This bill would prohibit federal payments from going to health care providers that have been terminated from participating in Medicaid, Medicare, or the Children’s Health Insurance Program (CHIP) for nonemergency services.
It also would provide states with additional assistance in identifying providers that are ineligible because of their termination from participating in another state’s Medicaid program or in Medicare, which they are required to do under current law.
Reporting requirements that come into effect when states terminate a provider from participating in Medicaid or CHIP would be revised to require providers to enroll in a state system by providing identifying information. When a state terminates a provider, they’d be required to notify the Dept. of Health and Human Services (HHS) by providing that identifying information along with the reason for, and date of termination. HHS would then include those termination notifications in a database or similar system.
States would be required to have a system for notifying a managed care organization (MCO) when a provider is terminated under Medicaid, Medicare, or CHIP. A contract between the state Medicaid program and an MCO must allow for terminated providers to be excluded from the MCO’s provider network.