Bill Details
HR.1433 - 119th Congress
Status
Latest action
2025-02-18 - Referred to the House Committee on Energy and Commerce.
Introduced Date
2025-02-18
Policy Area
Health
Committees
View committees (1)
Sponsors
Cosponsors
View cosponsors (11)
- Rep. Fitzpatrick, Brian K. [R-Pennsylvania-1]
- Rep. Castor, Kathy [D-Florida-14]
- Rep. DelBene, Suzan K. [D-Washington-1]
- Rep. Cohen, Steve [D-Tennessee-9]
- Rep. Tonko, Paul [D-New York-20]
- Rep. Meng, Grace [D-New York-6]
- Rep. Sewell, Terri A. [D-Alabama-7]
- Rep. Davis, Donald G. [D-North Carolina-1]
- Rep. Strickland, Marilyn [D-Washington-10]
- Rep. Magaziner, Seth [D-Rhode Island-2]
- Rep. Stansbury, Melanie A. [D-New Mexico-1]
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AI Summary This summary was generated by AI from the bill text. AI can get information wrong.
This bill would help Medicaid pay more for primary care services so more children and families can find and keep a doctor or other health care provider. It would restart a rule that makes Medicaid payment rates for primary care at least as high as Medicare rates, and it would expand which providers can qualify for the higher payment. The bill also says these higher payments should not apply to primary care services given in a hospital emergency room. In addition, it would require Medicaid managed care plans to pass these payment requirements on to providers, and it would ask the federal health department to study whether the change improves access to care for children and the number of providers taking Medicaid. The bill also expresses support for pediatric care using the American Academy of Pediatrics’ Bright Futures guidelines.
- Raises Medicaid payment for certain primary care services to at least the Medicare payment level, or higher if Medicare’s older payment formula would pay more.
- Expands the types of providers that can receive the higher rate, including certain doctors in family medicine, internal medicine, pediatrics, and obstetrics and gynecology, plus nurse practitioners, physician assistants, certified nurse-midwives, advanced practice clinicians, and some clinics.
- Excludes primary care services provided in hospital emergency departments from this higher-payment rule.
- Requires Medicaid managed care contracts to make sure providers are paid these required amounts, and directs the government to study the impact on child enrollment, provider participation, and payment levels, with $200,000 authorized for the study.
Official Summaries
Kids' Access to Primary Care Act of 2025
This bill modifies payments for Medicaid primary care services. Specifically, the bill applies a Medicare payment rate floor to Medicaid primary care services that are provided after the date of enactment of the bill and extends the payment rate to additional types of practitioners (e.g., obstetricians).
The Centers for Medicare & Medicaid Services must conduct a study on the number of children enrolled in Medicaid, the number of providers receiving payment for primary care services, and associated payment rates before and after the bill's implementation.
Current Full Text
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1433 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
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
February 18, 2025
Ms. Schrier (for herself, Mr. Fitzpatrick, Ms. Castor of Florida, Ms.
DelBene, Mr. Cohen, Mr. Tonko, Ms. Meng, Ms. Sewell, Mr. Davis of North
Carolina, Ms. Strickland, and Mr. Magaziner) introduced 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 program, and for other purposes.
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 ``Kids' Access to Primary Care Act of
2025''.
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 physician 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 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 2025--
``(I) by a physician with a primary
specialty designation of family
medicine, general internal medicine,
pediatric medicine, or obstetrics and
gynecology, but only if the physician
self-attests that the physician is
board-certified in family medicine,
general internal medicine, pediatric
medicine, or obstetrics and gynecology,
respectively;
``(II) by a physician with a
primary specialty designation of a
family medicine subspecialty, an
internal medicine subspecialty, a
pediatric subspecialty, or a
subspecialty of obstetrics and
gynecology, without regard to the board
that offers the designation for such a
subspecialty, but only if the physician
self-attests that the physician is
board-certified in such a subspecialty;
``(III) by an advanced practice
clinician, as defined by the Secretary,
that works under the supervision of--
``(aa) a physician
described 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)(2)) 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 described in
subclause (I) or (II), an advanced
practice clinician described in
subclause (III), or a nurse
practitioner, physician assistant, or
certified nurse-midwife described in
subclause (III)(bb), for services
furnished by--
``(aa) such a physician,
nurse practitioner, physician
assistant, or certified nurse-
midwife, respectively; or
``(bb) an advanced practice
clinician supervised by such a
physician, nurse practitioner,
physician assistant, or
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
described in subclause (III)(bb) 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 the
additional period specified in paragraph (2),'' after
``2015,''; and
(C) by adding at the end the following:
``(2) Additional period.--For purposes of paragraph (1),
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 2025.''.
