,,ii  #aai? ,,congress  #a/ ,session    
,s4 #gfj  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,febru>y #bf1          
#bjbe,mrs4 ,murray 7= h]self1 ,mr4      
,w>nock1 ,mr4 ,book]1 ,mr4 ,blum5?al1   
,mr4 ,lujn1 ,mr4 ,m]kley1 & ,mr4 ,wel*7 
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d title ,,xix
 ( ! ,social ,security ,act to r5ew !   
application ( ! ,m$ic>e paym5t rate     
floor to prim>y c>e s]vices furni%$ "u !
 ,m$icaid program1 & = o!r purposes4    
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,kids' ,access to ,prim>y ,c>e ,act ( 
#bjbe4  #b4 ,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%$ dur+ ! p]iod beg9n+ on !   
fir/ day ( ! fir/ mon? beg9n+ aft] !    
date ( ! enactm5t ( ! ,kids' ,access to 
,prim>y ,c>e ,act ( #bjbe-- 7,i7 by a   
physician ) a prim>y specialty          
designation ( family m$ic9e1 g5]al      
int]nal m$ic9e1 p$iatric m$ic9e1 or     
ob/etrics & gynecology1 b only if !     
physician self-atte/s t ! physician is  
bo>d-c]tifi$ 9 family m$ic9e1 g5]al     

int]nal m$ic9e1 p$iatric m$ic9e1 or     
ob/etrics & gynecology1 respectively2   
7,,ii7 by a physician ) a prim>y        
specialty designation ( a family m$ic9e 
subspecialty1 an int]nal m$ic9e         
subspecialty1 a p$iatric subspecialty1  
or a subspecialty ( ob/etrics &         
gynecology1 )\t reg>d to ! bo>d t (f]s !
 designation = su* a subspecialty1 b    
only if ! physician self-atte/s t !     
physician is bo>d-c]tifi$ 9 su* a       
subspecialty2  7,,iii7 by an advanc$    
practice cl9ician1 z def9$ by !         
,secret>y1 t works "u ! sup]vision (--  
7aa7 a physician describ$ 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#b77 :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*$ule applicable to a         
physician describ$ 9 subclause 7,i7 or  
7,,ii71 an advanc$ practice cl9ician    
describ$ 9 subclause 7,,iii71 or a nurse
 practition]1 physician assi/ant1 or    
c]tifi$ nurse-midwife describ$ 9        
subclause 7,,iii77bb71 = s]vices furni%$
 by-- 7aa7 su* a physician1 nurse       
practition]1 physician assi/ant1 or     
c]tifi$ nurse-midwife1 respectively2 or 
7bb7 an advanc$ practice cl9ician       
sup]vis$ by su* a physician1 nurse      
practition]1 physician assi/ant1 or     
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 describ$ 9 subclause      
7,,iii77bb7 :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+ ! additional p]iod specifi$
 9 p>agraph 7#b71 aft] #bjae12 &  7,c7  
by add+ at ! end ! foll[+3  7#b7        
,additional p]iod ,= purposes ( p>agraph
 7#a71 ! additional p]iod specifi$ 9 ?is
 p>agraph is ! p]iod beg9n+ on ! fir/   
day ( ! fir/ mon? beg9n+ aft] ! date ( !
 enactm5t ( ! ,kids' ,access to ,prim>y 
,c>e ,act ( #bjbe4  4  7b7 ,improv$     
t>get+ ( prim>y c>e  7#a7 ,9 g5]al      
,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 respectively1 
& mov+ ! m>g9 ( ea* su* subp>agraph1 z s

 r$esignat$1 #b ems to ! "r2  7,b7 by   
/rik+ ,= purposes ( & ins]t+ ! foll[+3  
7#a7 ,9 g5]al ,= purposes (  2 &  7,c7  
by add+ at ! end ! foll[+3  7#b7        
,exclusions ,su* t]m does n include any 
s]vices describ$ 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  7#b7 ,effective date ,!   
am5dm5ts made by p>agraph 7#a7 %all     
apply ) respect to prim>y c>e s]vices   
provid$ on or aft] ! fir/ day ( ! p]iod 
describ$ 9 subp>agraph 7,c77ii7 (       
section #aijb7;a77#ac7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acif;a7a77#ac771 z am5d$ by section #b4
  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 9 clause
 7xiii7-- 7i7 by mov+ ! m>g9 ( su*      
clause #b ems to ! left2 &  7ii7 by     
/rik+ ! p]iod at ! end & ins]t+ 2 &2 &  

