I 

118TH CONGRESS 

1ST SESSION H. R. 952 

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 9, 2023 

Ms. SCHRIER (for herself, Mr. FITZPATRICK, and Ms. CASTOR of Florida) 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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Kids’ Access to Pri5 mary Care Act of 2023’’. 


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1 SEC. 2. RENEWAL OF APPLICATION OF MEDICARE PAY2 MENT RATE FLOOR TO PRIMARY CARE SERV3 ICES FURNISHED UNDER MEDICAID AND IN4 CLUSION OF ADDITIONAL PROVIDERS. 

5 (a) RENEWAL OF PAYMENT FLOOR; ADDITIONAL

6 PROVIDERS.— 

7 (1) IN GENERAL.—Section 1902(a)(13) of the 

8 Social Security Act (42 U.S.C. 1396a(a)(13)) is 

9 amended by striking subparagraph (C) and inserting 

10 the following: 

11 ‘‘(C) payment for primary care services (as 

12 defined in subsection (jj)) at a rate that is not 

13 less than 100 percent of the payment rate that 

14 applies to such services and physician under 

15 part B of title XVIII (or, if greater, the pay16 ment rate that would be applicable under such 

17 part if the conversion factor under section 

18 1848(d) for the year involved were the conver19 sion factor under such section for 2009), and 

20 that is not less than the rate that would other21 wise apply to such services under this title if 

22 the rate were determined without regard to this 

23 subparagraph, and that are— 

24 ‘‘(i) furnished in 2013 and 2014, by a 

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1 tion of family medicine, general internal 

2 medicine, or pediatric medicine; or 

3 ‘‘(ii) furnished during the period be4 ginning on the first day of the first month 

5 beginning after the date of the enactment 

6 of the Kids’ Access to Primary Care Act of 

7 2023— 

8 ‘‘(I) by a physician with a pri9 mary specialty designation of family 

10 medicine, general internal medicine, 

11 pediatric medicine, or obstetrics and 

12 gynecology, but only if the physician 

13 self-attests that the physician is 

14 board-certified in family medicine, 

15 general internal medicine, pediatric 

16 medicine, or obstetrics and gyne17 cology, respectively; 

18 ‘‘(II) by a physician with a pri19 mary specialty designation of a family 

20 medicine subspecialty, an internal 

21 medicine subspecialty, a pediatric sub22 specialty, or a subspecialty of obstet23 rics and gynecology, without regard to 

24 the board that offers the designation 

25 for such a subspecialty, but only if the 


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1 physician self-attests that the physi2 cian is board-certified in such a sub3 specialty; 

4 ‘‘(III) by an advanced practice 

5 clinician, as defined by the Secretary, 

6 that works under the supervision of— 

7 ‘‘(aa) a physician described 

8 in subclause (I) or (II); or 

9 ‘‘(bb) a nurse practitioner or 

10 a physician assistant (as such 

11 terms are defined in section 

12 1861(aa)(5)(A)) who is working 

13 in accordance with State law, or 

14 a certified nurse-midwife (as de15 fined in section 1861(gg)(2)) who 

16 is working in accordance with 

17 State law; 

18 ‘‘(IV) by a rural health clinic, 

19 Federally-qualified health center, or 

20 other health clinic that receives reim21 bursement on a fee schedule applica22 ble to a physician described in sub23 clause (I) or (II), an advanced prac24 tice clinician described in subclause 

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1 cian assistant, or certified nurse-mid2 wife described in subclause (III)(bb), 

3 for services furnished by— 

4 ‘‘(aa) such a physician, 

5 nurse practitioner, physician as6 sistant, or certified nurse-mid7 wife, respectively; or 

8 ‘‘(bb) an advanced practice 

9 clinician supervised by such a 

10 physician, nurse practitioner, 

11 physician assistant, or certified 

12 nurse-midwife; or 

13 ‘‘(V) by a nurse practitioner or a 

14 physician assistant (as such terms are 

15 defined in section 1861(aa)(5)(A)) 

16 who is working in accordance with 

17 State law, or a certified nurse-midwife 

18 described in subclause (III)(bb) who is 

19 working in accordance with State law, 

20 in accordance with procedures that 

21 ensure that the portion of the pay22 ment for such services that the nurse 

23 practitioner, physician assistant, or 

24 certified nurse-midwife is paid is not 

25 less than the amount that the nurse 


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1 practitioner, physician assistant, or 

2 certified nurse-midwife would be paid 

3 if the services were provided under 

4 part B of title XVIII;’’. 

