Summary

Requires each State (the 50 States and DC) to adopt a streamlined Medicaid enrollment process that lets eligible out-of-State providers enroll to furnish, order, prescribe, refer, or certify eligibility for items and services for individuals under age 21 who are enrolled in the State’s Medicaid plan or waiver. The streamlined process must limit screening and documentation to the minimum needed for the State to pay the provider (examples include provider name and NPI) and an out-of-State provider enrolled this way is a participating provider for five years unless terminated or excluded. Adds definitions for eligible out-of-State provider, qualifying individual (under age 21 enrolled in the State plan or waiver), and State; makes conforming amendments to related Medicaid provisions; and takes effect three years after enactment.

• Requires all States and DC to adopt a streamlined Medicaid enrollment process for eligible out-of-State providers serving enrollees under age 21.
• Streamlined screening is limited to the minimum needed to pay the provider (e.g., provider name and NPI), plus any items HHS specifies.
• An out-of-State provider enrolled through the streamlined process is a participating provider for 5 years unless terminated or excluded.
• Adds statutory definitions for eligible out-of-State provider, qualifying individual (under 21), and State.
• Applies to Medicaid plans and waivers and includes conforming amendments to related Medicaid provisions.
• Takes effect three years after enactment, giving States time to implement changes.
• Intended to improve access to pediatric services, including cross-State and telehealth providers.
• Creates a new implementation requirement for State Medicaid agencies without specifying federal funding.
• Does not remove existing provider oversight, termination, or exclusion authorities.