Accelerating Kids’ Access to Care Act

To amend title XIX of the Social Security Act to streamline enrollment under the Medicaid program of certain providers across State lines, and for other purposes. 1. Short title This Act may be cited as the Accelerating Kids’ Access to Care Act 2. Streamlined enrollment process for eligible out-of-State providers under Medicaid and CHIP (a) In general Section 1902(kk) of the Social Security Act ( 42 U.S.C. 1396a(kk) (10) Streamlined enrollment process for eligible out-of-State providers (A) In general If the State does not have a standard agreement with other States governing coverage and payment for services furnished to Medicaid-eligible children with medically complex conditions that was developed consistent with guidance issued by the Secretary under section 1945A, the State— (i) adopts and implements a process to allow an eligible out-of-State provider to enroll under the State plan (or a waiver of such plan) to furnish items and services to, or order, prescribe, refer, or certify eligibility for, items and services for qualifying individuals without the imposition of screening or enrollment requirements in addition to those imposed by the State in which the eligible out-of-State provider is located; and (ii) provides that an eligible out-of-State provider that enrolls as a participating provider in the State plan (or a waiver of such plan) through such process shall be so enrolled for a 5-year period, unless the provider is terminated or excluded from participation during such period. (B) Definitions In this paragraph: (i) Eligible out-of-State provider The term eligible out-of-State provider (I) that is located in any other State; (II) that— (aa) was determined by the Secretary to have a limited risk of fraud, waste, and abuse for purposes of determining the level of screening to be conducted under section 1866(j)(2), has been so screened under such section 1866(j)(2), and is enrolled in the Medicare program under title XVIII; or (bb) was determined by the State agency administering or supervising the administration of the State plan (or a waiver of such plan) of such other State to have a limited risk of fraud, waste, and abuse for purposes of determining the level of screening to be conducted under paragraph (1) of this subsection, has been so screened under such paragraph (1), and is enrolled under such State plan (or a waiver of such plan); and (III) that has not been— (aa) excluded from participation in any Federal health care program pursuant to section 1128 or 1128A; (bb) excluded from participation in the State plan (or a waiver of such plan) pursuant to part 1002 of title 42, Code of Federal Regulations (or any successor regulation), or State law; or (cc) terminated from participating in a Federal health care program or the State plan (or a waiver of such plan) for a reason described in paragraph (8)(A). (ii) Qualifying individual The term qualifying individual (iii) State The term State . (b) Conforming amendments (1) Section 1902(a)(77) of the Social Security Act ( 42 U.S.C. 1396a(a)(77) enrollment, screening, (2) The subsection heading for section 1902(kk) of such Act ( 42 U.S.C. 1396a(kk) Enrollment, Screening, (3) Section 2107(e)(1)(G) of such Act ( 42 U.S.C. 1397gg(e)(1)(G) enrollment, screening, (c) Effective date The amendments made by this section shall take effect on the date that is 3 years after the date of enactment of this section. 3. Preventing the use of abusive spread pricing in medicaid (a) In general Section 1927(e) of the Social Security Act ( 42 U.S.C. 1396r–8(e) (6) Transparent prescription drug pass-through pricing required (A) In general A contract between the State and a pharmacy benefit manager (referred to in this paragraph as a PBM entity (i) any payment made by the entity or the PBM (as applicable) for such a drug— (I) is limited to— (aa) ingredient cost; and (bb) a professional dispensing fee that is not less than the professional dispensing fee that the State plan or waiver would pay if the plan or waiver was making the payment directly; (II) is passed through in its entirety (except as reduced under Federal or State laws and regulations in response to instances of waste, fraud, or abuse) by the entity or PBM to the pharmacy or provider that dispenses the drug; and (III) is made in a manner that is consistent with sections 447.502, 447.512, 447.514, and 447.518 of title 42, Code of Federal Regulations (or any successor regulation) as if such requirements applied directly to the entity or the PBM, except that any payment by the entity or the PBM for the ingredient cost of such drug purchased by a covered entity (as defined in subsection (a)(5)(B)) may exceed the actual acquisition cost (as defined in 447.502 of title 42, Code of Federal Regulations, or any successor regulation) for such drug if— (aa) such drug was subject to an agreement under section 340B of the Public Health Service Act; (bb) such payment for the ingredient cost of such drug does not exceed the maximum payment that would have been made by the entity or the PBM for the ingredient cost of such drug if such drug had not been purchased by such covered entity; and (cc) such covered entity reports to the