119-hr1433

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1433 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 1433

To amend title XIX of the Social Security Act to renew the application 
 of the Medicare payment rate floor to primary care services furnished 
 under the Medicaid program, and for other purposes.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 February 18, 2025

 Ms. Schrier (for herself, Mr. Fitzpatrick, Ms. Castor of Florida, Ms. 
DelBene, Mr. Cohen, Mr. Tonko, Ms. Meng, Ms. Sewell, Mr. Davis of North 
 Carolina, Ms. Strickland, and Mr. Magaziner) introduced the following 
 bill; which was referred to the Committee on Energy and Commerce

_______________________________________________________________________

 A BILL

To amend title XIX of the Social Security Act to renew the application 
 of the Medicare payment rate floor to primary care services furnished 
 under the Medicaid program, and for other purposes.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``Kids' Access to Primary Care Act of 
2025''.

SEC. 2. RENEWAL OF APPLICATION OF MEDICARE PAYMENT RATE FLOOR TO 
 PRIMARY CARE SERVICES FURNISHED UNDER MEDICAID AND 
 INCLUSION OF ADDITIONAL PROVIDERS.

    (a) Renewal of Payment Floor; Additional Providers.--

    (1) In general.--

Section 1902

    (a)

    (13) of the Social Security 
 Act (42 U.S.C. 1396a

    (a)

    (13) ) is amended by striking 
 subparagraph
            (C) and inserting the following:
 ``
            (C) payment for primary care services (as defined 
 in subsection

    (jj) ) at a rate that is not less than 100 
 percent of the payment rate that applies to such 
 services and physician under part B of title XVIII (or, 
 if greater, the payment rate that would be applicable 
 under such part if the conversion factor under 

section 1848
            (d) for the year involved were the conversion 
 factor under such section for 2009), and that is not 
 less than the rate that would otherwise apply to such 
 services under this title if the rate were determined 
 without regard to this subparagraph, and that are--
 ``
            (i) furnished in 2013 and 2014, by a 
 physician with a primary specialty designation 
 of family medicine, general internal medicine, 
 or pediatric medicine; or
 ``
            (ii) furnished during the period 
 beginning on the first day of the first month 
 beginning after the date of the enactment of 
 the Kids' Access to Primary Care Act of 2025--
 ``
            (I) by a physician with a primary 
 specialty designation of family 
 medicine, general internal medicine, 
 pediatric medicine, or obstetrics and 
 gynecology, but only if the physician 
 self-attests that the physician is 
 board-certified in family medicine, 
 general internal medicine, pediatric 
 medicine, or obstetrics and gynecology, 
 respectively;
 ``
            (II) by a physician with a 
 primary specialty designation of a 
 family medicine subspecialty, an 
 internal medicine subspecialty, a 
 pediatric subspecialty, or a 
 subspecialty of obstetrics and 
 gynecology, without regard to the board 
 that offers the designation for such a 
 subspecialty, but only if the physician 
 self-attests that the physician is 
 board-certified in such a subspecialty;
 ``
            (III) by an advanced practice 
 clinician, as defined by the Secretary, 
 that works under the supervision of--
 ``

    (aa) a physician 
 described in subclause
            (I) or
            (II) ; or
 ``

    (bb) a nurse practitioner 
 or a physician assistant (as 
 such terms are defined in 
 

section 1861

    (aa)

    (5)
        (A) ) who is 
 working in accordance with 
 State law, or a certified 
 nurse-midwife (as defined in 
 

section 1861

    (gg)

    (2) ) who is 
 working in accordance with 
 State law;
 ``
            (IV) by a rural health clinic, 
 Federally-qualified health center, or 
 other health clinic that receives 
 reimbursement on a fee schedule 
 applicable to a physician described in 
 subclause
            (I) or
            (II) , an advanced 
 practice clinician described in 
 subclause
            (III) , or a nurse 
 practitioner, physician assistant, or 
 certified nurse-midwife described in 
 subclause
            (III) (bb) , for services 
 furnished by--
 ``

