,,ii  #aad? ,,congress  #a/ ,session    
,s4 #gcg  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,m>* #ab1 #bjae,mr4    
,br[n 7= himself1 ,mrs4 ,murray1 ,mr4   
,he9ri*1 ,mr4 ,s*atz1 ,ms4 ,baldw91 ,mr4
 ,s&]s1 ,ms4 ,/ab5[1 ,mr4 ,frank51 ,mr4 
,blum5?al1 ,mrs4 ,box]1 ,mr4 ,leahy1    
,ms4 ,hirono1 & ,mr4 ,murphy7 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$4  7#c7 
,9 #bjad1 ! ,m$icaid program cov]$      
#fi1jjj1jjj 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  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$ic>e = ! same prim>y c>e s]vices4    
7#f7 ,congress has recogniz$ 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#g7 ,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#h7     

,accord+ to a /udy publi%$ e>li] ?is ye>
 9 ! ,new ,engl& ,j\rnal ( ,m$ic9e1     
high] ,m$icaid paym5t rates h           
significantly increas$ appo9tm5t        
availability = ,m$icaid enrollees4  7#i7
 ,six 9 #aj wom5 ages #ah to #dd 7#eh   
p]c5t7 report !y see an ob/etrics &     
gynecology 7,,ob_/,,gyn7 physician on a 
regul> basis4 ,!y are m likely to see _!
 ,,ob_/,,gyn physician on a regul> basis
 ?an any o!r type ( provid]4 ,giv5 t    
wom5 comprise ! majority ( ,m$icaid     
enrollees1 x is critical t prim>y c>e   
provid]s1 includ+ ,,ob_/,,gyn           
physicians1 receive suffici5t           
reimbursem5t to p>ticipate 9 ,m$icaid4  
7#aj7 ,nurse practition]s & o!r heal?   
pr(essionals deliv] _m prim>y c>e       
s]vices4 ,apply+ ,m$ic>e's rates = nurse
 practition]s & o!r 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
 ,r5ewal ( application ( ,m$ic>e paym5t 
rate floor to prim>y c>e s]vices furni%$
 "u ,m$icaid & inclusion ( additional   
provid]s  7a7 ,r5ewal ( paym5t floor2   
additional provid]s  7#a7 ,9 g5]al      
,section #aijb7;a77#ac7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#acif;a7a77#ac77 is am5d$ 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 ! #b-ye> p]iod t beg9s on
 ! fir/ day ( ! fir/ mon? t beg9s aft] !
 date ( enactm5t ( ! ,ensur+ ,access to 
,prim>y ,c>e = ,wom5  ,*ildr5 ,act--    
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 !     
physician is ,bo>d c]tifi$ 9 family     
m$ic9e1 g5]al int]nal m$ic9e1 or        
p$iatric m$ic9e2  7,,ii7 by a physician 
) a prim>y specialty designation (      
ob/etrics & gynecology1 b only if !     
physician self-atte/s t ! physician is  
,bo>d c]tifi$ 9 ob/etrics & gynecology2 
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 law2  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-midwife2 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      
,,xviii2  4  7#b7 ,con=m+ am5dm5ts      
,section #aije7;dd7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4           
#acif;d7dd77 is am5d$-- 7,a7 by /rik+   
,not)/&+ & ins]t+ ! foll[+3  7#a7 ,9    
g5]al ,not)/&+  2  7,b7 by ins]t+ or    
furni%$ dur+ an additional p]iod        
specifi$ 9 p>agraph 7#b71 aft] #bjae12 &
  7,c7 by add+ at ! end ! foll[+3  7#b7 
,additional p]iods ,= purposes (        

p>agraph 7#a71 ! foll[+ are additional  
p]iods3  7,a7 ,! #b-ye> p]iod t beg9s on
 ! fir/ day ( ! fir/ mon? t beg9s aft] !
 date ( enactm5t ( ! ,ensur+ ,access to 
,prim>y ,c>e = ,wom5  ,*ildr5 ,act4  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 ,ensur+ paym5t by     
manag$ c>e entities  7#a7 ,9 g5]al      
,section #aijc7m77#b77;,a7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#acif;b7m77#b77;,a77 is am5d$-- 7,a7 9  
clause 7xii71 by /rik+ & aft] !         

