II 

116TH CONGRESS 

2D SESSION S. 4088 

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 

JUNE 25, 2020 

Mr. BROWN (for himself, Mrs. MURRAY, Mr. LEAHY, Ms. BALDWIN, Mr. 

SCHATZ, Ms. STABENOW, Mr. MURPHY, and Mr. MERKLEY) 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. 

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 ‘‘Ensuring Access to 

5 Primary Care for Women & Children Act’’. 


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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 provider under part 

15 B of title XVIII (or, if greater, the payment 

16 rate that would be applicable under such part 

17 if the conversion factor under section 1848(d) 

18 for the year involved were the conversion factor 

19 under such section for 2009), and that is not 

20 less than the rate that would otherwise apply to 

21 such services under this title if the rate were 

22 determined without regard to this subpara23 graph, and that are— 

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

25 physician with a primary specialty designaVerDate Sep 11 2014 00:27 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S4088.IS S4088

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1 tion of family medicine, general internal 

2 medicine, or pediatric medicine; or 

3 ‘‘(ii) furnished in the 2-year period 

4 that begins on the first day of the first 

5 month that begins after the date of enact6 ment of the Ensuring Access to Primary 

7 Care for Women & Children Act or during 

8 any other additional period specified with 

9 respect to the State under section 

10 1905(dd)(2)— 

11 ‘‘(I) by a physician with a pri12 mary specialty designation of family 

13 medicine, general internal medicine, 

14 or pediatric medicine, but only if the 

15 physician self-attests that the physi16 cian is Board certified in family medi17 cine, general internal medicine, or pe18 diatric medicine; 

19 ‘‘(II) by a physician with a pri20 mary specialty designation of obstet21 rics and gynecology, but only if the 

22 physician self-attests that the physi23 cian is Board certified in obstetrics 

24 and gynecology; 


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1 ‘‘(III) by an advanced practice 

2 clinician, as defined by the Secretary 

3 (except that the Secretary shall define 

4 such term for purposes of this sub5 paragraph to exclude a provider de6 scribed in subclause (I), (II), or (V)), 

7 that works under the supervision of— 

8 ‘‘(aa) a physician that satis9 fies the criteria specified in sub10 clause (I) or (II); or 

11 ‘‘(bb) a nurse practitioner or 

12 a physician assistant (as such 

13 terms are defined in section 

14 1861(aa)(5)(A)) who is working 

15 in accordance with State law, or 

16 a certified nurse-midwife (as de17 fined in section 1861(gg)) who is 

18 working in accordance with State 

19 law; 

20 ‘‘(IV) by a rural health clinic, 

21 Federally-qualified health center, or 

22 other health clinic that receives reim23 bursement on a fee schedule applica24 ble to a physician, a nurse practi25 tioner or a physician assistant (as 


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1 such terms are defined in section 

2 1861(aa)(5)(A)) who is working in ac3 cordance with State law, or a certified 

4 nurse-midwife (as defined in section 

5 1861(gg)) who is working in accord6 ance with State law, for services fur7 nished by a physician, nurse practi8 tioner, physician assistant, or certified 

9 nurse-midwife, or services furnished 

10 by an advanced practice clinician su11 pervised by a physician described in 

12 subclause (I) or (II), another ad13 vanced practice clinician, a nurse 

14 practitioner, physician assistant, or a 

15 certified nurse-midwife; or 

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

17 physician assistant (as such terms are 

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

19 who is working in accordance with 

20 State law, or a certified nurse-midwife 

21 (as defined in section 1861(gg)) who 

22 is working in accordance with State 

23 law, in accordance with procedures 

24 that ensure that the portion of the 

25 payment for such services that the 


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1 nurse practitioner, physician assist2 ant, or certified nurse-midwife is paid 

3 is not less than the amount that the 

4 nurse practitioner, physician assist5 ant, or certified nurse-midwife would 

6 be paid if the services were provided 

7 under part B of title XVIII;’’. 

8 (2) CONFORMING AMENDMENTS.—Section 

9 1905(dd) of the Social Security Act (42 U.S.C. 

10 1396d(dd)) is amended— 

11 (A) by striking ‘‘Notwithstanding’’ and in12 serting the following: 

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

14 (B) by inserting ‘‘or furnished during a pe15 riod that is an additional period with respect to 

16 the State, as specified in paragraph (2),’’ after 

17 ‘‘2015,’’; and 

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

19 ‘‘(2) ADDITIONAL PERIODS.—For purposes of 

20 paragraph (1): 

21 ‘‘(A) The 2-year period that begins on the 

22 first day of the first month that begins after 

23 the date of enactment of the Ensuring Access 

24 to Primary Care for Women & Children Act 


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1 shall be an additional period with respect to all 

2 States. 

3 ‘‘(B) Any public health emergency period 

4 (as defined in paragraph (3)) with respect to a 

5 State shall be an additional period with respect 

6 to such State. 