Secretary (in a form and manner specified by the Secretary), on an annual basis and with respect to payments for the ingredient costs of such drugs so purchased by such covered entity that are in excess of the actual acquisition costs for such drugs, the aggregate amount of such excess; (ii) payment to the entity or the PBM (as applicable) for administrative services performed by the entity or PBM is limited to an administrative fee that reflects the fair market value of such services; (iii) the entity or the PBM (as applicable) makes available to the State, and the Secretary upon request, all costs and payments related to covered outpatient drugs and accompanying administrative services incurred, received, or made by the entity or the PBM, including ingredient costs, professional dispensing fees, administrative fees, post-sale and post-invoice fees, discounts, or related adjustments such as direct and indirect remuneration fees, and any and all other remuneration; and (iv) any form of spread pricing whereby any amount charged or claimed by the entity or the PBM (as applicable) that exceeds the amount paid to the pharmacies or providers on behalf of the State or entity, including any post-sale or post-invoice fees, discounts, or related adjustments such as direct and indirect remuneration fees or assessments (after allowing for an administrative fee as described in clause (ii)) is not allowable for purposes of claiming Federal matching payments under this title. (B) Making certain information available The Secretary shall publish, not less frequently than on an annual basis, information received by the Secretary pursuant to subparagraph (A)(i)(III)(cc). Such information shall be so published in an electronic and searchable format, such as through the 340B Office of Pharmacy Affairs Information System (or a successor system). . (b) Conforming amendments Section 1903(m) of such Act ( 42 U.S.C. 1396b(m) (1) in paragraph (2)(A)(xiii)— (A) by striking and (III) (III) (B) by inserting before the period at the end the following: , and (IV) if the contract includes provisions making the entity responsible for coverage of covered outpatient drugs, the entity shall comply with the requirements of section 1927(e)(6) (C) by moving the left margin 4 ems to the left; and (2) by adding at the end the following new paragraph: (10) No payment shall be made under this title to a State with respect to expenditures incurred by the State for payment for services provided by an other specified entity (as defined in paragraph (9)(D)(iii)) unless such services are provided in accordance with a contract between the State and such entity which satisfies the requirements of paragraph (2)(A)(xiii). . (c) Effective date The amendments made by this section shall apply to contracts between States and managed care entities, other specified entities, or pharmacy benefit managers that have an effective date beginning on or after the date that is 18 months after the date of enactment of this Act. (d) Implementation (1) In general Notwithstanding any other provision of law, the Secretary of Health and Human Services may implement the amendments made by this section by program instruction or otherwise. (2) Nonapplication of Administrative Procedure Act Implementation of the amendments made by this section shall be exempt from the requirements of section 553 of title 5, United States Code. (e) Nonapplication of paperwork reduction act Chapter 35 42 U.S.C. 1396r–8(f) 4. Medicaid improvement fund Section 1941(b)(3)(A) of the Social Security Act ( 42 U.S.C. 1396w–1(b)(3)(A) $0 $88,000,000 Amend the title so as to read: A bill to amend title XIX of the Social Security Act to streamline enrollment under the Medicaid program of certain providers across State lines, and to prevent the use of abusive spread pricing in Medicaid. July 23, 2024 Reported with amendments, committed to the Committee of the Whole House on the State of the Union, and ordered to be printed

Summary: Accelerating Kids' Access to Care ActThis bill requires state Medicaid programs to establish a process through which qualifying out-of-state providers may temporarily treat children without undergoing additional screening requirements. It also requires pass-through pricing models for covered drugs under Medicaid.Specifically, states must establish a process through which qualifying providers may enroll for five years as participating providers to treat individuals under the age of 21 without undergoing additional screening requirements, unless the state has an agreement with other states that governs coverage of children with medically complex conditions that is in accordance with specified guidance from the Centers for Medicare & Medicaid Services (CMS).A qualifying provider (1) must not have been excluded or terminated from participating in a federal health care program or state Medicaid program; and (2) must have been successfully enrolled in Medicare or a state Medicaid program based on a determination that the provider posed a limited risk of fraud, waste, or abuse.In addition, the bill requires pass-through pricing models, and prohibits spread-pricing, for payment arrangements with pharmacy benefit managers under Medicaid.