    (aa) such a physician, 
 nurse practitioner, physician 
 assistant, or certified nurse-
 midwife, respectively; or
 ``

    (bb) an advanced practice 
 clinician supervised by such a 
 physician, nurse practitioner, 
 physician assistant, or 
 certified nurse-midwife; or
 ``
            (V) by a nurse practitioner or a 
 physician assistant (as such terms are 
 defined in 

section 1861

    (aa)

    (5)
        (A) ) who 
 is working in accordance with State 
 law, or a certified nurse-midwife 
 described in subclause
            (III) (bb) who is 
 working in accordance with State law, 
 in accordance with procedures that 
 ensure that the portion of the payment 
 for such services that the nurse 
 practitioner, physician assistant, or 
 certified nurse-midwife is paid is not 
 less than the amount that the nurse 
 practitioner, physician assistant, or 
 certified nurse-midwife would be paid 
 if the services were provided under 
 part B of title XVIII;''.

    (2) Conforming amendments.--

Section 1905
            (dd) of the Social 
 Security Act (42 U.S.C. 1396d
            (dd) ) is amended--
        (A) by striking ``Notwithstanding'' and inserting 
 the following:
 ``

    (1) In general.--Notwithstanding'';
        (B) by inserting ``or furnished during the 
 additional period specified in paragraph

    (2) ,'' after 
 ``2015,''; and
            (C) by adding at the end the following:
 ``

    (2) Additional period.--For purposes of paragraph

    (1) , 
 the additional period specified in this paragraph is the period 
 beginning on the first day of the first month beginning after 
 the date of the enactment of the Kids' Access to Primary Care 
 Act of 2025.''.

    (b) Improved Targeting of Primary Care.--

    (1) In general.--

Section 1902

    (jj) of the Social Security 
 Act (42 U.S.C. 1396a

    (jj) ) is amended--
        (A) by redesignating paragraphs

    (1) and

    (2) as 
 subparagraphs
        (A) and
        (B) , respectively, and moving the 
 margin of each such subparagraph, as so redesignated, 2 
 ems to the right;
        (B) by striking ``For purposes of'' and inserting 
 the following:
 ``

    (1) In general.--For purposes of''; and
            (C) by adding at the end the following:
 ``

    (2) Exclusions.--Such term does not include any services 
 described in subparagraph
        (A) or
        (B) of paragraph

    (1) if such 
 services are provided in an emergency department of a 
 hospital.''.

    (2) Effective date.--The amendments made by paragraph

    (1) shall apply with respect to primary care services provided on 
 or after the first day of the period described in subparagraph
            (C) 
            (ii) of 

section 1902

    (a)

    (13) of the Social Security Act (42 
 U.S.C. 1396a

    (a)

    (13) ), as amended by 

section 2.
            (c) Ensuring Payment by Managed Care Entities.--

    (1) In general.--

Section 1903
            (m) (2)
        (A) of the Social 
 Security Act (42 U.S.C. 1396b
            (m) (2)
        (A) ) is amended--
        (A) in clause
            (xii) , by striking ``and'' after the 
 semicolon;
        (B) in clause
            (xiii) --
            (i) by moving the margin of such clause 2 
 ems to the left; and
            (ii) by striking the period at the end and 
 inserting ``; and''; and
            (C) by inserting after clause
            (xiii) the following:
 ``
            (xiv) such contract provides that
            (I) payments to health 
 care providers specified in 

section 1902

    (a)

    (13)
            (C) for 
 furnishing primary care services defined in 

section 1902

    (jj) during a year or period specified in 

section 1902

    (a)

    (13)
            (C) are 
 at least equal to the amounts set forth and required by the 
 Secretary by regulation,
            (II) the entity shall, upon request, 
 provide documentation to the State that is sufficient to enable 
 the State and the Secretary to ensure compliance with subclause
            (I) , and
            (III) the Secretary shall approve payments described 
 in subclause
            (I) that are furnished through an agreed-upon 
 capitation, partial capitation, or other value-based payment 
 arrangement if the agreed-upon capitation, partial capitation, 
 or other value-based payment arrangement is based on a 
 reasonable methodology and the entity provides documentation to 
 the State that is sufficient to enable the State and the 
 Secretary to ensure compliance with subclause
            (I) .''.

