The bipartisan bill delivers a “one-two punch” to strengthen Medicaid for the most vulnerable by helping increase access beyond the emergency room and reduce fraud.
H.R. 3716 is composed of two bills that unanimously passed the committee in November:
- H.R. 3716, the Ensuring Terminated Providers are Removed from Medicaid and CHIP Act (Authored by Rep. Larry Bucshon (R-IN))
- H.R. 3821, the Medicaid DOC Act (Authored by Rep. Chris Collins (R-NY))
The Congressional Budget Office estimates the bill’s reforms would save $15 million by eliminating payments to fraudulent providers. The package would also save state Medicaid programs several million dollars.
Getting Rid of Bad Actors (H.R. 3716)
HHS’ Inspector General previously found that more than one out of every ten (12 percent) providers terminated for fraud, integrity, or quality in one state, were still participating in another state’s Medicaid program. H.R. 3716 would require:
- State Medicaid and CHIP programs to report terminated providers to CMS within 21 business days, and CMS to include these providers in its Termination Notification Database within 21 business days.
- State Medicaid and CHIP managed care contracts to include a provision that providers terminated from Medicare, Medicaid or CHIP programs be terminated from participation in Medicaid and CHIP managed care provider networks.
- Providers serving Medicaid beneficiaries be enrolled with the state’s Medicaid agency, to ensure each state has a comprehensive list of providers serving Medicaid patients.
- CMS to develop a uniform terminology for classifying the reasons for terminations.
- States to refund CMS the federal portion of Medicaid/CHIP payments made to providers for services performed more than 60 days after the provider’s termination was included in the CMS Termination Notification Database.
Increasing Access Via Physician Directory (H.R.3821)
Today, too many Medicaid patients have a hard time finding a doctor and instead rely on the emergency room for their health care. To help provide vulnerable beneficiaries with better information, the bill requires:
- State Medicaid programs that operate fee-for-service (FFS) and/or primary care case management (PCCM) programs to include an electronic directory of physicians who served Medicaid patients in the prior year on the Medicaid program’s website.
- The directory to include the physician’s name, specialty, address, and telephone number, and—for physicians serving as case managers through PCCM programs—information on whether the physician is accepting new patients, and the physician’s cultural and linguistic capabilities.