Bill Details
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This bill would add new screening steps for health care providers and suppliers who want to enroll in Medicaid. Starting January 1, 2028, states would have to check certain federal and state databases when a provider first signs up, signs up again, or is reviewed for continued enrollment. States would also have to run this check at least once a month while the provider stays enrolled. The goal is to make sure states can quickly find out if a provider has already been removed from Medicare or from another state’s Medicaid or children’s health coverage program, which could help prevent bad actors from moving from one program or state to another without being caught.
- Applies to Medicaid provider and supplier enrollment, reenrollment, and revalidation.
- Requires monthly checks of a database or similar system that tracks terminations from Medicare and from other states’ Medicaid or CHIP programs.
- Would begin on January 1, 2028.
- Designed to improve oversight and help states screen out providers who have been kicked out of other public health programs.
Official Summaries
Medicaid Provider Screening Accountability Act
This bill requires state Medicaid programs to check, as part of the provider enrollment and reenrollment process, whether providers were terminated from participating in the Medicare program, any other state Medicaid program, or the Children's Health Insurance Program (CHIP) using certain databases (e.g., the Data EXchange system). The bill requires states to continue to check these databases on at least a monthly basis after providers are enrolled.
Current Full Text
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1875 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 1875
To amend title XIX of the Social Security Act to require certain
additional provider screening under the Medicaid program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 5, 2025
Mr. Langworthy (for himself, Mr. Morelle, and Ms. Malliotakis)
introduced the following bill; which was referred to the Committee on
Energy and Commerce
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to require certain
additional provider screening under the Medicaid program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicaid Provider Screening
Accountability Act''.
SEC. 2. MEDICAID PROVIDER SCREENING REQUIREMENTS.
Section 1902(kk)(1) of the Social Security Act (42 U.S.C.
1396a(kk)(1)) is amended--
(1) by striking ``The State'' and inserting:
``(A) In general.--The State''; and
(2) by adding at the end the following new subparagraph:
``(B) Additional provider screening.--Beginning
January 1, 2028, as part of the enrollment (or
reenrollment or revalidation of enrollment) of a
provider or supplier under this title, and not less
frequently than monthly during the period that such
provider or supplier is so enrolled, the State conducts
a check of any database or similar system developed
pursuant to section 6401(b)(2) of the Patient
Protection and Affordable Care Act to determine whether
the Secretary has terminated the participation of such
provider or supplier under title XVIII, or whether any
other State has terminated the participation of such
provider or supplier under such other State's State
plan under this title (or waiver of the plan), or such
other State's State child health plan under title XXI
(or waiver of the plan).''.
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