Comprehensive Addiction and Recovery Act of 2016 (CARA, P.L. 114-198) excludes certain abuse-deterrent drug formulations from the definition of line-extension drugs in the Medicaid drug rebate program. Additionally, the statute:
| Year | |
| Section 1893(g) | Medicare-Medicaid Data Match program |
| Section 1902(a)(4) and Section 1903(u) | Medicaid Eligibility Quality Control (MEQC) program |
| Section 1902(a)(4)(C) | Conflict-of-interest standards |
| Section 1902(a)(25) | Third-party liability |
| Section 1902(a)(30)(A) | Payment methods and procedures to safeguard against unnecessary utilization, consistent with efficiency, economy, and quality, and to provide access equal to the general population |
| Section 1902(a)(37) | Procedures for prepayment and postpayment claims review, including review of appropriate data with respect to the recipient and provider of a service and the nature of the service for which payment is claimed, to ensure the proper and efficient payment of claims and management of the program |
| Section 1902(a)(39) | Termination of provider participation under Medicaid if this provider has been terminated under Medicare or another state’s Medicaid program |
| Section 1902(a)(42)(B) | Recovery Audit Contractors for the Medicaid program |
| Section 1902(a)(46)(A) | State Income and Eligibility Verification System (also in Section 1137) |
| Section 1902(a)(46)(B) | Citizenship documentation |
| Section 1902(a)(61) | A state must effectively operate a Medicaid Fraud Control Unit, unless it can show that such efforts would not be cost-effective because minimal fraud exists and enrollees will be protected from abuse and neglect without such a unit |
| Section 1902(a)(77) | State compliance with provider screening, oversight, and reporting requirements in Section 1902(kk) |
| Section 1902(a)(79) | Requires billing agents, clearinghouses, and other alternate payees that submit claims on behalf of a provider to register with the state and HHS |
| Section 1902(a)(80) | Prohibits payment for items and services to any financial institution or entity located outside the United States |
| Section 1902(e)(13) | Express lane eligibility |
| Section 1902(ee) | Provides states with the option to verify citizenship through the Social Security Administration data match |
| Section 1902(kk) | Provider and supplier screening, oversight, and reporting requirements |
| Section 1903(a)(6) | Federal match for Medicaid Fraud Control Unit expenses |
| Section 1903(d)(2) | Allows states one year to return the federal share of most overpayments |
| Section 1903(i)(2) | Prohibits payments to an individual or entity excluded from the program |
| Section 1903(q) | Requirements Medicaid Fraud Control Units must meet |
| Section 1903(r)(1)(B)(iv) | National Correct Coding Initiative |
| Section 1903(r)(1)(F) | Requires states to report expanded set of data elements under MMIS to detect fraud and abuse |
| Section 1903(x) | Citizenship documentation |
| Section 1909 | State False Claims Act requirements for increased state share of recoveries |
| Section 1921 | Information reporting requirements concerning sanctions taken by state licensing authorities against health care practitioners and providers |
| Section 1927(g) | Drug use review |
| Section 1932(d) | Protections against fraud and abuse in managed care |
| Section 1936 | Medicaid Integrity Program |
| Section 1124 | Disclosure of ownership and related information |
| Section 1126 | Disclosure by institutions, organizations, and agencies of owners and certain other individuals who have been convicted of certain offenses |
| Section 1128 | Exclusion of certain individuals and entities from participation in Medicare and state health care programs |
| Section 1128A | Civil monetary penalties |
| Section 1128B | Criminal penalties for acts involving federal health care programs |
| Section 1128C | Fraud and Abuse Control Program |
| Section 1128D | Guidance regarding application of health care fraud and abuse sanctions |
| Section 1128E | Health Care Fraud and Abuse Data Collection Program |
| Section 1128F | Coordination of Medicare and Medicaid surety bond provisions (applies only to home health agencies) |
| Section 1128G | Transparency reports and reporting of physician ownership or investment interests |
| Section 1128H | Reporting information relating to drug samples |
| Section 1128I | Accountability requirements for facilities (skilled nursing facilities and nursing facilities) |
| Section 1128J | Medicare and Medicaid program integrity provisions |
| Section 1137 | Requirements for state income and eligibility verification systems (also in Section 1902(a)(46)(A)) |
| Section 1156 | Obligations of health care practitioners and providers of health care services, sanctions and penalties, hearings and review |