,,ii  #aac? ,,congress  #b;d ,session   
,s4 #bfid  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,july #cj1 #bjad ,mr4  
,br[n 7= himself1 ,mrs4 ,murray1 ,mr4   
,rockefell]1 & ,ms4 ,l&rieu7 introduc$ !
 foll[+ bill2 :i* 0 read twice & ref]r$ 
to ! ,committee on ,f9ance  ,a ,,bill   
,to am5d title ,,xix ( ! ,social        
,security ,act to ext5d ! application ( 
! ,m$ic>e paym5t rate floor to prim>y   
c>e s]vices furni%$ "u ,m$icaid & to    
apply ! rate floor to additional        
provid]s ( prim>y c>e s]vices4  #a4     
,%ort title ,?is ,act may be cit$ z !   
,ensur+ ,access to ,prim>y ,c>e = ,wom5 
,*ildr5 ,act4  #b4 ,f9d+s ,congress f9ds
 z foll[s3 7#a7 ,m$icaid plays a key    
role 9 provid+ cov]age = millions (     
work+ families4  7#b7 ,m$icaid enrollees
 include families1 pregnant wom51       
*ildr51 individuals ) disabilities1 &   
o!r l[-income individuals4 ,)\t ,m$icaid
 cov]age1 _m enrollees w\ld be un9sur$  
or lack cov]age = s]vices !y ne$4  7#c7 
,9 #bjac1 ! ,m$icaid program cov]$      

#fb1jjj1jjj individuals1 or #a 9 e #e   
,am]icans4 ,?is numb] w cont9ue to gr[1 
p>ticul>ly s9ce ! ,af=dable ,c>e ,act   
significantly exp&$ eligibility to      
millions ( un9sur$ adults4 ,enrollm5t 9 
,m$icaid & ! ,*ildr5's ,heal? ,insurance
 ,program is project$ to increase by    
#ab1hjj1jjj by #bjaf4  7#d7 ,if all     
,/ates exp& _! ,m$icaid programs1 an    
e/imat$ #g1jjj1jjj wom5 ages #ah to #fd 
w\ld ga9 cov]age "u ,m$icaid4  7#e7 ,9  
#dg ,/ates & 9 ! ,di/rict ( ,columbia1  
,m$icaid pays up to #fg p]c5t less ?an  
,m$ic>e = ! same prim>y c>e s]vices4    
7#f7 ,multiple /udies h conclud$ t high]
 ,m$icaid paym5t rates w\ld increase !  
probability ( prim>y c>e provid]s       
accept+ new ,m$icaid pati5ts1 & w\ld    
fur!r support curr5t ,m$icaid provid]s4 
7#g7 ,congress has recogniz$ t l[       
provid] p>ticipation 9 ,m$icaid         
decreases access to heal? c>e4 ,to      
address ?is problem1 ,congress act$ to  
increase ,m$icaid paym5ts = c]ta9 prim>y
 c>e s]vices to be n less ?an ! ,m$ic>e 

paym5t rates = #bjac & #bjad4  7#h7 ,z m
 ,am]icans become insur$ & emp[]$       
p>ticipants 9 _! own heal? c>e1 dem& =  
prim>y c>e s]vices is expect$ to        
increase ov] ! next few ye>s4  7#i7 ,six
 9 #aj wom5 ages #ah to #dd 7#eh p]c5t7 
report !y see an ob/etrics & gynecology 
7,,ob_/,,gyn7 physician on a regul>     
basis4 ,!y are m likely to see _!       
,,ob_/,,gyn physician on a regul> basis 
?an any o!r type ( provid]4 ,giv5 t wom5
 comprise ! majority ( ,m$icaid         
enrollees1 x is critical t prim>y c>e   
provid]s1 includ+ ,,ob_/,,gyn           
physicians1 receive suffici5t           
reimbursem5t to p>ticipate 9 ,m$icaid4  
7#aj7 ,nurse practition]s & o!r         
mid-level heal? pr(essionals deliv] _m  
prim>y c>e s]vices4 ,apply+ ,m$ic>e's   
rates = nurse practition]s & mid-level  
heal? pr(essionals enc\rages great]     
p>ticipation 9 ,m$icaid1 !reby increas+ 
access to prim>y c>e1 p>ticul>ly 9      
und]s]v$ areas4  7#aa7 ,! enhanc$       
,m$icaid reimbursem5t rate ensures      

