ACA requirements for Medicaid and CHIP programs to enhance their efforts to combat fraud will bolster the programs’ efficiency by strengthening quality controls on participating providers and suppliers. Implementation requires updates to state regulations.

*Milestone details:

*Full name: Update regulations to ensure compliance with provider and supplier screening, oversight, and reporting requirements in Medicaid and CHIP.

*Relevance to the ACA:

The ACA outlines several new requirements for Medicaid and CHIP providers and suppliers that will need to be monitored at both the state and federal levels.

§6401 - Provider screening and other enrollment requirements for providers participating in Medicare, Medicaid, and CHIP include:

-- New procedures (including licensure checks, criminal background checks, fingerprinting, site visits, and database checks) for screening Medicaid and CHIP providers;

-- Enhanced period of provisional oversight for new providers and suppliers,

-- Increased disclosure requirements for providers and suppliers of current or previous affiliations;

-- Enhanced state responsibility including provider and supplier oversight and reporting of adverse provider actions;

-- Federal development of compliance programs for providers and suppliers of medical and other services within particular industry sectors.