semicolon2  7,b7 by realign+ ! left m>g9
 ( clause 7xiii7 s z to align ) ! left  
m>g9 ( clause 7xii7 & by /rik+ ! p]iod  
at ! end ( clause 7xiii7 & ins]t+ 2 &2 &
  7,c7 by ins]t+ aft] clause 7xiii7 !   
foll[+3  7xiv7 su* contract provides t  
7,i7 paym5ts to provid]s specifi$ 9     
section #aijb7;a77#ac77;,c7 = prim>y c>e
 s]vices def9$ 9 section #aijb7;jj7 t   
are furni%$ dur+ a ye> or p]iod specifi$
 9 section #aijb7;a77#ac77;,c7 & section
 #aije7;dd7 are at lea/ equal to !      
am\nts set =? & requir$ by ! ,secret>y  
by regulation1 7,,ii7 ! entity %all1 ^u 
reque/1 provide docum5tation to ! ,/ate1
 suffici5t to enable ! ,/ate & !        
,secret>y to ensure compliance )        
subclause 7,i71 & 7,,iii7 ! ,secret>y   
%all approve paym5ts describ$ 9         
subclause 7,i7 t are furni%$ ?r\gh an   
agre$ ^u capitation1 p>tial capitation1 
or o!r value-bas$ paym5t arrangem5t if !
 capitation1 p>tial capitation1 or o!r  
value-bas$ paym5t arrangem5t is bas$ on 
a reasonable me?odology & ! entity      

provides docum5tation to ! ,/ate        
suffici5t to enable ! ,/ate & !         
,secret>y to ensure compliance )        
subclause 7,i74  4  7#b7 ,con=m+ am5dm5t
 ,section #aicb7;f7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4           
#acifu-#b7;f77 is am5d$ by ins]t+ &     
clause 7xiv7 ( section #aijc7m77#b77;,a7
 be=e ! p]iod4  #d4 ,improv+ quality &  
value = ,m$icaid b5efici>ies  7a7 ,,gao 
/udy ,n lat] ?an #a ye> aft] ! date (   
enactm5t ( ?is ,act1 ! ,comptroll]      
,g5]al ( ! ,unit$ ,/ates %all submit to 
,congress a report t exam9es ! use (    
alt]native paym5t models 9 ,/ate        
,m$icaid programs & id5tifies           
opportunities = dissem9at+ successful   
paym5t models among su* programs4  7b7  
,fund+ ! developm5t ( quality measures  
,! fir/ s5t5ce ( section #aaci;,b7e7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acbj;b-#i;b7e77 is am5d$ by ins]t+ 1 & 
= fiscal ye> #bjaf1 #ae1jjj1jjj1 be=e = 
! purpose4  7c7 ,develop+ quality       
measures = b5efici>ies ) disabilities   

,section #aaci;,b7b77#e7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acbj;b-#i;b7b77#e77 is am5d$ by add+ at
 ! end ! foll[+3  7,c7 ,quality measures
 specific to adult individuals )        
disabilities ,! ,secret>y1 act+ ?r\gh ! 
,adm9i/rator = ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices & ! ,director ( !     
,ag5cy = ,heal?c>e ,rese>* & ,quality1  
%all develop adult heal? quality        
measures t are specific to adult        
individuals ) disabilities & %all       
include ^? measures 9 ! ,m$icaid        
,quality ,measurem5t ,program4 ,9       
develop+ su* measures1 priority %all be 
giv5 to develop+ quality measures t     
assess ! impact on adult individuals )  
disabilities ( exi/+ programs & to !    
developm5t ( quality measures t assess !
 impact ( new s]vice deliv]y innovations
 on su* individuals4  4