II 

115TH CONGRESS 

2D SESSION S. 2415 

To amend title XIX of the Social Security Act to streamline enrollment 

of certain Medicaid providers and suppliers across State lines, and for 

other purposes. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 12, 2018 

Mr. GRASSLEY (for himself and Mr. BENNET) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XIX of the Social Security Act to streamline 

enrollment of certain Medicaid providers and suppliers 

across State lines, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Accelerating Kids’ Ac5 cess to Care Act’’. 

6 SEC. 2. FINDINGS. 

7 The Congress finds as follows: 

8 (1) Thankfully, most children are well. How9 ever, there is a small subset of children with mediVerDate Sep 11 2014 01:05 Feb 13, 2018 Jkt 079200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S2415.IS S2415

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1 cally complex needs. Many of these medically com2 plex needs are congenital, but some are acquired 

3 during childhood. Examples of children with medi4 cally complex needs include children with Down syn5 drome, cancer, cystic fibrosis, or Duchene muscular 

6 dystrophy. 

7 (2) Children with medically complex needs often 

8 require health care from multiple specialty providers 

9 that are not always located within their home State. 

10 (3) Children with medically complex needs and 

11 families on Medicaid who require care from pro12 viders outside of their home State must navigate a 

13 number of paperwork challenges that can impede 

14 timely access to care. 

15 (4) Health care providers treating children from 

16 out-of-State face significant burdens in being 

17 screened and enrolled to participate in the Medicaid 

18 program of the child being treated. 

19 (5) Current Federal regulation and guidance 

20 from the Center for Medicaid and CHIP Services 

21 allow States to rely on provider screenings done by 

22 Medicaid contractors or by other State Medicaid or 

23 CHIP programs. 

24 (6) The Provider Enrollment, Chain and Own25 ership System (PECOS) is an existing national enVerDate Sep 11 2014 01:05 Feb 13, 2018 Jkt 079200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S2415.IS S2415

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1 rollment system for Medicare providers and sup2 pliers that is being expanded to support better align3 ment between Medicare, Medicaid and the CHIP 

4 program and that system could serve as a nation5 wide platform for provider enrollment in Medicaid. 

6 (7) Congress recognizes the need for thorough 

7 screening of providers and suppliers in the Medicare, 

8 Medicaid and CHIP programs to prevent waste, 

9 fraud, and abuse. 

10 (8) A nationwide streamlined screening and en11 rollment process for limited risk providers who care 

12 for children (and the adults who have medically com13 plex needs which began in childhood) under the 

14 Medicaid and CHIP programs will accelerate access 

15 to appropriate care. In addition, such a process has 

16 the potential to strengthen program integrity efforts 

17 by requiring thorough screening and vetting of pro18 viders. 

19 SEC. 3. STREAMLINED SCREENING AND ENROLLMENT 

20 PROCESS FOR ELIGIBLE OUT-OF-STATE MED21 ICAID PROVIDERS AND SUPPLIERS. 

22 (a) IN GENERAL.—Section 1902(kk) of the Social Se23 curity Act (42 U.S.C. 1396a(kk)) is amended by adding 

24 at the end the following new paragraph: 


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1 ‘‘(10) STREAMLINED SCREENING AND ENROLL2 MENT PROCESS FOR ELIGIBLE OUT-OF-STATE PRO3 VIDERS AND SUPPLIERS.— 

4 ‘‘(A) IN GENERAL.—Subject to subsection 

5 (a)(65), the State adopts a streamlined screen6 ing and enrollment process for eligible out-of7 State providers and suppliers. 

8 ‘‘(B) STREAMLINED SCREENING AND EN9 ROLLMENT PROCESS.—For purposes of sub10 paragraph (A), the term ‘streamlined screening 

11 and enrollment process’ means a process that 

12 enables an eligible out-of-State provider or sup13 plier to enroll as a provider or supplier in the 

14 State plan on a simplified and streamlined basis 

15 in accordance with the requirements of sub16 paragraph (D). 

