,i #aacth ,,congress #b;d ,session ,h4 ,r4 #egbc ,,in ,,the ,,house ,,of ,,representatives ,november #ag1 #bjad ,ms4 ,castor of ,florida introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce ,a ,,bill ,to amend title ,,xix of the ,social ,security ,act to extend the application of the ,medicare payment rate floor to primary care services furnished under ,medicaid and to apply the rate floor to additional providers of primary care services4 #a4 ,short title ,this ,act may be cited as the ,ensuring ,access to ,primary ,care for ,women ,children ,act4 #b4 ,findings ,congress finds as follows3 7#a7 ,medicaid plays a key role in providing coverage for millions of working families4 7#b7 ,medicaid enrollees include families1 pregnant women1 children1 individuals with disabilities1 and other low-income individuals4 ,without ,medicaid coverage1 many enrollees would be uninsured or lack coverage for services they need4 7#c7 ,in #bjac1 the ,medicaid program covered #fb1jjj1jjj individuals1 or #a in every #e ,americans4 ,this number will continue to grow1 particularly since the ,affordable ,care ,act significantly expanded eligibility to millions of uninsured adults4 ,enrollment in ,medicaid and the ,children's ,health ,insurance ,program is projected to increase by #ab1hjj1jjj by #bjaf4 7#d7 ,if all ,states expand their ,medicaid programs1 an estimated #g1jjj1jjj women ages #ah to #fd would gain coverage under ,medicaid4 7#e7 ,in #dg ,states and in the ,district of ,columbia1 ,medicaid pays up to #fg percent less than ,medicare for the same primary care services4 7#f7 ,multiple studies have concluded that higher ,medicaid payment rates would increase the probability of primary care providers accepting new ,medicaid patients1 and would further support current ,medicaid providers4 7#g7 ,congress has recognized that low provider participation in ,medicaid decreases access to health care4 ,to address this problem1 ,congress acted to increase ,medicaid payments for certain primary care services to be not less than the ,medicare payment rates for #bjac and #bjad4 7#h7 ,as more ,americans become insured and empowered participants in their own health care1 demand for primary care services is expected to increase over the next few years4 7#i7 ,six in #aj women ages #ah to #dd 7#eh percent7 report they see an obstetrics and gynecology 7,,ob_/,,gyn7 physician on a regular basis4 ,they are more likely to see their ,,ob_/,,gyn physician on a regular basis than any other type of provider4 ,given that women comprise the majority of ,medicaid enrollees1 it is critical that primary care providers1 including ,,ob_/,,gyn physicians1 receive sufficient reimbursement to participate in ,medicaid4 7#aj7 ,nurse practitioners and other mid-level health professionals deliver many primary care services4 ,applying ,medicare's rates for nurse practitioners and mid-level health professionals encourages greater participation in ,medicaid1 thereby increasing access to primary care1 particularly in underserved areas4 7#aa7 ,the enhanced ,medicaid reimbursement rate ensures providers have the financial capability to serve their patients' primary care needs4 ,furthermore1 adding nurse practitioners1 physician assistants1 certified nurse-midwives1 and ,,ob_/,,gyn physicians serving in primary care settings increases access to critical health care services for women and children nationwide4 #c4 ,extension of application of ,medicare payment rate floor to primary care services furnished under ,medicaid and application to additional providers 7a7 ,in general ,section #aijb7;a77#ac7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#ac77 is amended by striking subparagraph 7,c7 and inserting the following3 7,c7 payment for primary care services 7as defined in subsection 7jj77 at a rate that is not less than #ajj percent of the payment rate that applies to such services and physician under part ,b of title ,,xviii 7or1 if greater1 the payment rate that would be applicable under such part if the conversion factor under section #ahdh7;d7 for the year involved were the conversion factor under such section for #bjji71 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 subparagraph1 and that are-- 7i7 furnished in #bjac and #bjad1 by a physician with a primary specialty designation of family medicine1 general internal medicine1 or pediatric medicine2 or 7ii7 furnished in #bjae and #bjaf-- 7,i7 by a physician with a primary specialty designation of family medicine1 general internal medicine1 or pediatric medicine1 but only if the physician self-attests that-- 7aa7 the physician is ,board certified in family medicine1 general internal medicine1 or pediatric medicine2 or 7bb7 with respect to the most recently completed calendar year 7or in the case of a newly eligible physician1 the preceding month71 #fj percent of all services the physician billed for under the ,state plan or a waiver under this title1 or provided through a medicaid managed care organization 7as defined in section #aijc7m77#a77;,a771 