Do the Feds Need to Ensure that Terminated Health Care Providers Don’t Receive Funds From Medicare, Medicaid or CHIP? (H.R. 3716)

What is H.R. 3716?

(Updated July 21, 2017)

This bill would prohibit federal payments from going to health care providers that have been terminated from participating in Medicaid, Medicare, or the Children’s Health Insurance Program (CHIP) for nonemergency services.

It also would provide states with additional assistance in identifying providers that are ineligible because of their termination from participating in another state’s Medicaid program or in Medicare, which they are required to do under current law.

Reporting requirements that come into effect when states terminate a provider from participating in Medicaid or CHIP would be revised to require providers to enroll in a state system by providing identifying information. When a state terminates a provider, they’d be required to notify the Dept. of Health and Human Services (HHS) by providing that identifying information along with the reason for, and date of termination. HHS would then include those termination notifications in a database or similar system.

States would be required to have a system for notifying a managed care organization (MCO) when a provider is terminated under Medicaid, Medicare, or CHIP. A contract between the state Medicaid program and an MCO must allow for terminated providers to be excluded from the MCO’s provider network.

Argument in favor

Health care providers that have been terminated by Medicare, Medicaid, or CHIP shouldn't be receiving federal funds. This bill would lead to better coordination between federal agencies and states, which will save $28 million in tax dollars.

Argument opposed

State Medicaid programs are already subject to reporting requirements when they terminate providers. Excluding terminated providers from CHIP and Medicare won't make much difference.

Impact

Providers that are terminated from participation in Medicaid, Medicare, or CHIP; managed care organizations; states; and HHS.

Cost of H.R. 3716

The CBO estimates that implementing this bill would reduce spending by $28 million over the 2016-2026.

Additional Info

In-Depth: Sponsoring Rep. Larry Bucshon (R-IN) was quoted in the Morning Consult that this legislation would save taxpayers an estimated “tens of millions of dollars” because it seeks “to hold accountable bad actors in Medicaid and the Children’s Health Insurance Program.”

The House Energy and Commerce Committee advanced this legislation by voice vote, and it was introduced in a bipartisan fashion by Rep. Bucshon, Rep. Peter Welch (D-VT) and Rep. G.K. Butterfield (D-NC).

Media:

• House Energy and Commerce Committee Press Release
• CBO Cost Estimate
• Morning Consult
• Politico

Summary by Eric Revell
(Photo Credit: Flickr user StockMonkeys.com)