I
119THCONGRESS
1
STSESSION H. R. 1433
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 program, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY18, 2025
Ms. S
CHRIER(for herself, Mr. FITZPATRICK, Ms. CASTORof Florida, Ms.
D
ELBENE, Mr. COHEN, Mr. TONKO, Ms. MENG, Ms. SEWELL, Mr.
D
AVISof North Carolina, Ms. STRICKLAND, and Mr. MAGAZINER) intro-
duced the following bill; 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 pro-
gram, and for other purposes.
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE. 3
This Act may be cited as the ‘‘Kids’ Access to Pri-4
mary Care Act of 2025’’. 5
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SEC. 2. RENEWAL OF APPLICATION OF MEDICARE PAY-1
MENT RATE FLOOR TO PRIMARY CARE SERV-2
ICES FURNISHED UNDER MEDICAID AND IN-3
CLUSION OF ADDITIONAL PROVIDERS. 4
(a) R
ENEWAL OF PAYMENTFLOOR; ADDITIONAL 5
P
ROVIDERS.— 6
(1) I
N GENERAL.—Section 1902(a)(13) of the 7
Social Security Act (42 U.S.C. 1396a(a)(13)) is 8
amended by striking subparagraph (C) and inserting 9
the following: 10
‘‘(C) payment for primary care services (as 11
defined in subsection (jj)) at a rate that is not 12
less than 100 percent of the payment rate that 13
applies to such services and physician under 14
part B of title XVIII (or, if greater, the pay-15
ment rate that would be applicable under such 16
part if the conversion factor under section 17
1848(d) for the year involved were the conver-18
sion factor under such section for 2009), and 19
that is not less than the rate that would other-20
wise apply to such services under this title if 21
the rate were determined without regard to this 22
subparagraph, and that are— 23
‘‘(i) furnished in 2013 and 2014, by a 24
physician with a primary specialty designa-25
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tion of family medicine, general internal 1
medicine, or pediatric medicine; or 2
‘‘(ii) furnished during the period be-3
ginning on the first day of the first month 4
beginning after the date of the enactment 5
of the Kids’ Access to Primary Care Act of 6
2025— 7
‘‘(I) by a physician with a pri-8
mary specialty designation of family 9
medicine, general internal medicine, 10
pediatric medicine, or obstetrics and 11
gynecology, but only if the physician 12
self-attests that the physician is 13
board-certified in family medicine, 14
general internal medicine, pediatric 15
medicine, or obstetrics and gyne-16
cology, respectively; 17
‘‘(II) by a physician with a pri-18
mary specialty designation of a family 19
medicine subspecialty, an internal 20
medicine subspecialty, a pediatric sub-21
specialty, or a subspecialty of obstet-22
rics and gynecology, without regard to 23
the board that offers the designation 24
for such a subspecialty, but only if the 25
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physician self-attests that the physi-1
cian is board-certified in such a sub-2
specialty; 3
‘‘(III) by an advanced practice 4
clinician, as defined by the Secretary, 5
that works under the supervision of— 6
‘‘(aa) a physician described 7
in subclause (I) or (II); or 8
‘‘(bb) a nurse practitioner or 9
a physician assistant (as such 10
terms are defined in section 11
1861(aa)(5)(A)) who is working 12
in accordance with State law, or 13
a certified nurse-midwife (as de-14
fined in section 1861(gg)(2)) who 15
is working in accordance with 16
State law; 17
‘‘(IV) by a rural health clinic, 18
Federally-qualified health center, or 19
other health clinic that receives reim-20
bursement on a fee schedule applica-21
ble to a physician described in sub-22
clause (I) or (II), an advanced prac-23
tice clinician described in subclause 24
(III), or a nurse practitioner, physi-25
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cian assistant, or certified nurse-mid-1
wife described in subclause (III)(bb), 2
for services furnished by— 3
‘‘(aa) such a physician, 4
nurse practitioner, physician as-5
sistant, or certified nurse-mid-6
