GAO Reports on State Challenges Implementing Provider Screening Requirements

The Government Accountability Office (GAO) has released a report that describes challenges states have faced in implementing new provider screening and enrollment requirements established by the Patient Protection and Affordable Care Act (PPACA) in 2010 and the 21st Century Cures Act; and examines Centers for Medicare and Medicaid Services (CMS) support for and oversight of states’ implementation of these requirements. GAO reviewed federal laws and CMS guidance. GAO also reviewed CMS documents, including reports resulting from CMS oversight activities published from 2014 through 2018 for seven states. These states were selected based on their use of CMS’s contractor site visits, among other things. GAO also interviewed officials from CMS and the seven selected states.

Officials from seven selected states that GAO interviewed described challenges they faced implementing the new provider screening and enrollment requirements, including establishing procedures for risk-based screenings, using federal databases and collecting required information, and screening an increased volume of providers. Due in part to these challenges, officials from five of the seven selected states told GAO they had not implemented certain requirements. For example, one state plans to launch its new information technology system, which automates screenings, before it will enroll providers under contract with managed care organizations, as required under these laws.

 In the report, GAO recommends that CMS expand its review of states’ implementation of provider screening and enrollment requirements to include states that have not participated in optional consultations; and for states not fully compliant with the requirements, annually monitor the progress of those states’ implementation.

 FMI: The report is available at