[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 1833 Introduced in Senate (IS)]
<DOC>
117th CONGRESS
1st Session
S. 1833
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 services.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 26, 2021
Mr. Brown (for himself, Mrs. Murray, Mr. Blumenthal, Mr. Murphy, Ms.
Baldwin, Mr. Schatz, Mr. Leahy, Mr. Merkley, and Mr. Sanders)
introduced the following bill; 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 services.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Ensuring Access to Primary Care for
Women & Children Act''.
SEC. 2. RENEWAL OF APPLICATION OF MEDICARE PAYMENT RATE FLOOR TO
PRIMARY CARE SERVICES FURNISHED UNDER MEDICAID AND
INCLUSION OF ADDITIONAL PROVIDERS.
(a) Renewal of Payment Floor; Additional Providers.--
(1) In general.--Section 1902(a)(13) of the Social Security
Act (42 U.S.C. 1396a(a)(13)) is amended by striking
subparagraph (C) and inserting the following:
``(C) payment for primary care services (as defined
in subsection (jj)) at a rate that is not less than 100
percent of the payment rate that applies to such
services and provider under part B of title XVIII (or,
if greater, the payment rate that would be applicable
under such part if the conversion factor under section
1848(d) for the year involved were the conversion
factor under such section for 2009), 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 subparagraph, and that are--
``(i) furnished in 2013 and 2014, by a
physician with a primary specialty designation
of family medicine, general internal medicine,
or pediatric medicine; or
``(ii) furnished in the 2-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 or during any other additional
period specified with respect to the State
under section 1905(dd)(2)--
``(I) by a physician with a primary
specialty designation of family
medicine, general internal medicine, or
pediatric medicine, but only if the
physician self-attests that the
physician is Board certified in family
medicine, general internal medicine, or
pediatric medicine;
``(II) by a physician with a
primary specialty designation of
obstetrics and gynecology, but only if
the physician self-attests that the
physician is Board certified in
obstetrics and gynecology;
``(III) by an advanced practice
clinician, as defined by the Secretary
(except that the Secretary shall define
such term for purposes of this
subparagraph to exclude a provider
described in subclause (I), (II), or
(V)), that works under the supervision
of--
``(aa) a physician that
satisfies the criteria
specified in subclause (I) or
(II); or
``(bb) a nurse practitioner
or a physician assistant (as
such terms are defined in
section 1861(aa)(5)(A)) who is
working in accordance with
State law, or a certified
nurse-midwife (as defined in
section 1861(gg)) who is
working in accordance with
State law;
``(IV) by a rural health clinic,
Federally-qualified health center, or
other health clinic that receives
reimbursement on a fee schedule
applicable to a physician, a nurse
practitioner or a physician assistant
(as such terms are defined in section
1861(aa)(5)(A)) who is working in
accordance with State law, or a
certified nurse-midwife (as defined in
section 1861(gg)) who is working in
accordance with State law, for services
furnished by a physician, nurse
practitioner, physician assistant, or
certified nurse-midwife, or services
furnished by an advanced practice
clinician supervised by a physician
described in subclause (I) or (II),
another advanced practice clinician, a
nurse practitioner, physician
assistant, or a certified nurse-
midwife; or
``(V) by a nurse practitioner or a
physician assistant (as such terms are
defined in section 1861(aa)(5)(A)) who
is working in accordance with State
law, or a certified nurse-midwife (as
defined in section 1861(gg)) who is
working in accordance with State law,
in accordance with procedures that
ensure that the portion of the payment
for such services that the nurse
practitioner, physician assistant, or
certified nurse-midwife is paid is not
less than the amount that the nurse
practitioner, physician assistant, or
certified nurse-midwife would be paid
if the services were provided under
part B of title XVIII;''.
(2) Conforming amendments.--Section 1905(dd) of the Social
Security Act (42 U.S.C. 1396d(dd)) is amended--
(A) by striking ``Notwithstanding'' and inserting
the following:
``(1) In general.--Notwithstanding'';
(B) by inserting ``or furnished during a period
that is an additional period with respect to the State,
as specified in paragraph (2),'' after ``2015,''; and
(C) by adding at the end the following:
``(2) Additional periods.--For purposes of paragraph (1):
``(A) The 2-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 shall be an additional period with
respect to all States.
