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Ensuring Removal of Terminated Providers from Medicaidand CHIP Act
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Ensuring Removal of Terminated Providers from Medicaid and CHIP Act This bill amends titles XIX (Medicaid) and XXI (Children's Health Insurance Program [CHIP]) of the Social Security Act to prohibit federal payment under Medicaid for nonemergency services furnished by providers whose participation in Medicaid, Medicare, or CHIP has been terminated. Under current law, a state must exclude from Medicaid participation any provider that has been terminated under any state's Medicaid program or under Medicare. The bill maintains those requirements and further requires a state to exclude from Medicaid participation any provider that has been terminated under CHIP. Furthermore, a state must exclude from CHIP participation any provider that has been terminated under Medicaid or Medicare. The bill also revises a state's reporting requirements with respect to terminating a provider under a state plan. A state shall require each Medicaid or CHIP provider, whether the provider participates on a fee-for-service (FFS) basis or within the network of a managed care organization (MCO), to enroll with the state by providing specified identifying information. When notifying the Department of Health and Human Services (HHS) that a provider has been terminated under a state plan, the state must submit this information as well as information regarding the termination date and reason. HHS shall review such termination notifications and, if appropriate, include them in a database or similar system, as specified by the bill. The bill prohibits federal payment under a state's Medicaid or CHIP program for services provided by an MCO unless: (1) the state has a system for notifying MCOs when a provider is terminated under Medicaid, Medicare, or CHIP; and (2) any contract between the state plan and an MCO provides that such providers be excluded from participation in the MCO provider network.
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Filing registrants (2)
2016 · fourth_quarter · Medicare/Medicaid
Actuarial soundness Appropriate payment, including risk adjustment, for D-SNPs and MMPs Appropriate quality measurement for D-SNPs and MMPs Education, implementation, evaluation, and improvement of coordinated care programs for dual eligibles H.R. 700, Stabilize Medicaid and CHIP Coverage Act High cost specialty medications Legislative solution to address churning in Medicaid/CHIP eligibility and improve quality measurement in both programs Medicaid and Medicare reform discussions with MACPAC and MedPAC Medicaid eligibility and enrollment issues Medicaid health plans serving as qualified health plans in the Exchange Medicaid managed care regulations Medicaid quality measurement and improvement Regulatory and systematic impact of Medicaid continuous coverage Risk adjustment S. 428, Stabilize Medicaid and CHIP Coverage Act S. 737, Ensuring Access to Primary Care for Women & Children Act 50th Anniversary of Medicaid HR 2505 HR 2506 HR 2507 HR 2579 ACE Kids Act, HR 546/S 298 Mental Health and Medicaid HR 2646 Medicaid DOC Act; Provider directories S.2104 Impact of enhanced state flexibility in managing Medicaid programs Medicaid eligibility and enrollment issues Medicaid Provider Payments Fraud Waste and Abuse in Medicare and Medicaid H.R.3716/S.2669 regarding prohibiting federal payment under Medicaid for nonemergency services furnished by providers whose participation in Medicaid, Medicare, or CHIP has been terminated H.R.5542 - Medicaid and CHIP Quality Improvement Act of 2016
Read twice and referred to the Committee on Finance. (text of measure as introduced: CR S1441-1442)
Introduced in Senate
Bills with similar content found using semantic analysis.