5 (2) CONFORMING AMENDMENTS.—Section 

6 1905(dd) of the Social Security Act (42 U.S.C. 

7 1396d(dd)) is amended— 

8 (A) by striking ‘‘Notwithstanding’’ and in9 serting the following: 

10 ‘‘(1) IN GENERAL.—Notwithstanding’’; 

11 (B) by inserting ‘‘or furnished during the 

12 additional period specified in paragraph (2),’’ 

13 after ‘‘2015,’’; and 

14 (C) by adding at the end the following: 

15 ‘‘(2) ADDITIONAL PERIOD.—For purposes of 

16 paragraph (1), the additional period specified in this 

17 paragraph is the period beginning on the first day 

18 of the first month beginning after the date of the en19 actment of the Kids’ Access to Primary Care Act of 

20 2023.’’. 

21 (b) IMPROVED TARGETING OF PRIMARY CARE.— 

22 (1) IN GENERAL.—Section 1902(jj) of the So23 cial Security Act (42 U.S.C. 1396a(jj)) is amend24 ed— 


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1 (A) by redesignating paragraphs (1) and 

2 (2) as subparagraphs (A) and (B), respectively, 

3 and moving the margin of each such subpara4 graph, as so redesignated, 2 ems to the right; 

5 (B) by striking ‘‘For purposes of’’ and in6 serting the following: 

7 ‘‘(1) IN GENERAL.—For purposes of’’; and 

8 (C) by adding at the end the following: 

9 ‘‘(2) EXCLUSIONS.—Such term does not include 

10 any services described in subparagraph (A) or (B) of 

11 paragraph (1) if such services are provided in an 

12 emergency department of a hospital.’’. 

13 (2) EFFECTIVE DATE.—The amendments made 

14 by paragraph (1) shall apply with respect to primary 

15 care services provided on or after the first day of the 

16 period described in subparagraph (C)(ii) of section 

17 1902(a)(13) of the Social Security Act (42 U.S.C. 

18 1396a(a)(13)), as amended by section 2. 

19 (c) ENSURING PAYMENT BY MANAGED CARE ENTI20 TIES.— 

21 (1) IN GENERAL.—Section 1903(m)(2)(A) of 

22 the Social Security Act (42 U.S.C. 1396b(m)(2)(A)) 

23 is amended— 

24 (A) in clause (xii), by striking ‘‘and’’ after 

25 the semicolon; 


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1 (B) in clause (xiii)— 

2 (i) by moving the margin of such 

3 clause 2 ems to the left; and 

4 (ii) by striking the period at the end 

5 and inserting ‘‘; and’’; and 

6 (C) by inserting after clause (xiii) the fol7 lowing: 

8 ‘‘(xiv) such contract provides that (I) payments 

9 to health care providers specified in section 

10 1902(a)(13)(C) for furnishing primary care services 

11 defined in section 1902(jj) during a year or period 

12 specified in section 1902(a)(13)(C) are at least equal 

13 to the amounts set forth and required by the Sec14 retary by regulation, (II) the entity shall, upon re15 quest, provide documentation to the State that is 

16 sufficient to enable the State and the Secretary to 

17 ensure compliance with subclause (I), and (III) the 

18 Secretary shall approve payments described in sub19 clause (I) that are furnished through an agreed20 upon capitation, partial capitation, or other value21 based payment arrangement if the agreed-upon capi22 tation, partial capitation, or other value-based pay23 ment arrangement is based on a reasonable method24 ology and the entity provides documentation to the 


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1 State that is sufficient to enable the State and the 

2 Secretary to ensure compliance with subclause (I).’’. 

3 (2) CONFORMING AMENDMENT.—Section 

4 1932(f) of the Social Security Act (42 U.S.C. 

