Streamlining Medicaid Credentialing Amendment Act of 2025

COUNCIL OF THE DISTRICT OF COLUMBIA
The John A. Wilson Building
1350 Pennsylvania Avenue, NW
Washington, D.C. 20004
Statement of Introduction
Streamlining Medicaid Credentialing Amendment Act of 2024
December 1, 2025
Today, I am pleased to introduce the Streamlining Medicaid Credentialing Amendment
Act of 2025, along with Councilmembers Charles Allen, Anita Bonds, Matthew Frumin, Janeese
Lewis George, Brianne K. Nadeau, Zachary Parker , and Robert C. White, Jr . This legislation
creates a centralized and standardized credentialing system for Medicaid providers in the District,
significantly easing the burden on qualified healthcare providers, and allowing them to deliver care
to patients, and be compensated for that care more quickly.
For individuals and families enrolled in Medicaid Managed Care Organizations (MCOs) ,
provider credentialing offers assurance that healthcare professionals are properly licensed,
certified and qualified ; this process ensures that the providers meet necessary requirements to
deliver safe, effective, and appropriate care.1 However, in the District’s current system, each MCO
conducts their own credentialing, creating unnecessary duplication, delays provider onboarding,
and increases administrative costs. These inefficiencies frustrate providers, reduce access to care,
and further strain our already overextended healthcare workforce.
This bill consolidates credentialing under the Department of Health Care Finance (DHCF),
the agency already responsible for all Medicaid provider enrollment. Once credentialed through
DHCF, a provider will be credentialed to serve patients across all MCOs in the District. The bill
requires adherence to nationally recognized standards and incorporates accountability measures to
ensure timely and transparent credentialing. Other states have demonstrated the benefits of
centralized credentialing. Ohio, for example, successfully centralized its system in their Medicaid
agency, streamlining provider updates and reducing costs .2 Maryland nearly doubled their
credentialed providers from 2017 to 2025 after implementing similar reforms.3
In adopting this approach, the District can improve efficiency, reduce delays in care, and
strengthen our healthcare delivery system. I look forward to working with my colleagues to
advance this important legislation in support of our providers and the residents they serve.
1 https://www.healthaffairs.org/sponsored-content/driving-medicaid-efficiency-through-centralized-provider-credentialing
2 https://maximus.com/insights/advancing-medicaid-with-centralized-provider-
credentialing#:~:text=Real%2Dworld%20success:%20Ohio's%20centralized,facilities%2C%20providers%2C%20and%20practices.
3 Reported to the DC Budget Research Office in April 2025.
Christina Henderson Committee Member
Councilmember, At-Large Human Services
Chairperson, Committee on Health Facilities
Transportation and the Environment
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Councilmember Robert C. White, Jr. Councilmember Christina Henderson 4
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Councilmember Brianne K. Nadeau. Councilmember Charles Allen 9
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Councilmember Matthew Frumin Councilmember Janeese Lewis George 14
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Councilmember Zachary Parker Councilmember Anita Bonds 19
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A BILL 22
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IN THE COUNCIL OF THE DISTRICT OF COLUMBIA 27
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To amend the Department of Health Care Finance Establishment Act of 2007 to require the 31
Department of Health Care Finance to develop a single application process for providers 32
seeking to be credentialed or recredentialed with a managed care organization, to set 33
timeframes and notice requirements for the Department of Health Care Finance to 34
respond to applications, to require notice of presumptive intent to credential and 35
provisional billing, and to require transferal of credentialing status if a provider changes 36
employers. 37
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BE IT ENACTED BY THE COUNCIL OF THE DISTRICT OF COLUMBIA, That this 39
act may be cited as the “Streamlining Medicaid Credentialing Amendment Act of 2025”. 40

Sec. 2. The Department of Health Care Finance Establishment Act of 2007, effective 41
February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.01 et seq.), is amended as 42
follows: 43
(a) Section 2 is amended as follows: 44
(1) A new paragraph (2A) is added to read as follows: 45
“(2A) “Complete application” means a credentialing application submitted by a 46
provider to a centralized credentialing verification organization as established in section 8e.”. 47
(2) A new paragraph (9) is added to read as follows: 48
“(10) “Provider” shall have the same meaning as provided in section 2(7) of the 49
Prompt Pay Act of 2002, effective July 23, 2002 (D.C. Law 14-176; D.C. Official Code § 31-50
3131(7)). 51
(b) A new section 8e is added to read as follows: 52
“Sec. 8e. Medicaid provider consolidated credentialing. 53
“(a) By no later than January 1, 2027, the Mayor shall develop and implement a single, 54
consolidated, and exclusive application process for providers seeking to be credentialed or 55
recredentialed with a managed care organization (“MCO”) under the District’s Medicaid 56
program. A provider whose credentials are approved by the Department shall be deemed 57
credentialed with all MCOs, and an MCO shall not require a provider to 58
be separately credentialed by that MCO in order to receive reimbursement. 59
“(b)(1) If the Department receives an incomplete application for a provider to be 60
credentialed or recredentialed, the Department shall return the application to the provider at the 61
address listed in the application within 10 days of receiving the application. 62
“(2) The Department shall notify the provider on what information is missing 63
from their application. 64
“(3) The time period for approving or disapproving the application set forth in 65
subsection (c) of this section shall be suspended while the application is deemed incomplete. 66
“(c)(1) Within 30 days of receiving a complete application, and upon determination that 67
the provider has a valid District professional or occupational license to provide the health care 68
services to which the credentialing would apply, the Department shall issue a temporary 69
credential to the provider, which shall be effective upon issuance and remain effective until the 70
provider’s credentialing application has been finally approved or denied; provided, that the 71
Department shall not issue temporary credentials to the provider if they have reported on their 72
application: 73
“(A) Any medical or other professional or occupational malpractice 74
claims; 75
“(B) A criminal record; or 76
“(C) Any medical or other licensing board, state, or federal disciplinary 77
action, including suspension from participating in a federal or state program. 78
“(2) The Department shall mail to the provider at the address listed on their 79
application written notice of either the Department’s issuance of temporary credentials to the 80
provider or rejection of their application and an explanation for the rejection. 81
“(d) The Department may not require a provider to recredential if: 82
“(1) The provider federal tax identification number changes; 83
“(2) The federal tax identification number of the provider’s employer changes; or 84
“(3) Their employer changes; provided, that their new employer is: 85
(A) A participating provider on any of the District’s MCO provider 86
panels; or 87
(B) The employer of providers that participate on any of the MCO’s 88
provider panels. 89
“(e) MCO plans shall upload all provider information on all applicable billing platforms, 90
including any subcontractors and vendors, within 7 business days of the Department’s issuance 91
of temporary credentials to the provider.”. 92
Sec. 3. Fiscal impact statement. 93
The Council adopts the fiscal impact statement in the committee report as the fiscal 94
impact statement required by section 4a of the General Legislative Procedures Act of 1975, 95
approved October 16, 2006 (120 Stat. 2038; D.C. Official Code § 1-301.47a). 96
Sec. 4. Effective date. 97
This act shall take effect following approval by the Mayor (or in the event of veto by the 98
Mayor, action by the Council to override the veto) and a 30-day period of congressional review 99
as provided in section 602(c)(1) of the District of Columbia Home Rule Act, approved December 100
24, 1973 (87 Stat. 813; D.C. Official Code § 1-206.02(c)(1)). 101