(b) Improved Targeting of Primary Care.--
(1) In general.--Section 1902(jj) of the Social Security
Act (42 U.S.C. 1396a(jj)) is amended--
(A) by redesignating paragraphs (1) and (2) as
subparagraphs (A) and (B), respectively, and moving the
margin of each such subparagraph, as so redesignated, 2
ems to the right;
(B) by striking ``For purposes of'' and inserting
the following:
``(1) In general.--For purposes of''; and
(C) 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.''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply with respect to primary care services provided on
or after the first day of the period described in subparagraph
(C)(ii) of section 1902(a)(13) of the Social Security Act (42
U.S.C. 1396a(a)(13)), as amended by section 2.
(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 moving the margin of such clause 2
ems to the left; 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 health
care providers specified in section 1902(a)(13)(C) for
furnishing primary care services defined in section 1902(jj)
during a year or period specified in section 1902(a)(13)(C) 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 that is 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 agreed-upon capitation, partial capitation,
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 (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.
(3) 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 Act.
SEC. 3. STUDY.
(a) In General.--Not later than the date that is one year and one
month after the date of the enactment of this Act, the Secretary of
Health and Human Services shall conduct a study--
(1) comparing the number of children enrolled in a State
plan under title XIX of the Social Security Act (42 U.S.C. 1396
et seq.) (or a waiver of such plan) during the 12-month period
preceding the first day of the period described in subparagraph
(C)(ii) of section 1902(a)(13) of such Act (42 U.S.C.
1396a(a)(13)), as amended by section 2, to the number of
children so enrolled during the 12-month period beginning on
such first day;
(2) comparing the number of health care providers receiving
payments for primary care services under the Medicaid program
under such title during the 12-month period preceding the first
day of the period described in subparagraph (C)(ii) of section
1902(a)(13) of such Act (42 U.S.C. 1396a(a)(13)), as amended by
section 2, to the number of health care providers receiving
such payments during the 12-month period beginning on such
first day; and
(3) comparing health care provider payment rates for
primary care services under the Medicaid program under such
title during the 12-month period beginning on the first day of
the period described in subparagraph (C)(ii) of section
1902(a)(13) of such Act (42 U.S.C. 1396a(a)(13)), as amended by
section 2, across States, using the indexes described in
subsection (b).
(b) Indexes Described.--The indexes described in this subsection
are each of the following:
(1) A Medicaid fee index, comparing each State's average
fee for primary care services under the Medicaid program under
such title to the national average for such services.
(2) A Medicaid-to-Medicare fee index, 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 (42
U.S.C. 1395 et seq.).
(3) A Medicaid fee change index, comparing fees for primary
care services under the Medicaid program under such title
during the 12-month period preceding the first day of the
period described in subparagraph (C)(ii) of section 1902(a)(13)
of such Act (42 U.S.C. 1396a(a)(13)), as amended by section 2,
to the fees for such services during the 12-month period
beginning on such first day.
(c) Authorization of Appropriations.--For purposes of this section,
there is authorized to be appropriated $200,000 for fiscal year 2026,
to be available until expended.
SEC. 4. SENSE OF CONGRESS REGARDING USE OF BRIGHT FUTURES GUIDELINES.
It is the sense of Congress that health care providers should
provide early and periodic screening, diagnostic, and treatment
services (as defined in section 1905(r) of the Social Security Act (42
U.S.C. 1396d(r))) in accordance with the guidelines of the American
Academy of Pediatrics entitled, ``Bright Futures: Guidelines for Health
Supervision of Infants, Children, and Adolescents''.
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