7,c7 by ins]t+ aft] clause 7xiii7 !     
foll[+3  7xiv7 su* contract provides t  
7,i7 paym5ts to heal? c>e provid]s      
specifi$ 9 section #aijb7;a77#ac77;,c7 =
 furni%+ prim>y c>e s]vices def9$ 9     
section #aijb7;jj7 dur+ a ye> or p]iod  
specifi$ 9 section #aijb7;a77#ac77;,c7  
are at lea/ equal to ! am\nts set =? &  
requir$ by ! ,secret>y by regulation1   
7,,ii7 ! entity %all1 ^u reque/1 provide
 docum5tation to ! ,/ate t is 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 ! agre$-^u capitation1    
p>tial capitation1 or o!r value-bas$    
paym5t arrangem5t is bas$ on a          
reasonable me?odology & ! entity        
provides docum5tation to ! ,/ate t is   
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  7#c7 ,effective date ,! 
am5dm5ts made by ?is subsection %all    
apply ) respect to contracts ent]$ into 
on or aft] ! date ( ! enactm5t ( ?is    
,act4  #c4 ,/udy  7a7 ,9 g5]al ,n lat]  
?an ! date t is "o ye> & "o mon? aft] ! 
date ( ! enactm5t ( ?is ,act1 !         
,secret>y ( ,heal? & ,human ,s]vices    
%all conduct a /udy-- 7#a7 comp>+ !     
numb] ( *ildr5 enroll$ 9 a ,/ate plan "u
 title ,,xix ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #acif et seq47 7or a     
waiv] ( su* plan7 dur+ ! #ab-mon? p]iod 
prec$+ ! fir/ day ( ! p]iod describ$ 9  
subp>agraph 7,c77ii7 ( section          
#aijb7;a77#ac7 ( su* ,act 7#db ,u4,s4,c4
 #acif;a7a77#ac771 z am5d$ by section   
#b1 to ! numb] ( *ildr5 s enroll$ dur+ !
 #ab-mon? p]iod beg9n+ on su* fir/ day2 
7#b7 comp>+ ! numb] ( heal? c>e provid]s
 receiv+ paym5ts = prim>y c>e s]vices "u

 ! ,m$icaid program "u su* title dur+ ! 
#ab-mon? p]iod prec$+ ! fir/ day ( !    
p]iod describ$ 9 subp>agraph 7,c77ii7 ( 
section #aijb7;a77#ac7 ( su* ,act 7#db  
,u4,s4,c4 #acif;a7a77#ac771 z am5d$ by  
section #b1 to ! numb] ( heal? c>e      
provid]s receiv+ su* paym5ts dur+ !     
#ab-mon? p]iod beg9n+ on su* fir/ day2 &
  7#c7 comp>+ heal? c>e provid] paym5t  
rates = prim>y c>e s]vices "u ! ,m$icaid
 program "u su* title dur+ ! #ab-mon?   
p]iod beg9n+ on ! fir/ day ( ! p]iod    
describ$ 9 subp>agraph 7,c77ii7 (       
section #aijb7;a77#ac7 ( su* ,act 7#db  
,u4,s4,c4 #acif;a7a77#ac771 z am5d$ by  
section #b1 across ,/ates1 us+ ! indexes
 describ$ 9 subsection 7b74  7b7        
,indexes describ$ ,! indexes describ$ 9 
?is subsection are ea* ( ! foll[+3 7#a7 
,a ,m$icaid fee index1 comp>+ ea*       
,/ate's av]age fee = prim>y c>e s]vices 
"u ! ,m$icaid program "u su* title to ! 
national av]age = su* s]vices4  7#b7 ,a 
,m$icaid-to-,m$ic>e fee index1 comp>+   
ea* ,/ate's av]age fee = prim>y c>e     

s]vices "u ! ,m$icaid program "u su*    
title to ! fee = su* s]vices "u !       
,m$ic>e program "u title ,,xviii ( su*  
,act 7#db ,u4,s4,c4 #acie et seq474     
7#c7 ,a ,m$icaid fee *ange index1 comp>+
 fees = prim>y c>e s]vices "u ! ,m$icaid
 program "u su* title dur+ ! #ab-mon?   
p]iod prec$+ ! fir/ day ( ! p]iod       
describ$ 9 subp>agraph 7,c77ii7 (       
section #aijb7;a77#ac7 ( su* ,act 7#db  
,u4,s4,c4 #acif;a7a77#ac771 z am5d$ by  
section #b1 to ! fees = su* s]vices dur+
 ! #ab-mon? p]iod beg9n+ on su* fir/    
day4  7c7 ,au?orization ( appropriations
 ,= purposes ( ?is section1 !re is      
au?oriz$ to be appropriat$ #bjj1jjj =   
fiscal ye> #bjbf1 to be available until 
exp5d$4