``(B) Any public health emergency period (as
defined in paragraph (3)) with respect to a State shall
be an additional period with respect to such State.
``(3) Public health emergency period.--For purposes of
paragraph (2), the term `public health emergency period' means,
with respect to a State, a period that--
``(A) begins on the date on which a public health
emergency is declared with respect to the State by the
Secretary pursuant to section 319 of the Public Health
Service Act; and
``(B) ends on the last day of the sixth month that
begins on or after the date on which such declaration
expires.''.
(b) Improved Targeting of Primary Care.--Section 1902(jj) of the
Social Security Act (42 U.S.C. 1396a(jj)) is amended--
(1) by redesignating paragraphs (1) and (2) as
subparagraphs (A) and (B), respectively, and realigning the
left margins accordingly;
(2) by striking ``For purposes of'' and inserting the
following:
``(1) In general.--For purposes of''; and
(3) by adding at the end the following:
``(2) Exclusions.--Such term does not include any services
described in subparagraph (A) or (B) of paragraph (1) if such
services are provided in an emergency department of a
hospital.''.
(c) Ensuring Payment by Managed Care Entities.--
(1) In general.--Section 1903(m)(2)(A) of the Social
Security Act (42 U.S.C. 1396b(m)(2)(A)) is amended--
(A) in clause (xii), by striking ``and'' after the
semicolon;
(B) in clause (xiii)--
(i) by realigning the left margin so as to
align with the left margin of clause (xii); and
(ii) by striking the period at the end and
inserting ``; and''; and
(C) by inserting after clause (xiii) the following:
``(xiv) such contract provides that (I) payments to
providers specified in section 1902(a)(13)(C) for primary care
services defined in section 1902(jj) that are furnished during
a year or period specified in section 1902(a)(13)(C) and
section 1905(dd) are at least equal to the amounts set forth
and required by the Secretary by regulation, (II) the entity
shall, upon request, provide documentation to the State,
sufficient to enable the State and the Secretary to ensure
compliance with subclause (I), and (III) the Secretary shall
approve payments described in subclause (I) that are furnished
through an agreed upon capitation, partial capitation, or other
value-based payment arrangement if the capitation, partial
capitation, 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 (I).''.
(2) Conforming amendment.--Section 1932(f) of the Social
Security Act (42 U.S.C. 1396u-2(f)) is amended by inserting
``and clause (xiv) of section 1903(m)(2)(A)'' before the
period.
SEC. 3. IMPROVING QUALITY AND VALUE FOR MEDICAID BENEFICIARIES.
(a) GAO Study.--Not later than 3 years after the date of enactment
of this Act, the Comptroller General of the United States shall submit
to Congress a report that examines the effects of the payment rate
floor for primary care services under Medicaid provided under section
1902(a)(13)(C) of the Social Security Act (42 U.S.C. 1396a(a)(13)(C))
on beneficiary access to such services, including any recommendations
for how the payment rate floor for such services could be more
effective.
(b) Funding the Development of Quality Measures.--The first
sentence of section 1139B(e) of the Social Security Act (42 U.S.C.
1320b-9b(e)) is amended by inserting ``, and for fiscal year 2022,
$15,000,000,'' before ``for the purpose''.
(c) Developing Quality Measures for Beneficiaries With
Disabilities.--Section 1139B(b)(5) of the Social Security Act (42
U.S.C. 1320b-9b(b)(5)) is amended by adding at the end the following:
``(D) Quality measures specific to adult
individuals with disabilities.--The Secretary, acting
through the Administrator for the Centers for Medicare
& Medicaid Services and the Director of the Agency for
Healthcare Research and Quality, shall develop adult
health quality measures that are specific to adult
individuals with disabilities and shall include those
measures in the Medicaid Quality Measurement Program.
In developing such measures, 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 individuals.''.
<all>