Medicaid Provider Screening Accountability Act
Sponsored By: Representative Langworthy
Introduced
Summary
Monthly cross-state termination checks for Medicaid providers. This bill would require states to use the Patient Protection and Affordable Care Act's centralized database (for example, the Data EXchange system) to check whether a provider was terminated from Medicare, another state's Medicaid program, or the Children's Health Insurance Program when enrolling, reenrolling, or during ongoing enrollment.
Show full summary
- States and Medicaid enrollment entities would have an added screening duty. They must run the database check as part of enrollment, reenrollment, or revalidation and continue checks at least monthly, beginning January 1, 2028.
- Providers and suppliers would face ongoing verification against Medicare (title XVIII), other states' Medicaid (title XIX), and CHIP (title XXI) termination records; such findings would be grounds for disqualification or removal.
- Medicaid beneficiaries would see strengthened program integrity aimed at reducing participation by providers with prior terminations.
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Bill Overview
Analyzed Economic Effects
1 provisions identified: 0 benefits, 0 costs, 1 mixed.
Monthly checks on Medicaid providers
Starting January 1, 2028, states would need to check Medicaid and CHIP providers at least monthly. States would use the Affordable Care Act database (or a similar system) to see if a provider was terminated. They would look for terminations under Medicare or in any other state’s Medicaid or CHIP. The checks would happen at enrollment, reenrollment, revalidation, and during enrollment. This could block terminated providers and protect patients, but add paperwork and delays for states and providers.
Sponsors & CoSponsors
Sponsor
Langworthy
NY • R
Cosponsors
Morelle
NY • D
Sponsored 3/5/2025
Malliotakis
NY • R
Sponsored 3/5/2025
Davis (NC)
NC • D
Sponsored 4/9/2025
Roll Call Votes
No roll call votes available for this bill.
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