of the program, an important protection. This is smart policy that stakeholders and the administration agree will improve Federal and State efforts.

I urge Members to support the bill.

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