provid]s h ! f9ancial capability to s]ve
 _! pati5ts' prim>y c>e ne$s4           
,fur!rmore1 add+ nurse practition]s1    
physician assi/ants1 c]tifi$            
nurse-midwives1 & ,,ob_/,,gyn physicians
 s]v+ 9 prim>y c>e sett+s increases     
access to critical heal? c>e s]vices =  
wom5 & *ildr5 nationwide4  #c4          
,ext5sion ( application ( ,m$ic>e paym5t
 rate floor to prim>y c>e s]vices       
furni%$ "u ,m$icaid & application to    
additional provid]s  7a7  ,9 g5]al      
,section #aijb7;a77#ac7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#acif;a7a77#ac77 is am5d$ by /rik+      
subp>agraph 7,c7 & ins]t+ ! foll[+3     
7,c7 paym5t = prim>y c>e s]vices 7z     
def9$ 9 subsection 7jj77 at a rate t is 
n less ?an #ajj p]c5t ( ! paym5t rate t 
applies to su* s]vices & physician "u "p
 ,b ( title ,,xviii 7or1 if great]1 !   
paym5t rate t w\ld be applicable "u su* 
"p if ! conv]sion factor "u section     
#ahdh7;d7 = ! ye> involv$ 7 ! conv]sion 
factor "u su* section = #bjji71 & t is n

 less ?an ! rate t w\ld o!rwise apply to
 su* s]vices "u ?is title if ! rate 7   
det]m9$ )\t reg>d to ?is subp>agraph1 & 
t are--  7i7 furni%$ 9 #bjac & #bjad1 by
 a physician ) a prim>y specialty       
designation ( family m$ic9e1 g5]al      
int]nal m$ic9e1 or p$iatric m$ic9e2 or  
7ii7 furni%$ 9 #bjae & #bjaf--  7,i7 by 
a physician ) a prim>y specialty        
designation ( family m$ic9e1 g5]al      
int]nal m$ic9e1 or p$iatric m$ic9e1 b   
only if ! physician self-atte/s t--     
7aa7 ! physician is ,bo>d c]tifi$ 9     
family m$ic9e1 g5]al int]nal m$ic9e1 or 
p$iatric m$ic9e2 or  7bb7 ) respect to !
 mo/ rec5tly complet$ cal5d> ye> 7or 9 !
 case ( a newly eligible physician1 !   
prec$+ mon?71 #fj p]c5t ( all s]vices ! 
physician bill$ = "u ! ,/ate plan or a  
waiv] "u ?is title1 or provid$ ?r\gh a  
m$icaid manag$ c>e organization 7z def9$
 9 section #aijc7m77#a77;,a771 7 =      
s]vices describ$ 9 subp>agraph 7,a7 or  
7,b7 ( subsection 7jj77#a72  7,,ii7 by a
 physician ) a prim>y specialty         

designation ( ob/etrics & gynecology1 b 
only if ! physician self-atte/s t--     
7aa7 ! physician is ,bo>d c]tifi$ 9     
ob/etrics & gynecology2 &  7bb7 )       
respect to ! mo/ rec5tly complet$ cal5d>
 ye> 7or 9 ! case ( a newly eligible    
physician1 ! prec$+ mon?71 #fj p]c5t (  
all s]vices ! physician bill$ = "u !    
,/ate plan or a waiv] "u ?is title1 or  
provid$ ?r\gh a m$icaid manag$ c>e      
organization 7z def9$ 9 section         
#aijc7m77#a77;,a771 7 = s]vices describ$
 9 subp>agraph 7,a7 or 7,b7 ( subsection
 7jj77#a72  7,,iii7 by an advanc$       
practice cl9ician1 z def9$ by !         
,secret>y1 t works "u ! sup]vision (--  
7aa7 a physician t satisfies ! crit]ia  
specifi$ 9 subclause 7,i7 or 7,,ii72 or 
7bb7 a nurse practition] or a physician 
assi/ant 7z su* t]ms are def9$ 9 section
 #ahfa7;aa77#e77;,a77 :o is work+ 9     
accordance ) ,/ate law1 or a c]tifi$    
nurse-midwife 7z def9$ 9 section        
#ahfa7;gg77 :o is work+ 9 accordance )  
,/ate law1 b only if ! nurse            

