To amend title XIX of the Social Security Act to streamline enrollment under the Medicaid program of certain providers across State lines, and for other purposes.
Analysis under review: This bill has generated analysis that may be too generic or incomplete. Clause-level evidence remains available below.
Summary
What This Bill Does
This bill creates a streamlined process for healthcare providers licensed in one state to enroll as Medicaid and CHIP providers in other states. It removes the requirement for additional state-level screening when providers have already passed federal screening and are considered low-risk for fraud.
Who Benefits and How
Out-of-state healthcare providers benefit by being able to treat children in other states without navigating separate enrollment processes in each state. Children with medically complex conditions benefit from expanded access to specialized providers. States benefit from reduced administrative burden in screening already-vetted providers.
Who Bears the Burden and How
State Medicaid agencies must implement the new streamlined enrollment process within 2 years. States lose some autonomy over their provider screening processes, as they must accept federally-screened low-risk providers.
Key Provisions
- States must allow eligible out-of-state providers to enroll without additional screening if they are already enrolled in Medicare or their home state Medicaid and are deemed low-risk
- Enrollment lasts 5 years unless the provider is terminated or excluded
- The process specifically targets providers treating children under 21 with medical conditions
- States have 2 years to implement, with extensions for states requiring legislative changes
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers.
At a Glance
What This Bill Does
Requires states to adopt a streamlined enrollment process allowing out-of-state healthcare providers to participate in Medicaid and CHIP without additional state screening requirements
Key Policy Areas
Healthcare, Medicaid, Children's Health
Primary Purpose
Requires states to adopt a streamlined enrollment process allowing out-of-state healthcare providers to participate in Medicaid and CHIP without additional state screening requirements
Policy Domains
Section 2 - Streamlined Enrollment Process
Identified Gains
Contextual inference, no direct clause citation- Out-of-state healthcare providers
- Children with medically complex conditions
- Pediatric specialists
Contextual inference, no direct clause citation
Identified Costs
Contextual inference, no direct clause citation- State Medicaid agencies
- State health departments
Contextual inference, no direct clause citation
Sponsors
Legislative Progress
IntroducedMr. Grassley (for himself, Mr. Bennet, Mrs. Blackburn, Ms. Cortez …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Pediatric specialists treating medically complex children
Children under 21 with medical conditions
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "the_secretary"
- → Secretary of Health and Human Services
Key Definitions
Terms defined in this bill
A provider located in another state that furnishes services to qualifying individuals, has been determined to be limited risk for fraud/waste/abuse, is enrolled in Medicare or their home state Medicaid, and has not been excluded from federal health care programs
An individual under 21 years of age to whom the provider furnishes items and services for the treatment of a condition
One of the 50 States or the District of Columbia
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology