S.Amdt. 2787

SA 2787, submitted by Mr. Grassley, aims to add a streamlined enrollment process for eligible out-of-state providers under Medicaid and CHIP.

The purpose of this amendment is to require States to implement a process that allows eligible out-of-state providers to enroll in the State plan (or a waiver of that plan). This allows these providers to furnish items and services to, or certify eligibility for items and services for, qualifying individuals, who are defined as individuals under 21 years of age enrolled under the State plan or waiver.

The amendment seeks to change the following:

• Enrollment Requirements: States cannot impose screening or enrollment requirements that exceed the minimum necessary for payment, such as the provider's National Provider Identifier and name.
• Enrollment Duration: Providers who enroll through this process will be enrolled for a 5-year period, unless they are excluded or terminated.
• Provider Eligibility: To be an eligible out-of-state provider, a provider must be located in another State, be enrolled in Medicare or another State's plan with a determined limited risk of fraud, waste, and abuse, and not be excluded from Federal health care programs or State plans.

The amendments made by this section would take effect 3 years after the date of enactment.