practition]1 physician assi/ant1 or     
c]tifi$ nurse-midwife self-atte/s t1 )  
respect to ! mo/ rec5tly complet$ cal5d>
 ye> 7or 9 ! case ( a newly eligible    
nurse practition]1 physician assi/ant1  
or c]tifi$ nurse-midwife1 ! prec$+      
mon?71 #fj p]c5t ( all s]vices ! nurse  
practition]1 physician assi/ant1 or     
c]tifi$ nurse-midwife bill$ = "u ! ,/ate
 plan or a waiv] "u ?is title1 or       
provid$ ?r\gh a m$icaid manag$ c>e      
organization 7z def9$ 9 section         
#aijc7m77#a77;,a771 7 = s]vices describ$
 9 subp>agraph 7,a7 or 7,b7 ( subsection
 7jj77#a72  7,,iv7 by a rural heal?     
cl9ic1 ,f$]ally-qualifi$ heal? c5t]1 or 
o!r heal? cl9ic t receives reimbursem5t 
on a fee s*$ule applicable to a         
physician1 a nurse practition] or a     
physician assi/ant 7z su* t]ms are def9$
 9 section #ahfa7;aa77#e77;,a77 :o is   
work+ 9 accordance ) ,/ate law1 or a    
c]tifi$ nurse-midwife 7z def9$ 9 section
 #ahfa7;gg77 :o is work+ 9 accordance ) 
,/ate law1 = s]vices furni%$ by a       

physician1 nurse practition]1 physician 
assi/ant1 or c]tifi$ nurse-midwife1 or  
s]vices furni%$ by an advanc$ practice  
cl9ician sup]vis$ by a physician        
describ$ 9 subclause 7,i77aa7 or        
7,,ii77aa71 ano!r advanc$ practice      
cl9ician1 or a c]tifi$ nurse-midwife1 b 
only if ! rural heal? cl9ic or          
,f$]ally-qualifi$ heal? c5t] self-atte/s
 t #fj p]c5t ( all s]vices bill$ = "u ! 
,/ate plan or a waiv] "u ?is title1 or  
provid$ ?r\gh a m$icaid manag$ c>e      
organization 7z def9$ 9 section         
#aijc7m77#a77;,a771 7 = s]vices describ$
 9 subp>agraph 7,a7 or 7,b7 ( subsection
 7jj77#a72 or  7,v7 by a nurse          
practition] or a physician assi/ant 7z  
su* t]ms are def9$ 9 section            
#ahfa7;aa77#e77;,a77 :o is work+ 9      
accordance ) ,/ate law1 or a c]tifi$    
nurse-midwife 7z def9$ 9 section        
#ahfa7;gg77 :o is work+ 9 accordance )  
,/ate law1 9 accordance ) proc$ures t   
ensure t ! portion ( ! paym5t = su*     
s]vices t ! nurse practition]1 physician

 assi/ant1 or c]tifi$ nurse-midwife is  
paid is n less ?an ! am\nt t ! nurse    
practition]1 physician assi/ant1 or     
c]tifi$ nurse-midwife w\ld be paid if ! 
s]vices 7 provid$ "u "p ,b ( title      
,,xviii1 b only if ! nurse practition]1 
physician assi/ant1 or c]tifi$          
nurse-midwife self-atte/s t1 ) respect  
to ! mo/ rec5tly complet$ cal5d> ye> 7or
 9 ! case ( a newly eligible nurse      
practition]1 physician assi/ant1 or     
c]tifi$ nurse-midwife1 ! prec$+ mon?71  
#fj p]c5t ( all s]vices ! nurse         
practition]1 physician assi/ant1 or     
c]tifi$ nurse-midwife bill$ = "u ! ,/ate
 plan or a waiv] "u ?is title1 or       
provid$ ?r\gh a m$icaid manag$ c>e      
organization 7z def9$ 9 section         
#aijc7m77#a77;,a771 7 = s]vices describ$
 9 subp>agraph 7,a7 or 7,b7 ( subsection
 7jj77#a72  4  7b7  ,improv$ t>get+ (   
prim>y c>e  ,section #aijb7;jj7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acif;a7jj77 is am5d$--  7#a7 by        
r$esignat+ p>agraphs 7#a7 & 7#b7 z      

subp>agraphs 7,a7 & 7,b71 respectively &
 realign+ ! left m>g9s accord+ly2  7#b7 
by /rik+ ,= purposes ( & ins]t+ !       
foll[+3  7#a7  ,9 g5]al  ,= purposes (  
2 &  7#c7 by add+ at ! end ! foll[+3    
7#b7  ,exclusions  ,su* t]m does n      
include any s]vices describ$ 9          
subp>agraph 7,a7 or 7,b7 ( p>agraph 7#a7
 if su* s]vices are provid$ 9 an em]g5cy
 dep>tm5t ( a hospital4  4  7c7  ,con=m+
 am5dm5t  ,section #aije7;dd7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#acif;d7dd77 is am5d$ by /rik+ ,janu>y  
#a1 #bjae & ins]t+ ,janu>y #a1 #bjag4   
7d7  ,effective date  ,! am5dm5ts made  
by ?is section take effect on ,janu>y   
#a1 #bjae4