    (2) Conforming amendment.--

Section 1932

    (f) of the Social 
 Security Act (42 U.S.C. 1396u-2

    (f) ) is amended by inserting 
 ``and clause
            (xiv) of 

section 1903
            (m) (2)
        (A) '' before the 
 period.

    (3) Effective date.--The amendments made by this subsection 
 shall apply with respect to contracts entered into on or after 
 the date of the enactment of this Act.

SEC. 3. STUDY.

    (a) In General.--Not later than the date that is one year and one 
month after the date of the enactment of this Act, the Secretary of 
Health and Human Services shall conduct a study--

    (1) comparing the number of children enrolled in a State 
 plan under title XIX of the Social Security Act (42 U.S.C. 1396 
 et seq.) (or a waiver of such plan) during the 12-month period 
 preceding the first day of the period described in subparagraph
            (C) 
            (ii) of 

section 1902

    (a)

    (13) of such Act (42 U.S.C. 
 1396a

    (a)

    (13) ), as amended by 

section 2, to the number of 
 children so enrolled during the 12-month period beginning on 
 such first day;

    (2) comparing the number of health care providers receiving 
 payments for primary care services under the Medicaid program 
 under such title during the 12-month period preceding the first 
 day of the period described in subparagraph
            (C) 
            (ii) of 

section 1902

    (a)

    (13) of such Act (42 U.S.C. 1396a

    (a)

    (13) ), as amended by 
 

section 2, to the number of health care providers receiving 
 such payments during the 12-month period beginning on such 
 first day; and

    (3) comparing health care provider payment rates for 
 primary care services under the Medicaid program under such 
 title during the 12-month period beginning on the first day of 
 the period described in subparagraph
            (C) 
            (ii) of 

section 1902

    (a)

    (13) of such Act (42 U.S.C. 1396a

    (a)

    (13) ), as amended by 
 

section 2, across States, using the indexes described in 
 subsection

    (b) .

    (b) Indexes Described.--The indexes described in this subsection 
are each of the following:

    (1) A Medicaid fee index, comparing each State's average 
 fee for primary care services under the Medicaid program under 
 such title to the national average for such services.

    (2) A Medicaid-to-Medicare fee index, comparing each 
 State's average fee for primary care services under the 
 Medicaid program under such title to the fee for such services 
 under the Medicare program under title XVIII of such Act (42 
 U.S.C. 1395 et seq.).

    (3) A Medicaid fee change index, comparing fees for primary 
 care services under the Medicaid program under such title 
 during the 12-month period preceding the first day of the 
 period described in subparagraph
            (C) 
            (ii) of 

section 1902

    (a)

    (13) of such Act (42 U.S.C. 1396a

    (a)

    (13) ), as amended by 

section 2, 
 to the fees for such services during the 12-month period 
 beginning on such first day.
            (c) Authorization of Appropriations.--For purposes of this section, 
there is authorized to be appropriated $200,000 for fiscal year 2026, 
to be available until expended.

SEC. 4. SENSE OF CONGRESS REGARDING USE OF BRIGHT FUTURES GUIDELINES.

 It is the sense of Congress that health care providers should 
provide early and periodic screening, diagnostic, and treatment 
services (as defined in 

section 1905

    (r) of the Social Security Act (42 
U.S.C. 1396d

    (r) )) in accordance with the guidelines of the American 
Academy of Pediatrics entitled, ``Bright Futures: Guidelines for Health 
Supervision of Infants, Children, and Adolescents''.
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