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H.R.5210 / 114th Congress

PADME Act

Received in the Senate and Read twice and referred to the Committee on Finance.

Official summary

Version 36 · Passed House amended · Jul 5, 2016

Patient Access to Durable Medical Equipment Act of 2016 or the PADME Act

(Sec. 2) 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.

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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.

HHS shall report to Congress on this bill's implementation.

(Sec. 3) A state must publish and annually update a public directory of FFS providers participating under the state plan.

(Sec. 4) HHS shall: (1) delay by three months the full implementation of new Medicare payment rates for durable medical equipment (DME), and (2) study and report on the impact of applicable payment adjustments on the availability of DME to Medicare beneficiaries.

(Sec. 5) For purposes of eligibility determinations for federal public benefits, the bill excludes payments made under a state eugenics compensation program from classification as income or resources. A "state eugenics compensation program" is a state program intended to compensate individuals who were sterilized under the state's authority.

(Sec. 6) The bill makes available $3 million to the Medicare Improvement Fund for services furnished during and after FY2020.

Read the summary on Congress.gov
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Who introduced it

Rep. Price, Tom [R-GA-6] · R–GA

Committees

  • Finance Committee
  • Ways and Means Committee
  • Energy and Commerce Committee
121 cosponsorship records, including any withdrawals

Actions

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  1. Received in the Senate and Read twice and referred to the Committee on Finance.

  2. Motion to reconsider laid on the table Agreed to without objection.

  3. On motion to suspend the rules and pass the bill, as amended Agreed to by voice vote. (text: CR H4230-4232)

  4. Passed/agreed to in House: On motion to suspend the rules and pass the bill, as amended Agreed to by voice vote.(text: CR H4230-4232)

  5. DEBATE - The House proceeded with forty minutes of debate on H.R. 5210.

  6. Considered under suspension of the rules. (consideration: CR H4230-4235)

  7. Mr. Pitts moved to suspend the rules and pass the bill, as amended.

  8. Referred to the Subcommittee on Health.

  9. Referred to the Subcommittee on Health.

  10. Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

  11. Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

  12. Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

  13. Introduced in House

  14. Introduced in House

Bill text & related measures

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