Commentary: Congressman Steve Pearce issued the following statement after the House passed H.R. 3716, Ensuring Access to Quality Medicaid Providers Act:
“Obamacare created a new normal, in which Americans are consistently denied access to care and choice. This system forces Medicaid patients to rely on emergency rooms due to a lack of primary care physicians. Americans deserve a better, more stable system. The House voted today to pass a bipartisan bill to help some of the most vulnerable Americans stay out of emergency rooms by offering increased information on Medicaid physicians in their state and ensuring only transparent and accountable providers are participating in the Medicaid system.
“Often, providers who have been terminated for reasons of fraud and poor service are operating in other states’ Medicaid programs. This is unacceptable. By eliminating these fraudulent providers, the bill saves approximately $15 million over the next ten years. But Washington cannot do it alone; every state has the responsibility to ensure its health care programs are running efficiently and transparently,” said Congressman Pearce.
Although state Medicaid and CHIP programs are required by Obamacare to report the termination of providers on reasons of fraud, integrity, and quality, the HHS Inspector General found the management system to be insufficient. One in every ten terminated providers still participates in other state Medicaid programs. H.R. 3716 eliminates this capability and requires the reporting of terminated providers to CMS within 21 days; CMS is subsequently required to list these providers in a Termination Notification Database within 21 days. The bill additionally stipulates that states keep a comprehensive list of providers, requiring providers to enroll with the state’s Medicaid agency. Moreover, H.R. 3716 incorporates H.R. 3821, a bill requiring state Medicaid programs with fee-for-service and primary care case management keep an electronic directory of physicians who service Medicaid beneficiaries on the program’s website.