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From Health Law Daily, September 14, 2015

House committee reviewing various, loophole-closing Medicaid bills

By Mary Damitio, J.D.

As the Medicaid program continues to grow even in states that have not expanded eligibility, lawmakers are reviewing various legislation aimed at closing loopholes and eliminating fraud within the program. The House of Representatives Energy and Commerce Subcommittee on Health held a hearing to review six bills authored by its committee members that address various aspects of the program, including eligibility determinations and fraud control.

Hearing. Subcommittee Chairman Rep. Joe Pitts (R-PA), in an opening statement to Subcommittee before the hearing said, “It is my hope that through the policies we discuss today, and through future actions by this committee, we can work together on a bipartisan basis to boost Medicaid program integrity, while making the program more sustainable, accountable, and transparent.”

Terminated providers. Among the proposed legislation discussed by the Subcommittee members was a bill authored by Rep. Larry Buchson, M.D. (R-Ind), Ensuring Terminated Providers are Removed from Medicaid and CHIP Act, which stemmed from an HHS Office of Inspector General (OIG) report that found that health care providers who had been terminated from Medicaid in one state continued to participate in the Medicaid and CHIP programs of other states.

According to testimony provided by John Hagg, Director of Medicaid Audits at HHS OIG, a review conducted by the OIG found that 12 percent of providers who were terminated for cause from a state Medicaid program in 2011 continued to participate in programs in other states. Section 6401 of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) required CMS to implement a process for states to share terminated provider information. Hagg pointed out that despite the fact that CMS developed a central database to share such information, the OIG found that many states were not reporting providers who were terminated for cause or were sharing termination information that did not meet the CMS definition of a “for cause termination.”

Territory transparency. The Subcommittee also discussed a bipartisan bill that was authored by Rep. Gus Bilirakis (R-Fla), H.R. 1570, the Medicaid and CHIP Territory Transparency Act, which would require CMS to provide information about federal Medicaid and CHIP program expenditures in the territories on its website.

Medicaid eligibility. Two bills were proposed to close loopholes relating to Medicaid eligibility determinations. One such bill, H.R. 1771, which was authored by Rep. Markwayn Mullin (R-Okla), would include annuity income of a community spouse as income available to institutionalized spouses in determining eligibility for long-term care services.

Another such proposed bill, H.R. 2339, authored by Subcommittee Chairman Pitts, is aimed at providing states better options in using lottery winnings in calculating Medicaid eligibility. Pitts stated, “I hope we can all agree that multi-million dollar lottery winners should not be eligible to receive Medicaid—which is precisely the problem in current law that my bill would fix.”

Personal care services. Subcommittee Vice Chairman Rep. Brett Guthrie (R-Ky) authored H.R. 2446, the Electronic Visit Verification System Required for Personal Care Services Under Medicaid, which would require states to implement an electronic visit verification system for personal care services provided to enrollees. The system would be designed to verify the date, time, and location of any visit and the provider’s identification.

Territory fraud. One area of that was highlighted at the hearing was the lack of adequate fraud control measures being implemented in the territories, particularly in Puerto Rico, which Hagg noted, is the territory with the largest Medicaid program. Proposed legislation, H.R. 3444, the Medicaid and CHIP Territory Fraud Prevention Act, which was co-authored by Subcommittee Chairman Pitts and Rep. Susan Brooks (R-Ind.), encourages territories to create Medicaid Fraud Control Units.

Hagg noted the importance of Medicaid oversight efforts and said, “Given the growth of the Medicaid program, OIG believes it is critical that we continue to conduct effective oversight to ensure that funds are spent appropriately and that steps are taken to improve the quality of care for Medicaid beneficiaries.”

MainStory: TopStory FederalLegislationNews CMSNews FraudNews HomeNews MedicaidNews EligibilityNews ProgramIntegrityNews

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