Streamlined Enrollment Process for Eligible Out-Of-State Providers under Medicaid and Chip
Section 6101 · Sec. 6101 ·
What this chapter is about
This part adds a rule to the Social Security Act about state health plans for people with low income. A state must set up an easy way for a doctor in another state to sign up. The sign-up lasts five years. The rule starts three years after this law passed.
The document says “requires”Who acts: State Medicaid agenciesHow: statuteSec. 6101 in the PDF
What the document says
“adopts and implements a process to allow an eligible out-of-State provider to enroll under the State plan (or a waiver of such plan) to furnish items and services to, or order, prescribe, refer, or certify eligibility for items and services for, qualifying individuals without the imposition of screening or enrollment requirements by such State that exceed the minimum necessary for such State to provide payment”
Section 6101 adds a new paragraph (10) to section 1902(kk) of the Social Security Act. A state must adopt and implement a process letting an eligible out-of-State provider enroll under the state plan or a waiver to furnish, order, prescribe, refer for or certify eligibility for items and services for qualifying individuals, without screening or enrollment requirements beyond the minimum needed to pay the provider, such as the provider's name and National Provider Identifier.
What the document actually says
“adopts and implements a process to allow an eligible out-of-State provider to enroll under the State plan (or a waiver of such plan) to furnish items and services to, or order, prescribe, refer, or certify eligibility for items and services for, qualifying individuals without the imposition of screening or enrollment requirements by such State that exceed the minimum necessary for such State to provide payment”
That sentence, in plain words
A state must set up a way for a doctor in another state to sign up. The state may not ask for more than it needs to pay that doctor.
What this is about
A state runs its own health plan for people with low income. A doctor must sign up with the state to be paid. Sign-up used to differ from state to state.
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The document says “shall”Who acts: State Medicaid agenciesHow: statuteSec. 6101 in the PDF
What the document says
“provides that an eligible out-of-State provider that enrolls as a participating provider in the State plan (or a waiver of such plan) through such process shall be so enrolled for a 5-year period, unless the provider is terminated or excluded from participation during such period.”
The new paragraph requires the state plan to provide that a provider who enrolls through the streamlined process stays enrolled for five years, unless terminated or excluded from participation during that period.
What the document actually says
“provides that an eligible out-of-State provider that enrolls as a participating provider in the State plan (or a waiver of such plan) through such process shall be so enrolled for a 5-year period, unless the provider is terminated or excluded from participation during such period.”
That sentence, in plain words
A doctor who signs up this way stays signed up for five years. That ends early only if the doctor is cut off or shut out.
What this is about
Sign-up can run out and have to be done again. A five year term cuts down on that paperwork.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
“The term `qualifying individual' means an individual under 21 years of age who is enrolled under the State plan (or waiver of such plan).”
The new paragraph defines its terms. A qualifying individual is an enrollee under 21 years of age. State means one of the 50 States or the District of Columbia. An eligible out-of-State provider is one located in another State, screened as a limited risk of fraud, waste and abuse either by the Secretary under section 1866(j)(2) or by the other State's agency under paragraph (1), enrolled accordingly, and not excluded or terminated on the grounds the paragraph lists.
What the document actually says
“The term `qualifying individual' means an individual under 21 years of age who is enrolled under the State plan (or waiver of such plan).”
That sentence, in plain words
The words qualifying individual mean one thing here. They mean a person under 21 who is signed up for the state plan.
What this is about
The easy sign-up covers care for young people only. It does not cover care for adults on the plan.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
The document says “is amended”Who acts: CongressHow: statuteSec. 6101 in the PDF
What the document says
“Section 1902(a)(77) of the Social Security Act (42 U.S.C. 1396a(a)(77)) is amended by inserting ``enrollment,'' after ``screening,''.”
Subsection (b) of section 6101 makes three conforming amendments, inserting the word enrollment after the word screening in section 1902(a)(77), in the subsection heading for section 1902(kk), and in section 2107(e)(1)(G) of the Social Security Act.
What the document actually says
“Section 1902(a)(77) of the Social Security Act (42 U.S.C. 1396a(a)(77)) is amended by inserting ``enrollment,'' after ``screening,''.”
That sentence, in plain words
In one part of an older law, write in one more word. It goes right after another word.
What this is about
A conforming change keeps the rest of a law in step. The new rule is about sign-up. So the word sign-up is added where the old law named only checks.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
“The amendments made by this section shall take effect on the date that is 3 years after the date of enactment of this Act.”
Subsection (c) of section 6101 provides that the amendments made by the section take effect three years after the date of enactment. The Act was approved on February 3, 2026.
What the document actually says
“The amendments made by this section shall take effect on the date that is 3 years after the date of enactment of this Act.”
That sentence, in plain words
These changes start three years after the day this law passed.
What this is about
A state needs time to build a new sign-up system. The delay gives it that time.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
The main things the section does: add a new paragraph (10) to section 1902(kk) of the Social Security Act requiring a streamlined process, set the five year enrollment term, define the terms the new paragraph uses, make three conforming amendments, and set the effective date.
The full text of the definitions, condition by condition, and the exclusion and termination grounds the new paragraph lists by cross reference.
The section amends the Social Security Act, which is not indexed here. What sections 1902, 1905, 1866, 1128, 1128A and 2107 of that Act otherwise require is not recorded on this site.
