US Congress House Bill 4802 (Prior Session Legislation)

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Spectrum: Partisan Bill (Democrat 2-0)
Status: Introduced on March 17 2016 - 25% progression, died in committee
Action: 2016-03-18 - Referred to the Subcommittee on Health.
Pending: House Subcommittee on Health Committee
Text: Latest bill text (Introduced) [PDF]

Medicaid Program Integrity Enhancement Act of 2016 This bill amends title XIX (Medicaid) of the Social Security Act to require a state Medicaid agency to establish a process by which a provider may appeal a decision by the agency to suspend payment to the provider on the basis of credible fraud allegations. The Centers for Medicare & Medicaid Services (CMS) must revise specified regulations related to such suspensions in order to comply with due process requirements established by the bill. Specifically, a state Medicaid agency may not suspend payment until the agency: (1) consults with the state's Medicaid fraud control unit or, if the state has no such unit, with the state's attorney general; (2) certifies that it has considered whether the suspension will jeopardize beneficiary access and whether there is good cause not to suspend payment; and (3) furnishes the provider with the agency's reasons for finding no such good cause. Furthermore, the agency must periodically evaluate whether there is good cause to discontinue a suspension for which an investigation is pending. With specified exceptions, such good cause shall be deemed to exist if the investigation remains unresolved after a suspension has been in effect for 18 months. CMS must also revise specified regulations to provide that an allegation of fraud shall be considered credible only if the allegation has indications of reliability and the state Medicaid agency: (1) has reviewed all allegations, facts, and evidence carefully; (2) acts judiciously on a case-by-case basis; and (3) has considered the potential impact a payment suspension may have on beneficiary access to care.

Medicaid Program Integrity Enhancement Act of 2016

Sen. Ben Lujan [D-NM]

Rep. Michelle Lujan Grisham [D-NM]

Date	Chamber	Action
2016-03-18	House	Referred to the Subcommittee on Health.
2016-03-17	House	Referred to the House Committee on Energy and Commerce.
2016-03-17	House	Introduced in House

SB2701 (Same As) 2016-03-17 - Read twice and referred to the Committee on Finance.

Type	Source
Summary	https://www.congress.gov/bill/114th-congress/house-bill/4802/all-info
Text	https://www.congress.gov/114/bills/hr4802/BILLS-114hr4802ih.pdf