Medicaid Provider Screening Accountability Act

Bill Number

H.R. 1875

Origin Chamber

House

Congress

119th Congress, Session 1

Policy Area

Health

Status

Introduced

Latest Action

2025-03-05: Referred to the House Committee on Energy and Commerce.

Last Updated

2025-05-30T23:51:55Z

AI-Generated Summary

Purpose

The Medicaid Provider Screening Accountability Act (H.R. 1875) aims to strengthen oversight of healthcare providers and suppliers participating in Medicaid by requiring states to perform more frequent checks for terminations from Medicare or other states' programs. This helps prevent providers who have been barred elsewhere from enrolling or continuing in a state's Medicaid program.

Key Provisions

• Enhanced Screening Requirement: Starting January 1, 2028, states must check specific databases during the initial enrollment, reenrollment, or revalidation of a provider or supplier under Medicaid.
• Ongoing Monthly Checks: These database checks must occur at least once a month while the provider or supplier remains enrolled in the state's Medicaid program.
• Databases Checked: The checks target systems developed under section 6401(b)(2) of the Patient Protection and Affordable Care Act (ACA), which track terminations. States must verify:
• If the federal Secretary of Health and Human Services has ended the provider's participation in Medicare (under title XVIII of the Social Security Act).
• If any other state has terminated the provider's participation in its Medicaid program (or waiver), or its Children's Health Insurance Program (CHIP, under title XXI, or waiver).

Significant Changes to Existing Law

• Amends section 1902(kk)(1) of the Social Security Act (which governs Medicaid provider screening) by adding a new subparagraph (B).
• Expands beyond current one-time screening at enrollment to include mandatory monthly checks for ongoing enrolled providers.
• Builds on existing requirements by incorporating cross-state and federal termination data, ensuring terminations in one program (Medicare or another state's Medicaid/CHIP) trigger scrutiny in others.

Potential Impacts

• On Government Agencies: State Medicaid agencies will face increased administrative workload and costs for monthly database checks, potentially requiring updates to IT systems. The federal Centers for Medicare & Medicaid Services (CMS) may see indirect benefits through better enforcement of terminations but no direct new duties.
• On Citizens: Medicaid and CHIP beneficiaries could benefit from reduced risk of receiving care from disqualified providers, potentially improving program integrity and patient safety. However, delays in provider enrollment might temporarily limit access to services in some areas.
• On International Relations: No direct impacts, as the bill focuses on domestic U.S. health programs.

Main Stakeholders Affected

• State Medicaid and CHIP Agencies: Primarily responsible for implementing the monthly checks, affecting their operations and budgets.
• Healthcare Providers and Suppliers: Face stricter eligibility requirements, with potential denial or termination of enrollment if flagged in databases; this includes doctors, hospitals, pharmacies, and other billing entities.
• Federal Government (CMS and HHS): Benefits from enhanced data sharing and enforcement across programs.
• Medicaid and CHIP Beneficiaries: Low-income individuals and families relying on these programs for healthcare coverage.

Notable Legal, Constitutional, or Political Implications

• Legal Implications: Reinforces federal standards for state Medicaid plans under the Social Security Act, promoting uniformity in provider oversight to combat fraud and abuse. Non-compliance by states could risk loss of federal funding, as Medicaid is a joint federal-state program.
• Constitutional Implications: Aligns with Congress's spending power under the Constitution to attach conditions to federal grants (like Medicaid funds), without raising federalism concerns since states already administer the program.
• Political Implications: Bipartisan sponsorship (introduced by Reps. Langworthy, Morelle, and Malliotakis) suggests broad support for accountability measures. It could reduce program waste but may spark debate over added burdens on states amid ongoing efforts to streamline healthcare regulations.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Rep. Langworthy, Nicholas A. [R-NY-23]

Cosponsors (3)

Rep. Morelle, Joseph D. [D-NY-25], Rep. Malliotakis, Nicole [R-NY-11], Rep. Davis, Donald G. [D-NC-1]

Recent Actions

• 2025-03-05: Referred to the House Committee on Energy and Commerce.
• 2025-03-05: Introduced in House
• 2025-03-05: Introduced in House

Bill Versions

• Medicaid Provider Screening Accountability Act — issued 2025-03-05 — PDF (2 pages)