Sources: Congress.gov
Client expense: Not reported · Firm income: $30,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2016 · third_quarter · Medicare/Medicaid
Actuarial soundness Appropriate payment, including risk adjustment, for D-SNPs and MMPs Appropriate quality measurement for D-SNPs and MMPs Education, implementation, evaluation, and improvement of coordinated care programs for dual eligibles H.R. 700, Stabilize Medicaid and CHIP Coverage Act High cost specialty medications Legislative solution to address churning in Medicaid/CHIP eligibility and improve quality measurement in both programs Medicaid and Medicare reform discussions with MACPAC and MedPAC Medicaid eligibility and enrollment issues Medicaid health plans serving as qualified health plans in the Exchange Medicaid managed care regulations Medicaid quality measurement and improvement Regulatory and systematic impact of Medicaid continuous coverage Risk adjustment S. 428, Stabilize Medicaid and CHIP Coverage Act S. 737, Ensuring Access to Primary Care for Women & Children Act 50th Anniversary of Medicaid HR 2505 HR 2506 HR 2507 HR 2579 ACE Kids Act, HR 546/S 298 Mental Health and Medicaid HR 2646 Medicaid DOC Act; Provider directories S.2104 Impact of enhanced state flexibility in managing Medicaid programs Medicaid eligibility and enrollment issues Medicaid Provider Payments Fraud Waste and Abuse in Medicare and Medicaid H.R.3716/S.2669 regarding prohibiting federal payment under Medicaid for nonemergency services furnished by providers whose participation in Medicaid, Medicare, or CHIP has been terminated H.R.5542 - Medicaid and CHIP Quality Improvement Act of 2016
Client expense: Not reported · Firm income: $30,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2016 · second_quarter · Medicare/Medicaid
Actuarial soundness Appropriate payment, including risk adjustment, for D-SNPs and MMPs Appropriate quality measurement for D-SNPs and MMPs Education, implementation, evaluation, and improvement of coordinated care programs for dual eligibles H.R. 700, Stabilize Medicaid and CHIP Coverage Act High cost specialty medications Legislative solution to address churning in Medicaid/CHIP eligibility and improve quality measurement in both programs Medicaid and Medicare reform discussions with MACPAC and MedPAC Medicaid eligibility and enrollment issues Medicaid health plans serving as qualified health plans in the Exchange Medicaid managed care regulations Medicaid quality measurement and improvement Regulatory and systematic impact of Medicaid continuous coverage Risk adjustment S. 428, Stabilize Medicaid and CHIP Coverage Act S. 737, Ensuring Access to Primary Care for Women & Children Act 50th Anniversary of Medicaid HR 2505 HR 2506 HR 2507 HR 2579 ACE Kids Act, HR 546/S 298 Mental Health and Medicaid HR 2646 Medicaid DOC Act; Provider directories S.2104 Impact of enhanced state flexibility in managing Medicaid programs Medicaid eligibility and enrollment issues Medicaid Provider Payments Fraud Waste and Abuse in Medicare and Medicaid H.R.3716/S.2669 regarding prohibiting federal payment under Medicaid for nonemergency services furnished by providers whose participation in Medicaid, Medicare, or CHIP has been terminated H.R.5542 - Medicaid and CHIP Quality Improvement Act of 2016
Client expense: Not reported · Firm income: $30,000
Government targets: HOUSE OF REPRESENTATIVES, SENATE
2016 · second_quarter · Medicare/Medicaid
Actuarial soundness; Appropriate payment, including risk adjustment, for D-SNPs and MMPs; Appropriate quality measurement for D-SNPs and MMPs; Changes to Medicare/Medicaid programs as part of entitlement reform and deficit reduction efforts; Education, implementation, evaluation, and improvement of coordinated care programs for dual eligibles; Fraud, waste, and abuse issues for Medicare and Medicaid; H.R. 2646, Helping Families in Mental Health Crisis Act of 2015; H.R. 546 and S. 298, The Advancing Care for Exceptional (ACE) Kids Act of 2015; H.R. 700, Stabilize Medicaid and CHIP Coverage Act; High cost specialty medications; Impact of significant budget cuts in Medicaid; Legislative solution to address churning in Medicaid/CHIP eligibility and improve quality measurement in both programs; Medicaid and Medicare reform discussions with MACPAC and MedPAC; Medicaid eligibility and enrollment issues; Medicaid health plans serving as qualified health plans in the Exchange; Medicaid managed care regulations; Medicaid quality measurement and improvement; Mental Health Issues and Legislation; Mental Health Parity; Network adequacy; Risk adjustment; S. 2438, Medicaid and CHIP Quality Improvement Act; S. 428, Stabilize Medicaid and CHIP Coverage Act; SNP reauthorization; SNP sustainability and improvements to MMPs; H.R. 4588, Incentivizing Medicaid Expansion Act of 2016; Amendment to S. Con. Res. 11 Regarding Continuous Eligibility in Medicaid; Capped Medicaid Funding Proposals; H.R.3716/S.2669 regarding prohibiting federal payment under Medicaid for nonemergency services furnished by providers whose participation in Medicaid, Medicare, or CHIP has been terminated; H.R.5542 - Medicaid and CHIP Quality Improvement Act of 2016
Client expense: $30,000 · Firm income: Not reported
Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA)