,,ii #aadth ,,congress #ast ,session ,s4 #gcg ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #ab1 #bjae,mr4 ,brown 7for himself1 ,mrs4 ,murray1 ,mr4 ,heinrich1 ,mr4 ,schatz1 ,ms4 ,baldwin1 ,mr4 ,sanders1 ,ms4 ,stabenow1 ,mr4 ,franken1 ,mr4 ,blumenthal1 ,mrs4 ,boxer1 ,mr4 ,leahy1 ,ms4 ,hirono1 and ,mr4 ,murphy7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,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 #bjad1 the ,medicaid program covered #fi1jjj1jjj 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 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 ,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#g7 ,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#h7 ,according to a study published earlier this year in the ,new ,england ,journal of ,medicine1 higher ,medicaid payment rates have significantly increased appointment availability for ,medicaid enrollees4 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 health professionals deliver many primary care services4 ,applying ,medicare's rates for nurse practitioners and other 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 ,renewal of application of ,medicare payment rate floor to primary care services furnished under ,medicaid and inclusion of additional providers 7a7 ,renewal of payment floor2 additional providers 7#a7 ,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 the #b-year period that begins on the first day of the first month that begins after the date of enactment of the ,ensuring ,access to ,primary ,care for ,women ,children ,act-- 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 the physician is ,board certified in family medicine1 general internal medicine1 or pediatric medicine2 7,,ii7 by a physician with a primary specialty designation of obstetrics and gynecology1 but only if the physician self-attests that the physician is ,board certified in obstetrics and gynecology2 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 law2 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-midwife2 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 ,,xviii2 4 7#b7 ,conforming amendments ,section #aije7;dd7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7dd77 is amended-- 7,a7 by striking ,notwithstanding and inserting the following3 7#a7 ,in general ,notwithstanding 2 7,b7 by inserting or furnished during an additional period specified in paragraph 7#b71 after #bjae12 and 7,c7 by adding at the end the following3 7#b7 ,additional periods ,for purposes of paragraph 7#a71 the following are additional periods3 7,a7 ,the #b-year period that begins on the first day of the first month that begins after the date of enactment of the ,ensuring ,access to ,primary ,care for ,women ,children ,act4 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 ,ensuring payment by managed care entities 7#a7 ,in general ,section #aijc7m77#b77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7m77#b77;,a77 is amended-- 7,a7 in clause 7xii71 by striking and after the semicolon2 7,b7 by realigning the left margin of clause 7xiii7 so as to align with the left margin of clause 7xii7 and by striking the period at the end of clause 7xiii7 and inserting 2 and2 and 7,c7 by inserting after clause 7xiii7 the following3 7xiv7 such contract provides that 7,i7 payments to providers specified in section #aijb7;a77#ac77;,c7 for primary care services defined in section #aijb7;jj7 that are furnished during a year or period specified in section #aijb7;a77#ac77;,c7 and section #aije7;dd7 are at least equal to the amounts set forth and required by the ,secretary by regulation1 7,,ii7 the entity shall1 upon request1 provide documentation to the ,state1 sufficient to enable the ,state and the ,secretary to ensure compliance with subclause 7,i71 and 7,,iii7 the ,secretary shall approve payments described in subclause 7,i7 that are furnished through an agreed upon capitation1 partial capitation1 or other value-based payment arrangement if the capitation1 partial capitation1 or other value-based payment arrangement is based on a reasonable methodology and the entity provides documentation to the ,state sufficient to enable the ,state and the ,secretary to ensure compliance with subclause 7,i74 4 7#b7 ,conforming amendment ,section #aicb7;f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#b7;f77 is amended by inserting and clause 7xiv7 of section #aijc7m77#b77;,a7 before the period4 #d4 ,improving quality and value for ,medicaid beneficiaries 7a7 ,,gao study ,not later than #a year after the date of enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report that examines the use of alternative payment models in ,state ,medicaid programs and identifies opportunities for disseminating successful payment models among such programs4 7b7 ,funding the development of quality measures ,the first sentence of section #aaci;,b7e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#i;b7e77 is amended by inserting 1 and for fiscal year #bjaf1 #ae1jjj1jjj1 before for the purpose4 7c7 ,developing quality measures for beneficiaries with disabilities ,section #aaci;,b7b77#e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#i;b7b77#e77 is amended by adding at the end the following3 7,c7 ,quality measures specific to adult individuals with disabilities ,the ,secretary1 acting through the ,administrator for the ,centers for ,medicare ,medicaid ,services and the ,director of the ,agency for ,healthcare ,research and ,quality1 shall develop adult health quality measures that are specific to adult individuals with disabilities and shall include those measures in the ,medicaid ,quality ,measurement ,program4 ,in developing such measures1 priority shall be given to developing quality measures that assess the impact on adult individuals with disabilities of existing programs and to the development of quality measures that assess the impact of new service delivery innovations on such individuals4 4