Legislation Requiring Information Sharing to Identify Providers Terminated from Medicaid Passed by House
Bill would require states to terminate providers that have been terminated in other states
March 7, 2016 09:04 AM
On Tuesday, March 2, the U.S. House of Representatives unanimously passed by a vote of 406-0 H.R. 3716, the Ensuring Access to Quality Medicaid Providers Act, to require and make it easier for states to identify and terminate health care providers that have been terminated by Medicare or another state Medicaid program or Children’s Health Insurance Program (CHIP) for reasons of fraud, integrity, or quality. The bill requires state Medicaid programs to identify and submit to the Secretary of Health and Human Services (HHS) the name, type and specialty of providers terminated from Medicare, Medicaid or CHIP.
The legislation was introduced by House member Dr. Larry Bucshon (R-IN-8) who said the measure addresses issues raised by a recent reportfrom the HHS Office of the Inspector General that found occurrences of health care providers terminated from Medicaid in one state still participating in other state Medicaid and CHIP programs. Cosponsors of the bipartisan legislation include Congressman Peter Welch (D-VT-At Large) and Congressman G.K. Butterfield (D-NC-1).
“It is critical that fraudulent providers are not allowed to defraud taxpayers or harm patients across the board,” said Dr. Bucshon. “Medicaid beneficiaries are some of the most vulnerable patients, so I am glad this bipartisan bill will ensure they and the program are better protected.”
The Obama Administration also expressed support for the bill, saying it would improve program integrity and “the ability of states to identify health care providers” that have been terminated by Medicare or in other states. “The Affordable Care Act requires that State Medicaid programs terminate participation of health care providers that have been terminated by Medicare or another State Medicaid program. This legislation would improve States' ability to fulfill this requirement by codifying this requirement in CHIP, requiring providers participating in Medicaid and CHIP managed care to enroll with the State, and increasing required reporting, sharing of information, and standardization of documentation of reasons for termination,” the Obama Administration said in its Statement of Administration Policy.
The Congressional Budget Office estimates the legislation would reduce federal spending by $28 million over 10 years by reducing the number of terminated providers that participate in the programs.
The legislation has now been referred to the Senate Finance Committee.
The National Association for Home Care & Hospice recommends that multistate home care and hospice companies pay attention to this legislation. In the original establishment of cross state termination authority, a hospice or home care company terminated in one state would face automatic termination in other states simply because of the compliance from a separately operating entity under common ownership. This bill maintains that requirement while extending it to the CHIP program and establishing more robust reporting requirements.
Stay tuned to NAHC Report for further coverage of this issue.