Streamlined enrollment process for eligible out-of-State providers under Medicaid and CHIP

(a)

In general

Section 1902(kk) of the Social Security Act (42 U.S.C. 1396a(kk)) is amended by adding at the end the following new paragraph:

(10)

Streamlined enrollment process for eligible out-of-State providers

(A)

In general

The State adopts and implements a process that enables an eligible out-of-State provider to enroll as a participating provider in the State plan (or a waiver of such plan) without the imposition of additional screening requirements by the State, unless the State has a standard agreement with other States governing coverage and payment for services furnished to Medicaid-eligible children with medically complex conditions that was developed in accordance with guidance issued by the Secretary under section 1945A. An eligible out-of-State provider that enrolls as a participating provider in the State plan (or a waiver of such plan) through such process shall be enrolled for a 5-year period unless the provider is terminated or excluded from participation during such period. (B)

Definitions

In this paragraph: (i)

Eligible out-of-State provider

The term eligible out-of-State provider means, with respect to a State, a provider— (I)that furnishes to a qualifying individual any item or service for which Federal financial assistance is available under the State plan (or a waiver of such plan); (II)that is located in any other State; (III)with respect to which the Secretary has determined (or, in the case of a provider for which no risk level determination has been made by the Secretary, the State agency administering or supervising the administration of the State plan (or a waiver of such plan) has determined) there is a limited risk of fraud, waste, and abuse for purposes of determining the level of screening to be conducted under section 1866(j)(2) (except that, if such State agency has designated a higher risk level for the provider than the Secretary, the State agency's designation shall apply); (IV)that has been screened under such section 1866(j)(2) and enrolled in the Medicare program under title XVIII, or screened under paragraph (1) of this subsection and enrolled in the State plan (or a waiver of such plan) in which such provider is located; and (V)that has not been excluded from participation in any Federal health care program pursuant to section 1128 or 1128A, excluded from participation in the State plan (or a waiver of such plan) pursuant to part 1002 of title 42, Code of Federal Regulations, or State law, or terminated from participating in a Federal health care program or the State plan (or a waiver of such plan) for a reason described in paragraph (8)(A) of this subsection. (ii)

Qualifying individual

The term qualifying individual means, with respect to an eligible out-of-State provider, an individual under 21 years of age to whom the provider furnishes items and services for the treatment of a condition. (iii)

State

The term State means 1 of the 50 States or the District of Columbia.

(b)

Conforming amendments

(1)Section 1902(a)(77) of the Social Security Act (42 U.S.C. 1396a(a)(77)) is amended by inserting enrollment, after screening,. (2)The subsection heading for section 1902(kk) of such Act (42 U.S.C. 1396a(kk)) is amended by inserting

Enrollment,

after

Screening,

. (3)Section 2107(e)(1)(G) of such Act (42 U.S.C. 1397gg(e)(1)(G)) is amended by inserting enrollment, after screening,. (c)

Effective date

(1)

In general

Except as provided in paragraph (2), the amendments made by this section take effect on the date that is 2 years after the date of enactment of this Act. (2)

Exception for State legislation

In the case of a State plan under Medicaid or a State child health plan under CHIP which the Secretary determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements imposed by the amendments made by this section, such State plan or State child health plan shall not be regarded as failing to comply with the requirements of Medicaid or CHIP, respectively, solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.