I 

117TH CONGRESS 

1ST SESSION H. R. 1025 

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 11, 2021 

Ms. SCHRIER (for herself, Ms. CASTOR of Florida, and Mr. FITZPATRICK) 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 2021’’. 


pamtmann on DSKBC07HB2PROD with BILLS
2 

•HR 1025 IH

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 

25 physician with a primary specialty designaVerDate Sep 11 2014 18:09 Mar 10, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1025.IH H1025

pamtmann on DSKBC07HB2PROD with BILLS
3 

•HR 1025 IH

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 2021— 

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 


pamtmann on DSKBC07HB2PROD with BILLS
4 

•HR 1025 IH

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 

25 (III), or a nurse practitioner, physiVerDate Sep 11 2014 18:09 Mar 10, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1025.IH H1025

pamtmann on DSKBC07HB2PROD with BILLS
5 

•HR 1025 IH

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, 

14 physician assistant, or certified nurse15 midwife described in subclause 

16 (III)(bb), in accordance with proce17 dures that ensure that the portion of 

18 the payment for such services that the 

19 nurse practitioner, physician assist20 ant, or certified nurse-midwife is paid 

21 is not less than the amount that the 

22 nurse practitioner, physician assist23 ant, or certified nurse-midwife would 

24 be paid if the services were provided 

25 under part B of title XVIII;’’. 


pamtmann on DSKBC07HB2PROD with BILLS
6 

•HR 1025 IH

1 (2) CONFORMING AMENDMENTS.—Section 

2 1905(dd) of the Social Security Act (42 U.S.C. 

3 1396d(dd)) is amended— 

4 (A) by striking ‘‘Notwithstanding’’ and in5 serting the following: 

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

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

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

9 after ‘‘2015,’’; and 

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

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

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

13 paragraph is the period beginning on the first day 

14 of the first month beginning after the date of the en15 actment of the Kids’ Access to Primary Care Act of 

16 2021.’’. 

17 (b) IMPROVED TARGETING OF PRIMARY CARE.— 

18 (1) IN GENERAL.—Section 1902(jj) of the So19 cial Security Act (42 U.S.C. 1396a(jj)) is amend20 ed— 

21 (A) by redesignating paragraphs (1) and 

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

23 and moving the margin of each such subpara24 graph, as so redesignated, 2 ems to the right; 


pamtmann on DSKBC07HB2PROD with BILLS
7 

•HR 1025 IH

1 (B) by striking ‘‘For purposes of’’ and in2 serting the following: 

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

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

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

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

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

8 emergency department of a hospital.’’. 

9 (2) EFFECTIVE DATE.—The amendments made 

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

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

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

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

14 1396a(a)(13)), as amended by section 2. 

15 (c) ENSURING PAYMENT BY MANAGED CARE ENTI16 TIES.— 

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

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

19 is amended— 

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

21 the semicolon; 

22 (B) in clause (xiii)— 

23 (i) by moving the margin of such 

24 clause 2 ems to the left; and 


pamtmann on DSKBC07HB2PROD with BILLS
8 

•HR 1025 IH

1 (ii) by striking the period at the end 

2 and inserting ‘‘; and’’; and 

3 (C) by inserting after clause (xiii) the fol4 lowing: 

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

6 to health care providers specified in section 

7 1902(a)(13)(C) for furnishing primary care services 

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

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

10 to the amounts set forth and required by the Sec11 retary by regulation, (II) the entity shall, upon re12 quest, provide documentation to the State that is 

13 sufficient to enable the State and the Secretary to 

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

15 Secretary shall approve payments described in sub16 clause (I) that are furnished through an agreed17 upon capitation, partial capitation, or other value18 based payment arrangement if the agreed-upon capi19 tation, partial capitation, or other value-based pay20 ment arrangement is based on a reasonable method21 ology and the entity provides documentation to the 

22 State that is sufficient to enable the State and the 

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

24 (2) CONFORMING AMENDMENT.—Section 

25 1932(f) of the Social Security Act (42 U.S.C. 


pamtmann on DSKBC07HB2PROD with BILLS
9 

•HR 1025 IH

1 1396u–2(f)) is amended by inserting ‘‘and clause 

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

3 (3) EFFECTIVE DATE.—The amendments made 

4 by this subsection shall apply with respect to con5 tracts entered into on or after the date of the enact6 ment of this Act. 

7 SEC. 3. STUDY. 

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

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

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

11 shall conduct a study— 

12 (1) comparing the number of children enrolled 

13 in a State plan under title XIX of the Social Secu14 rity Act (42 U.S.C. 1396 et seq.) (or a waiver of 

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

16 first day of the period described in subparagraph 

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

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

19 the number of children so enrolled during the 12- 

20 month period beginning on such first day; 

21 (2) comparing the number of health care pro22 viders receiving payments for primary care services 

23 under the Medicaid program under such title during 

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

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


pamtmann on DSKBC07HB2PROD with BILLS
10 

•HR 1025 IH

1 1902(a)(13) of such Act (42 U.S.C. 1396a(a)(13)), 

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

3 care providers receiving such payments during the 

4 12-month period beginning on such first day; and 

5 (3) comparing health care provider payment 

6 rates for primary care services under the Medicaid 

7 program under such title during the 12-month pe8 riod beginning on the first day of the period de9 scribed in subparagraph (C)(ii) of section 

10 1902(a)(13) of such Act (42 U.S.C. 1396a(a)(13)), 

11 as amended by section 2, across States, using the in12 dexes described in subsection (b). 

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

14 this subsection are each of the following: 

15 (1) A Medicaid fee index, comparing each 

16 State’s average fee for primary care services under 

17 the Medicaid program under such title to the na18 tional average for such services. 

19 (2) A Medicaid-to-Medicare fee index, com20 paring each State’s average fee for primary care 

21 services under the Medicaid program under such 

22 title to the fee for such services under the Medicare 

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

24 1395 et seq.). 


pamtmann on DSKBC07HB2PROD with BILLS
11 

•HR 1025 IH

1 (3) A Medicaid fee change index, comparing 

2 fees for primary care services under the Medicaid 

3 program under such title during the 12-month pe4 riod preceding the first day of the period described 

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

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

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

8 12-month period beginning on such first day. 

9 (c) AUTHORIZATION OF APPROPRIATIONS.—For pur10 poses of this section, there is authorized to be appro11 priated $200,000 for fiscal year 2022, to be available until 

12 expended. 

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

14 FUTURES GUIDELINES. 

15 It is the sense of Congress that health care providers 

16 should provide early and periodic screening, diagnostic, 

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

18 the Social Security Act (42 U.S.C. 1396d(r))) in accord19 ance with the guidelines of the American Academy of Pe20 diatrics entitled, ‘‘Bright Futures: Guidelines for Health 

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

Æ 


pamtmann on DSKBC07HB2PROD with BILLS