17 ‘‘(C) ELIGIBLE OUT-OF-STATE PROVIDER

18 OR SUPPLIER.—For purposes of subparagraph 

19 (A), the term ‘eligible out-of-State provider or 

20 supplier’ means a provider or supplier of med21 ical or other items or services furnished to a 

22 child for which payment is available under the 

23 State plan under this title that is located in an24 other State and with respect to which the Sec25 retary has determined there is a limited risk of 


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1 fraud, waste, or abuse for purposes of deter2 mining the level of screening to be conducted 

3 under section 1866(j)(2)(B). 

4 ‘‘(D) REQUIREMENTS.—For purposes of 

5 subparagraph (B), the requirements of this sub6 paragraph are the following: 

7 ‘‘(i) An eligible out-of-State provider 

8 or supplier that elects to be and is enrolled 

9 in the program established under this title 

10 in accordance with the process established 

11 by the Secretary under section 2(b) of the 

12 Accelerating Kids’ Access to Care Act is 

13 enrolled in the State plan under this title 

14 without being subject to any additional 

15 screening and enrollment activities re16 quired by the State. 

17 ‘‘(ii) An eligible out-of-State provider 

18 or supplier that is enrolled in the State 

19 plan through the streamlined screening 

20 and enrollment process shall be enrolled 

21 for a period of 5 years before being re22 quired to obtain revalidation. 

23 ‘‘(iii) An eligible out-of-State provider 

24 or supplier that is enrolled in the State 

25 plan through the streamlined screening 


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1 and enrollment process shall be permitted 

2 to order all clinically necessary follow-up 

3 care, including with respect to the pre4 scribing of medications.’’. 

5 (b) COORDINATION WITH MEDICARE.—The Sec6 retary shall establish a process for permitting a provider 

7 or a supplier, as the case may be, the option when enroll8 ing in the program established under the Medicare pro9 gram under title XVIII of the Social Security Act pursu10 ant to subpart P of part 424 of title 42, Code of Federal 

11 Regulations (or any successor regulation), to elect, at the 

12 same time, to enroll in the Medicaid program under title 

13 XIX of such Act for purposes of all State plans under 

14 such title XIX. The Secretary may utilize the Medicare 

15 Provider Enrollment, Chain and Ownership System (re16 ferred to as ‘‘PECOS’’), or another national, standard17 ized, and widely accessible platform to establish such proc18 ess. 

19 (c) CONFORMING AMENDMENTS.— 

20 (1) Section 1902(a)(77) of such Act (42 U.S.C. 

21 1396a(a)(77)), is amended by inserting ‘‘enroll22 ment,’’ after ‘‘screening,’’. 

23 (2) Section 1902(kk) of such Act (42 U.S.C. 

24 1396a(kk)), as amended by subsection (a), is further 

25 amended— 


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1 (A) in the subsection heading, by inserting 

2 ‘‘ENROLLMENT,’’ after ‘‘SCREENING,’’; and 

3 (B) in paragraph (9), by striking ‘‘Noth4 ing’’ and inserting ‘‘Except as provided in para5 graph (10)(D)(i), nothing’’. 

6 (3) Section 2107(e)(1)(F) of such Act (42 

7 U.S.C. 1397gg(e)(1)(F)) is amended by inserting 

8 ‘‘enrollment,’’ after ‘‘screening,’’. 

9 (d) EFFECTIVE DATE.— 

10 (1) IN GENERAL.—Except as provided in para11 graph (2), the amendments made by this section 

12 take effect on January 1, 2019. 

13 (2) EXCEPTION FOR STATE LEGISLATION.—In 

14 the case of a State plan for medical assistance under 

15 title XIX of the Social Security Act or a State child 

16 health plan under title XXI of such Act which the 

17 Secretary of Health and Human Services determines 

18 requires State legislation (other than legislation ap19 propriating funds) in order for the plan to meet the 

20 additional requirements imposed by the amendments 

21 made by this section, such State plan shall not be 

22 regarded as failing to comply with the requirements 

23 of such title solely on the basis of its failure to meet 

24 these additional requirements before the first day of 

25 the first calendar quarter beginning after the close 


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1 of the first regular session of the State legislature 

2 that begins after the date of the enactment of this 

3 Act. For purposes of the previous sentence, in the 

4 case of a State that has a 2-year legislative session, 

5 each year of such session shall be deemed to be a 

6 separate regular session of the State legislature. 

Æ 


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