wife, respectively; or 7
‘‘(bb) an advanced practice 8
clinician supervised by such a 9
physician, nurse practitioner, 10
physician assistant, or certified 11
nurse-midwife; or 12
‘‘(V) by a nurse practitioner or a 13
physician assistant (as such terms are 14
defined in section 1861(aa)(5)(A)) 15
who is working in accordance with 16
State law, or a certified nurse-midwife 17
described in subclause (III)(bb) who is 18
working in accordance with State law, 19
in accordance with procedures that 20
ensure that the portion of the pay-21
ment for such services that the nurse 22
practitioner, physician assistant, or 23
certified nurse-midwife is paid is not 24
less than the amount that the nurse 25
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practitioner, physician assistant, or 1
certified nurse-midwife would be paid 2
if the services were provided under 3
part B of title XVIII;’’. 4
(2) C
ONFORMING AMENDMENTS .—Section 5
1905(dd) of the Social Security Act (42 U.S.C. 6
1396d(dd)) is amended— 7
(A) by striking ‘‘Notwithstanding’’ and in-8
serting the following: 9
‘‘(1) I
N GENERAL.—Notwithstanding’’; 10
(B) by inserting ‘‘or furnished during the 11
additional period specified in paragraph (2),’’ 12
after ‘‘2015,’’; and 13
(C) by adding at the end the following: 14
‘‘(2) A
DDITIONAL PERIOD.—For purposes of 15
paragraph (1), the additional period specified in this 16
paragraph is the period beginning on the first day 17
of the first month beginning after the date of the en-18
actment of the Kids’ Access to Primary Care Act of 19
2025.’’. 20
(b) I
MPROVEDTARGETING OFPRIMARYCARE.— 21
(1) I
N GENERAL.—Section 1902(jj) of the So-22
cial Security Act (42 U.S.C. 1396a(jj)) is amend-23
ed— 24
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(A) by redesignating paragraphs (1) and 1
(2) as subparagraphs (A) and (B), respectively, 2
and moving the margin of each such subpara-3
graph, as so redesignated, 2 ems to the right; 4
(B) by striking ‘‘For purposes of’’ and in-5
serting the following: 6
‘‘(1) I
N GENERAL.—For purposes of’’; and 7
(C) by adding at the end the following: 8
‘‘(2) E
XCLUSIONS.—Such term does not include 9
any services described in subparagraph (A) or (B) of 10
paragraph (1) if such services are provided in an 11
emergency department of a hospital.’’. 12
(2) E
FFECTIVE DATE.—The amendments made 13
by paragraph (1) shall apply with respect to primary 14
care services provided on or after the first day of the 15
period described in subparagraph (C)(ii) of section 16
1902(a)(13) of the Social Security Act (42 U.S.C. 17
1396a(a)(13)), as amended by section 2. 18
(c) E
NSURINGPAYMENT BYMANAGEDCAREENTI-19
TIES.— 20
(1) I
N GENERAL.—Section 1903(m)(2)(A) of 21
the Social Security Act (42 U.S.C. 1396b(m)(2)(A)) 22
is amended— 23
(A) in clause (xii), by striking ‘‘and’’ after 24
the semicolon; 25
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(B) in clause (xiii)— 1
(i) by moving the margin of such 2
clause 2 ems to the left; and 3
(ii) by striking the period at the end 4
and inserting ‘‘; and’’; and 5
(C) by inserting after clause (xiii) the fol-6
lowing: 7
‘‘(xiv) such contract provides that (I) payments 8
to health care providers specified in section 9
1902(a)(13)(C) for furnishing primary care services 10
defined in section 1902(jj) during a year or period 11
specified in section 1902(a)(13)(C) are at least equal 12
to the amounts set forth and required by the Sec-13
retary by regulation, (II) the entity shall, upon re-14
quest, provide documentation to the State that is 15
sufficient to enable the State and the Secretary to 16
ensure compliance with subclause (I), and (III) the 17
Secretary shall approve payments described in sub-18
clause (I) that are furnished through an agreed- 19
upon capitation, partial capitation, or other value- 20
based payment arrangement if the agreed-upon capi-21
tation, partial capitation, or other value-based pay-22
ment arrangement is based on a reasonable method-23
