Synopsis:

This bill would require states to simplify and centralize the Medicaid process for children with medically complex needs to receive care from out-of-state providers. Supporters argue that, in areas with few specialty care clinicians or medical device suppliers, the best option for families is often across state lines. However, they say, the current Medicaid system for approving out-of-state providers can be slow, redundant and vulnerable to fraud, as it relies on third-party contractors. S. 2415 would allow state Medicaid programs to use an established federal system called the Provider Enrollment, Chain and Ownership System (PECOS). PECOS collects all approved providers in one database, but is currently only used for Medicare. This bill would expand it to include Medicaid and Children’s Health Insurance Program (CHIP) providers. As the U.S. Department of Health and Human Services determines eligibility for PECOS, this legislation would also standardize the screening process.

Supporters:

Sens. Chuck Grassley (R-Iowa), Michael Bennet (D-Colo.), Elizabeth Warren (D-Mass.) et al.; Children’s Hospital Association.

Opponents:

None reported.

Links to Additional Resources: