The House and Senate have both approved H.R. 1839, the Medicaid Services Investment and Accountability Act of 2019, clearing it for President Trump’s signature.  Notably, the legislation would: subject drug manufacturers to a new civil monetary penalty (CMP) for knowingly misclassifying or misreporting covered outpatient drugs under a Medicaid drug rebate agreement (such as by knowingly submitting incorrect drug product information).  The penalty would equal up to two times the difference between the rebate amount the manufacturer paid and the amount the manufacturer would have paid if the drug had been correctly classified.  The CMP would be imposed in addition to any other penalties or recoveries.  Furthermore, the legislation would strengthen requirements for recovery of unpaid rebate amounts, without regard to whether the manufacturer knowingly made the misclassification or should have known that the misclassification would be made, and it dedicates funding to improve oversight and enforcement of drug rebate obligation compliance.  These provisions would take effect on the date of enactment, and would apply to covered outpatient drugs supplied by manufacturers under rebate agreements on or after the enactment date.

The bill also would:

  • Establish a new state Medicaid option for coordinated care provided to children with complex medical conditions through a health home.
  • Extend through September 30, 2019 the applicability of current Medicaid spousal impoverishment protections for recipients of home- and community-based services.
  • Extend the Community Mental Health Services Demonstration Program.
  • Provide additional funding for the “Money Follows the Person Rebalancing Demonstration.”
  • Deny federal matching funds for expenditures relating to vacuum erection systems or penile prosthetic implants that are not medically necessary.
  • Increase the number of days that a state may delay Medicaid payments to providers for medical services provided to a child with a medical support order.