ology and the entity provides documentation to the 24
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State that is sufficient to enable the State and the 1
Secretary to ensure compliance with subclause (I).’’. 2
(2) C
ONFORMING AMENDMENT .—Section 3
1932(f) of the Social Security Act (42 U.S.C. 4
1396u–2(f)) is amended by inserting ‘‘and clause 5
(xiv) of section 1903(m)(2)(A)’’ before the period. 6
(3) E
FFECTIVE DATE.—The amendments made 7
by this subsection shall apply with respect to con-8
tracts entered into on or after the date of the enact-9
ment of this Act. 10
SEC. 3. STUDY. 11
(a) I
NGENERAL.—Not later than the date that is 12
one year and one month after the date of the enactment 13
of this Act, the Secretary of Health and Human Services 14
shall conduct a study— 15
(1) comparing the number of children enrolled 16
in a State plan under title XIX of the Social Secu-17
rity Act (42 U.S.C. 1396 et seq.) (or a waiver of 18
such plan) during the 12-month period preceding the 19
first day of the period described in subparagraph 20
(C)(ii) of section 1902(a)(13) of such Act (42 21
U.S.C. 1396a(a)(13)), as amended by section 2, to 22
the number of children so enrolled during the 12- 23
month period beginning on such first day; 24
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(2) comparing the number of health care pro-1
viders receiving payments for primary care services 2
under the Medicaid program under such title during 3
the 12-month period preceding the first day of the 4
period described in subparagraph (C)(ii) of section 5
1902(a)(13) of such Act (42 U.S.C. 1396a(a)(13)), 6
as amended by section 2, to the number of health 7
care providers receiving such payments during the 8
12-month period beginning on such first day; and 9
(3) comparing health care provider payment 10
rates for primary care services under the Medicaid 11
program under such title during the 12-month pe-12
riod beginning on the first day of the period de-13
scribed in subparagraph (C)(ii) of section 14
1902(a)(13) of such Act (42 U.S.C. 1396a(a)(13)), 15
as amended by section 2, across States, using the in-16
dexes described in subsection (b). 17
(b) I
NDEXESDESCRIBED.—The indexes described in 18
this subsection are each of the following: 19
(1) A Medicaid fee index, comparing each 20
State’s average fee for primary care services under 21
the Medicaid program under such title to the na-22
tional average for such services. 23
(2) A Medicaid-to-Medicare fee index, com-24
paring each State’s average fee for primary care 25
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services under the Medicaid program under such 1
title to the fee for such services under the Medicare 2
program under title XVIII of such Act (42 U.S.C. 3
1395 et seq.). 4
(3) A Medicaid fee change index, comparing 5
fees for primary care services under the Medicaid 6
program under such title during the 12-month pe-7
riod preceding the first day of the period described 8
in subparagraph (C)(ii) of section 1902(a)(13) of 9
such Act (42 U.S.C. 1396a(a)(13)), as amended by 10
section 2, to the fees for such services during the 11
12-month period beginning on such first day. 12
(c) A
UTHORIZATION OFAPPROPRIATIONS.—For pur-13
poses of this section, there is authorized to be appro-14
priated $200,000 for fiscal year 2026, to be available until 15
expended. 16
SEC. 4. SENSE OF CONGRESS REGARDING USE OF BRIGHT 17
FUTURES GUIDELINES. 18
It is the sense of Congress that health care providers 19
should provide early and periodic screening, diagnostic, 20
and treatment services (as defined in section 1905(r) of 21
the Social Security Act (42 U.S.C. 1396d(r))) in accord-22
ance with the guidelines of the American Academy of Pe-23
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diatrics entitled, ‘‘Bright Futures: Guidelines for Health 1
Supervision of Infants, Children, and Adolescents’’. 2
Æ
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