What does STREAMLINED ENROLLMENT PROCESS FOR ELIGIBLE OUT-OF-STATE of Bipartisan Health Care Act do?

This section amends the Social Security Act to establish a streamlined enrollment process for eligible out-of-state providers under Medicaid and CHIP. States are required to adopt a process allowing eligible out-of-state providers to enroll without screening requirements exceeding the minimum necessary, such as verifying the provider's name and National Provider Identifier. Eligible out-of-state providers who enroll through this process will be enrolled for a 5-year period, unless terminated or excluded. An 'eligible out-of-state provider' is defined as a provider located in another state who has either been screened for fraud risk under Medicare or a similar state plan and is enrolled, and has not been excluded or terminated from any federal or state health care program. A 'qualifying individual' is defined as an individual under 21 years of age enrolled under the State plan. The amendments also include conforming changes to sections 1902(a)(77), 1902(kk), and 2107(e)(1)(G) of the Social Security Act, adding the term 'enrollment' after 'screening'. These changes will take effect three years after the date of enactment of this Act.

What does MAKING CERTAIN ADJUSTMENTS TO COVERAGE OF HOME OR COMMUNITY- of Bipartisan Health Care Act do?

This section amends Section 1915(c) of the Social Security Act to increase transparency of Home and Community-Based Services (HCBS) coverage under Medicaid. States with HCBS waiver waiting lists must provide detailed information to the Secretary, including list maintenance procedures, eligibility screening, list size, and average waiting times. States must also report data on the timeliness of service delivery and the percentage of authorized hours provided for homemaker, home health aide, personal care, and habilitation services. The Secretary may approve waivers for up to 5 states to expand HCBS coverage for a 3-year period, subject to certain requirements and limitations. States selected for the demonstration program must receive planning grants and meet specific criteria related to geographic diversity and population characteristics. The Paperwork Reduction Act of 1995 does not apply to the implementation of these amendments. The Secretary must issue guidance to states on providing interim HCBS coverage under Section 1915. Funding of $71,000,000 is appropriated for fiscal year 2025 to carry out the guidance and demonstration program, with $50,000,000 reserved for planning grants.

What does REMOVING CERTAIN AGE RESTRICTIONS ON MEDICAID ELIGIBILITY FOR of Bipartisan Health Care Act do?

This section modifies the Social Security Act to remove age restrictions on Medicaid eligibility for working adults with disabilities. Specifically, it strikes the phrase 'but less than 65' from sections 1902(a)(10)(A)(ii)(XV) and 1905(v)(1)(A) of the Social Security Act. States that already provide medical assistance to individuals described in these sections will not be considered to be failing to comply with the requirements before January 1, 2027.

What does MEDICAID STATE PLAN REQUIREMENT FOR DETERMINING RESIDENCY AND of Bipartisan Health Care Act do?

This section amends Section 1902 of the Social Security Act to establish requirements for determining Medicaid residency and coverage for military families. Beginning January 1, 2028, states must treat active duty relocated individuals as residents for Medicaid eligibility purposes unless they opt out. If an active duty relocated individual is on a home and community-based services waiting list, they must remain on the list until an assessment is completed or they elect to be removed. The bill provides for payment of medical assistance for active duty relocated individuals in the military service relocation state, to the extent such assistance is available and in accordance with guidance from the Secretary. The term 'active duty relocated individual' is defined as an individual who is an active duty service member, a dependent of such member, or was receiving home and community-based services at the time of relocation. The term 'home and community-based services waiting list' refers to a list maintained by a state with limits on the number of individuals receiving such services.

What does ENSURING THE RELIABILITY OF ADDRESS INFORMATION PROVIDED of Bipartisan Health Care Act do?

This section amends the Social Security Act to establish requirements for obtaining and transmitting address information for individuals enrolled in Medicaid and CHIP. Beginning January 1, 2026, states and the District of Columbia are required to regularly obtain address information from reliable data sources for Medicaid enrollees. Managed care organizations under State Medicaid plans are required to transmit address information directly from or verified by the individual to the state, starting January 1, 2026. Section 1902(a) of the Social Security Act is amended to include the new paragraph (89) regarding address information. Section 2107(e)(1) of the Social Security Act is amended to include a reference to Section 1902(a)(89).