5 1396u–2(f)) is amended by inserting ‘‘and clause 

6 (xiv) of section 1903(m)(2)(A)’’ before the period. 

7 (3) EFFECTIVE DATE.—The amendments made 

8 by this subsection shall apply with respect to con9 tracts entered into on or after the date of the enact10 ment of this Act. 

11 SEC. 3. STUDY. 

12 (a) IN GENERAL.—Not later than the date that is 

13 one year and one month after the date of the enactment 

14 of this Act, the Secretary of Health and Human Services 

15 shall conduct a study— 

16 (1) comparing the number of children enrolled 

17 in a State plan under title XIX of the Social Secu18 rity Act (42 U.S.C. 1396 et seq.) (or a waiver of 

19 such plan) during the 12-month period preceding the 

20 first day of the period described in subparagraph 

21 (C)(ii) of section 1902(a)(13) of such Act (42 

22 U.S.C. 1396a(a)(13)), as amended by section 2, to 

23 the number of children so enrolled during the 12- 

24 month period beginning on such first day; 


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1 (2) comparing the number of health care pro2 viders receiving payments for primary care services 

3 under the Medicaid program under such title during 

4 the 12-month period preceding the first day of the 

5 period described in subparagraph (C)(ii) of section 

6 1902(a)(13) of such Act (42 U.S.C. 1396a(a)(13)), 

7 as amended by section 2, to the number of health 

8 care providers receiving such payments during the 

9 12-month period beginning on such first day; and 

10 (3) comparing health care provider payment 

11 rates for primary care services under the Medicaid 

12 program under such title during the 12-month pe13 riod beginning on the first day of the period de14 scribed in subparagraph (C)(ii) of section 

15 1902(a)(13) of such Act (42 U.S.C. 1396a(a)(13)), 

16 as amended by section 2, across States, using the in17 dexes described in subsection (b). 

18 (b) INDEXES DESCRIBED.—The indexes described in 

19 this subsection are each of the following: 

20 (1) A Medicaid fee index, comparing each 

21 State’s average fee for primary care services under 

22 the Medicaid program under such title to the na23 tional average for such services. 

24 (2) A Medicaid-to-Medicare fee index, com25 paring each State’s average fee for primary care 


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1 services under the Medicaid program under such 

2 title to the fee for such services under the Medicare 

3 program under title XVIII of such Act (42 U.S.C. 

4 1395 et seq.). 

5 (3) A Medicaid fee change index, comparing 

6 fees for primary care services under the Medicaid 

7 program under such title during the 12-month pe8 riod preceding the first day of the period described 

9 in subparagraph (C)(ii) of section 1902(a)(13) of 

10 such Act (42 U.S.C. 1396a(a)(13)), as amended by 

11 section 2, to the fees for such services during the 

12 12-month period beginning on such first day. 

13 (c) AUTHORIZATION OF APPROPRIATIONS.—For pur14 poses of this section, there is authorized to be appro15 priated $200,000 for fiscal year 2024, to be available until 

16 expended. 

17 SEC. 4. SENSE OF CONGRESS REGARDING USE OF BRIGHT 

18 FUTURES GUIDELINES. 

19 It is the sense of Congress that health care providers 

20 should provide early and periodic screening, diagnostic, 

21 and treatment services (as defined in section 1905(r) of 

22 the Social Security Act (42 U.S.C. 1396d(r))) in accord23 ance with the guidelines of the American Academy of PeVerDate Sep 11 2014 00:51 Mar 10, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H952.IH H952

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1 diatrics entitled, ‘‘Bright Futures: Guidelines for Health 

2 Supervision of Infants, Children, and Adolescents’’. 

Æ 


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