policy

Dear Speaker Ryan and Leaders McConnell, Pelosi and Schumer:

We are writing to express our concerns with the implementation timetable for the Medicaid managed care provider enrollment requirements under Section 5005 of the 21st Century Cures Act and request your assistance. We support the goals of the provider enrollment requirements to ensure that Medicaid beneficiaries are receiving medical care and services from qualified and high-quality providers. However, States, Medicaid and CHIP managed care plans, and other stakeholders are very concerned that more time is needed to achieve full compliance, given the significant work required with information systems and data exchanges. In addition, outstanding questions exist with respect to the applicability of some of the requirements that would benefit from clarification before the implementation date.

In May 2016, the Centers for Medicare and Medicaid Services (CMS) issued final Medicaid managed care regulations that included Medicaid managed care provider enrollment requirements. Per the final CMS rule, all Medicaid and CHIP managed care providers and pharmacies were required to be screened and enrolled with state Medicaid agencies with an initial compliance date of July 1, 2018. However, under Section 5005 of the 21st Century Cures Act—enacted in December 2016 after the issuance of final CMS rules—that compliance date was accelerated to January 1, 2018.

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