Medicaid Provider Screening Accountability Act
Medicaid Provider Screening Accountability Act would expand the screening obligations for providers enrolling in or renewing enrollment in the Medicaid program. Starting January 1, 2028, states must, as part of each provider’s enrollment, reenrollment, or revalidation, perform a monthly check of a federal database or similar system created under the ACA (as described in section 6401(b)(2)) to verify whether the provider has been terminated from participating in Medicare (title XVIII) or by other states’ Medicaid/CHIP programs (or waivers). If a provider has been terminated elsewhere, that information would be grounds to deny or restrict enrollment in the Medicaid program. The bill would amend the Social Security Act to add this “additional provider screening” to the existing enrollment process. In short, the bill strengthens cross-state and cross-program termination checks to prevent providers who have been terminated from one program or state from enrolling in Medicaid elsewhere, with a specified implementation date and ongoing monthly verification.
Key Points
- 1Adds a new “Additional provider screening” requirement to Medicaid enrollment starting January 1, 2028.
- 2Requires monthly checks during enrollment, reenrollment, or revalidation against a database/system created under ACA section 6401(b)(2) to see if the provider has been terminated by Medicare or by another state’s Medicaid/CHIP program (or waivers).
- 3Checks are used to determine whether the Secretary (Medicare/Health and Human Services) or other states have terminated the provider’s participation.
- 4Applies to the enrollment process for providers or suppliers under title XIX (Medicaid); effectively broadens cross-program/s cross-state termination awareness.
- 5The measure is an amendment to Section 1902(kk)(1) of the Social Security Act, adding a new subparagraph (B) for this purpose.