,i  #aafth ,,congress  #b;d ,session    
,h4 ,r4 #faei  ,,in ,,the ,,house ,,of  
,,representatives  ,march #i1 #bjbj,ms4 
,schrier 7for herself1 ,ms4 ,castor of  
,florida1 and ,mr4 ,fitzpatrick7        
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 renew the application of the    
,medicare payment rate floor to primary 
care services furnished under the       
,medicaid program1 and for other        
purposes4  #a4 ,short title ,this ,act  
may be cited as the ,kids' ,access to   
,primary ,care ,act of #bjbj4  #b4      
,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  
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       

#bjbj-- 7,i7 by a physician with a      
primary specialty designation of family 
medicine1 general internal medicine1    
pediatric medicine1 or obstetrics and   
gynecology1 but only if the physician   
self-attests that the physician is      
board-certified in family medicine1     
general internal medicine1 pediatric    
medicine1 or obstetrics and gynecology1 
respectively2  7,,ii7 by a physician    
with a primary specialty designation of 
a family medicine subspecialty1 an      
internal medicine subspecialty1 a       
pediatric subspecialty1 or a            
subspecialty of obstetrics and          
gynecology1 without regard to the board 
that offers the designation for such a  
subspecialty1 but only if the physician 
self-attests that the physician is      
board-certified in such a subspecialty2 
7,,iii7 by an advanced practice         
clinician1 as defined by the ,secretary1
 that works under the supervision of--  
7aa7 a physician described 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#b77 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 physician described in  
subclause 7,i7 or 7,,ii71 an advanced   
practice clinician described in         
subclause 7,,iii71 or a nurse           
practitioner1 physician assistant1 or   
certified nurse-midwife described in    
subclause 7,,iii77bb71 for services     
furnished by-- 7aa7 such a physician1   
nurse practitioner1 physician assistant1
 or certified nurse-midwife1            
respectively2 or  7bb7 an advanced      
practice clinician supervised by such a 
physician1 nurse practitioner1 physician
 assistant1 or certified nurse-midwife2 

or  7,v7 by a nurse practitioner1       
physician assistant1 or certified       
nurse-midwife described in subclause    
7,,iii77bb71 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 the additional      
period specified in paragraph 7#b71     
after #bjae12 and  7,c7 by adding at the
 end the following3  7#b7 ,additional   
period ,for purposes of paragraph 7#a71 

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
 #bjbj4  4  7b7 ,improved targeting of  
primary care  7#a7 ,in general ,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            
respectively1 and moving the margin of  
each such subparagraph1 as so           
redesignated1 #b ems to the right2  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  7#b7      
,effective date ,the amendments made by 

paragraph 7#a7 shall apply with respect 
to primary care services provided on or 
after the first day of the period       
described in subparagraph 7,c77ii7 of   
section #aijb7;a77#ac7 of the ,social   
,security ,act 7#db ,u4,s4,c4           
#acif;a7a77#ac771 as amended by section 
#b4  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 in clause 7xiii7-- 
7i7 by moving the margin of such clause 
#b ems to the left2 and  7ii7 by        
striking the period at the end and      
inserting 2 and2 and  7,c7 by inserting 
after clause 7xiii7 the following3      
7xiv7 such contract provides that 7,i7  
payments to health care providers       
specified in section #aijb7;a77#ac77;,c7
 for furnishing primary care services   
defined in section #aijb7;jj7 during a  
year or period specified in section     

#aijb7;a77#ac77;,c7 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 ,state that is     
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 
agreed-upon capitation1 partial         
capitation1 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 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    
7#c7 ,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
 ,act4  #c4 ,study  7a7 ,in general ,not
 later than the date that is one year   
and one month after the date of the     
enactment of this ,act1 the ,secretary  
of ,health and ,human ,services shall   
conduct a study-- 7#a7 comparing the    
number of children enrolled in a ,state 
plan under title ,,xix of the ,social   
,security ,act 7#db ,u4,s4,c4 #acif et  
seq47 7or a waiver of such plan7 during 
the #ab-month period preceding the first
 day of the period described in         
subparagraph 7,c77ii7 of section        
#aijb7;a77#ac7 of such ,act 7#db        
,u4,s4,c4 #acif;a7a77#ac771 as amended  
by section #b1 to the number of children
 so enrolled during the #ab-month period
 beginning on such first day2  7#b7     
comparing the number of health care     
providers receiving payments for primary

 care services under the ,medicaid      
program under such title during the     
#ab-month period preceding the first day
 of the period described in subparagraph
 7,c77ii7 of section #aijb7;a77#ac7 of  
such ,act 7#db ,u4,s4,c4                
#acif;a7a77#ac771 as amended by section 
#b1 to the number of health care        
providers receiving such payments during
 the #ab-month period beginning on such 
first day2 and  7#c7 comparing health   
care provider payment rates for primary 
care services under the ,medicaid       
program under such title during the     
#ab-month period beginning on the first 
day of the period described in          
subparagraph 7,c77ii7 of section        
#aijb7;a77#ac7 of such ,act 7#db        
,u4,s4,c4 #acif;a7a77#ac771 as amended  
by section #b1 across ,states1 using the
 indexes described in subsection 7b74   
7b7 ,indexes described ,the indexes     
described in this subsection are each of
 the following3 7#a7 ,a ,medicaid fee   
index1 comparing each ,state's average  

fee for primary care services under the 
,medicaid program under such title to   
the national average for such services4 
7#b7 ,a ,medicaid-to-,medicare fee      
index1 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 7#db ,u4,s4,c4 #acie et      
seq474  7#c7 ,a ,medicaid fee change    
index1 comparing fees for primary care  
services under the ,medicaid program    
under such title during the #ab-month   
period preceding the first day of the   
period described in subparagraph        
7,c77ii7 of section #aijb7;a77#ac7 of   
such ,act 7#db ,u4,s4,c4                
#acif;a7a77#ac771 as amended by section 
#b1 to the fees for such services during
 the #ab-month period beginning on such 
first day4  7c7 ,authorization of       
appropriations ,for purposes of this    
section1 there is authorized to be      
appropriated #bjj1jjj for fiscal year   

#bjba1 to be available until expended4  
#d4 ,sense of ,congress regarding use of
 ,bright ,futures guidelines ,it is the 
sense of ,congress that health care     
providers should provide early and      
periodic screening1 diagnostic1 and     
treatment services 7as defined in       
section #aije7r7 of the ,social         
,security ,act 7#db ,u4,s4,c4           
#acif;d7r77 in accordance with the      
guidelines of the ,american ,academy of 
,pediatrics entitled1 ,bright ,futures3 
,guidelines for ,health ,supervision of 
,infants1 ,children1 and ,adolescents4