7 ‘‘(3) PUBLIC HEALTH EMERGENCY PERIOD.— 

8 For purposes of paragraph (2), the term ‘public 

9 health emergency period’ means, with respect to a 

10 State, a period that— 

11 ‘‘(A) begins on the date on which a public 

12 health emergency is declared with respect to the 

13 State by the Secretary pursuant to section 319 

14 of the Public Health Service Act; and 

15 ‘‘(B) ends on the last day of the sixth 

16 month that begins on or after the date on which 

17 such declaration expires.’’. 

18 (b) IMPROVED TARGETING OF PRIMARY CARE.—Sec19 tion 1902(jj) of the Social Security Act (42 U.S.C. 

20 1396a(jj)) is amended— 

21 (1) by redesignating paragraphs (1) and (2) as 

22 subparagraphs (A) and (B), respectively and realign23 ing the left margins accordingly; 

24 (2) by striking ‘‘For purposes of’’ and inserting 

25 the following: 


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

2 (3) by adding at the end the following: 

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

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

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

6 emergency department of a hospital.’’. 

7 (c) ENSURING PAYMENT BY MANAGED CARE ENTI8 TIES.— 

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

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

11 is amended— 

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

13 the semicolon; 

14 (B) by realigning the left margin of clause 

15 (xiii) so as to align with the left margin of 

16 clause (xii) and by striking the period at the 

17 end of clause (xiii) and inserting ‘‘; and’’; and 

18 (C) by inserting after clause (xiii) the fol19 lowing: 

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

21 to providers specified in section 1902(a)(13)(C) for 

22 primary care services defined in section 1902(jj) 

23 that are furnished during a year or period specified 

24 in section 1902(a)(13)(C) and section 1905(dd) are 

25 at least equal to the amounts set forth and required 


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1 by the Secretary by regulation, (II) the entity shall, 

2 upon request, provide documentation to the State, 

3 sufficient to enable the State and the Secretary to 

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

5 Secretary shall approve payments described in sub6 clause (I) that are furnished through an agreed 

7 upon capitation, partial capitation, or other value8 based payment arrangement if the capitation, partial 

9 capitation, or other value-based payment arrange10 ment is based on a reasonable methodology and the 

11 entity provides documentation to the State sufficient 

12 to enable the State and the Secretary to ensure com13 pliance with subclause (I).’’. 

14 (2) CONFORMING AMENDMENT.—Section 

15 1932(f) of the Social Security Act (42 U.S.C. 

16 1396u–2(f)) is amended by inserting ‘‘and clause 

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

18 SEC. 3. IMPROVING QUALITY AND VALUE FOR MEDICAID 

19 BENEFICIARIES. 

20 (a) GAO STUDY.—Not later than 3 years after the 

21 date of enactment of this Act, the Comptroller General 

22 of the United States shall submit to Congress a report 

23 that examines the effects of the payment rate floor for 

24 primary care services under Medicaid provided under sec25 tion 1902(a)(13)(C) of the Social Security Act (42 U.S.C. 


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1 1396a(a)(13)(C)) on beneficiary access to such services, 

2 including any recommendations for how the payment rate 

3 floor for such services could be more effective. 

4 (b) FUNDING THE DEVELOPMENT OF QUALITY

5 MEASURES.—The first sentence of section 1139B(e) of 

6 the Social Security Act (42 U.S.C. 1320b–9b(e)) is 

7 amended by inserting ‘‘, and for fiscal year 2016, 

8 $15,000,000,’’ before ‘‘for the purpose’’. 

9 (c) DEVELOPING QUALITY MEASURES FOR BENE10 FICIARIES WITH DISABILITIES.—Section 1139B(b)(5) of 

11 the Social Security Act (42 U.S.C. 1320b–9b(b)(5)) is 

12 amended by adding at the end the following: 

13 ‘‘(D) QUALITY MEASURES SPECIFIC TO

14 ADULT INDIVIDUALS WITH DISABILITIES.—The 

15 Secretary, acting through the Administrator for 

16 the Centers for Medicare & Medicaid Services 

17 and the Director of the Agency for Healthcare 

18 Research and Quality, shall develop adult 

19 health quality measures that are specific to 

20 adult individuals with disabilities and shall in21 clude those measures in the Medicaid Quality 

22 Measurement Program. In developing such 

23 measures, priority shall be given to developing 

24 quality measures that assess the impact on 

25 adult individuals with disabilities of existing 


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1 programs and to the development of quality 

2 measures that assess the impact of new service 

3 delivery innovations on such individuals.’’. 

Æ 


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