What does CODIFYING CERTAIN MEDICAID PROVIDER SCREENING REQUIREMENTS of Bipartisan Health Care Act do?

This section amends Section 1902(kk)(1) of the Social Security Act. The amendment adds a new subparagraph (B) requiring states to check the Death Master File. States must conduct these checks during provider enrollment, re-enrollment, or revalidation. The checks must occur at least quarterly while a provider or supplier is enrolled. These requirements are effective beginning January 1, 2027.

What does MODIFYING CERTAIN STATE REQUIREMENTS FOR ENSURING DECEASED of Bipartisan Health Care Act do?

This section modifies the Social Security Act to establish requirements for states to verify the enrollment status of individuals receiving medical assistance. Beginning January 1, 2026, states must conduct quarterly screenings using the Death Master File to identify deceased enrollees. If a state determines an enrollee is deceased based on the Death Master File, they must treat the information as factual, disenroll the individual, and discontinue payments. States must immediately reenroll individuals erroneously disenrolled due to misidentification in the Death Master File, retroactive to the date of disenrollment. The section clarifies that states can use other electronic data sources to identify potentially deceased beneficiaries, provided they comply with the established requirements.

What does ONE-YEAR DELAY OF MEDICAID AND CHIP REQUIREMENTS FOR HEALTH of Bipartisan Health Care Act do?

This section amends provisions of the Consolidated Appropriations Act, 2023 (Public Law 117-328) related to Medicaid and Children's Health Insurance Program (CHIP) requirements for health screenings, referrals, and case management services for eligible juveniles in public institutions. It delays the date by which states must comply with certain juvenile justice-related requirements to January 1, 2026. The amendments clarify that the requirements do not apply to individuals in federal custody, including those in federal prisons. States are required to submit an interim work plan to the Secretary of Health and Human Services by June 30, 2025, detailing their progress and plans to comply with the requirements. The amendments made by this subsection take effect as if enacted on December 29, 2022.

What does STATE STUDIES AND HHS REPORT ON COSTS OF PROVIDING MATERNITY, of Bipartisan Health Care Act do?

This section requires each state to conduct a study, every 5 years starting 24 months after enactment, on the costs of providing maternity, labor, and delivery services in applicable hospitals. The state studies must include estimates of costs, analysis of factors affecting costs, payment rates under various programs (Medicare, Medicaid, CHIP, private insurance), and evaluations of potential reimbursement changes for hospitals. An 'applicable hospital' is defined as one providing labor and delivery services and meeting either criteria: over 50% of births financed by Medicaid/CHIP, or located in a rural area with low birth volume. The Secretary is allocated $10,000,000 for fiscal year 2025 to provide grants and technical assistance to small hospitals compiling cost information. The Secretary must issue a public report annually, within 12 months of state submissions, compiling and detailing the results of the state studies. The Secretary must also submit a report to Congress within 3 years of enactment analyzing the initial state studies and recommending improvements to data collection. An additional $3,000,000 is appropriated for fiscal year 2025 for implementing this section.

What does MODIFYING CERTAIN DISPROPORTIONATE SHARE HOSPITAL ALLOTMENTS. of Bipartisan Health Care Act do?

This section modifies disproportionate share hospital (DSH) allotments under the Social Security Act. It extends the DSH allotment for Tennessee through the first quarter of fiscal year 2027, setting the allotment for that quarter at $13,275,000. The section eliminates and delays DSH allotment reductions, extending the period covered by these reductions to end September 30, 2027, and including fiscal year 2028. Specific dates related to these allotments are adjusted, shifting timelines from April 1, 2025, to January 1, 2027.

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Bipartisan Health Care Act

Last updated: 3/6/2025 · Introduced: 3/6/2025

Author: Ron Wyden (D-OR)

AI TL;DR will appear once section summaries are generated.

119th Congressin committeeS. 3716(In Committee)Official page

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Other Sections

Includes provisions on preamble, streamlined enrollment process for eligible out-of-state, and 12 more.

14 sections