were for services described in subparagraph 7,a7 or 7,b7 of subsection 7jj77#a72 7,,ii7 by a physician with a primary specialty designation of obstetrics and gynecology1 but only if the physician self-attests that-- 7aa7 the physician is ,board certified in obstetrics and gynecology2 and 7bb7 with respect to the most recently completed calendar year 7or in the case of a newly eligible physician1 the preceding month71 #fj percent of all services the physician billed for under the ,state plan or a waiver under this title1 or provided through a medicaid managed care organization 7as defined in section #aijc7m77#a77;,a771 were for services described in subparagraph 7,a7 or 7,b7 of subsection 7jj77#a72 7,,iii7 by an advanced practice clinician1 as defined by the ,secretary1 that works under the supervision of-- 7aa7 a physician that satisfies the criteria specified in subclause 7,i7 or 7,,ii72 or 7bb7 a nurse practitioner or a physician assistant 7as such terms are defined in section #ahfa7;aa77#e77;,a77 who is working in accordance with ,state law1 or a certified nurse-midwife 7as defined in section #ahfa7;gg77 who is working in accordance with ,state law1 but only if the nurse practitioner1 physician assistant1 or certified nurse-midwife self-attests that1 with respect to the most recently completed calendar year 7or in the case of a newly eligible nurse practitioner1 physician assistant1 or certified nurse-midwife1 the preceding month71 #fj percent of all services the nurse practitioner1 physician assistant1 or certified nurse-midwife billed for under the ,state plan or a waiver under this title1 or provided through a medicaid managed care organization 7as defined in section #aijc7m77#a77;,a771 were for services described in subparagraph 7,a7 or 7,b7 of subsection 7jj77#a72 7,,iv7 by a rural health clinic1 ,federally-qualified health center1 or other health clinic that receives reimbursement on a fee schedule applicable to a physician1 a nurse practitioner or a physician assistant 7as such terms are defined in section #ahfa7;aa77#e77;,a77 who is working in accordance with ,state law1 or a certified nurse-midwife 7as defined in section #ahfa7;gg77 who is working in accordance with ,state law1 for services furnished by a physician1 nurse practitioner1 physician assistant1 or certified nurse-midwife1 or services furnished by an advanced practice clinician supervised by a physician described in subclause 7,i77aa7 or 7,,ii77aa71 another advanced practice clinician1 or a certified nurse-midwife1 but only if the rural health clinic or ,federally-qualified health center self-attests that #fj percent of all services billed for under the ,state plan or a waiver under this title1 or provided through a medicaid managed care organization 7as defined in section #aijc7m77#a77;,a771 were for services described in subparagraph 7,a7 or 7,b7 of subsection 7jj77#a72 or 7,v7 by a nurse practitioner or a physician assistant 7as such terms are defined in section #ahfa7;aa77#e77;,a77 who is working in accordance with ,state law1 or a certified nurse-midwife 7as defined in section #ahfa7;gg77 who is working in accordance with ,state law1 in accordance with procedures that ensure that the portion of the payment for such services that the nurse practitioner1 physician assistant1 or certified nurse-midwife is paid is not less than the amount that the nurse practitioner1 physician assistant1 or certified nurse-midwife would be paid if the services were provided under part ,b of title ,,xviii1 but only if the nurse practitioner1 physician assistant1 or certified nurse-midwife self-attests that1 with respect to the most recently completed calendar year 7or in the case of a newly eligible nurse practitioner1 physician assistant1 or certified nurse-midwife1 the preceding month71 #fj percent of all services the nurse practitioner1 physician assistant1 or certified nurse-midwife billed for under the ,state plan or a waiver under this title1 or provided through a medicaid managed care organization 7as defined in section #aijc7m77#a77;,a771 were for services described in subparagraph 7,a7 or 7,b7 of subsection 7jj77#a72 4 7b7 ,improved targeting of primary care ,section #aijb7;jj7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7jj77 is amended-- 7#a7 by redesignating paragraphs 7#a7 and 7#b7 as subparagraphs 7,a7 and 7,b71 respectively and realigning the left margins accordingly2 7#b7 by striking ,for purposes of and inserting the following3 7#a7 ,in general ,for purposes of 2 and 7#c7 by adding at the end the following3 7#b7 ,exclusions ,such term does not include any services described in subparagraph 7,a7 or 7,b7 of paragraph 7#a7 if such services are provided in an emergency department of a hospital4 4 7c7 ,conforming amendment ,section #aije7;dd7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7dd77 is amended by striking ,january #a1 #bjae and inserting ,january #a1 #bjag4 7d7 ,effective date ,the amendments made by this section take effect on ,january #a1 #bjae4