(1) Medicaid plays a key role in providing cov-
erage for millions of working families. 
(2) Medicaid enrollees include families, preg-
nant women, children, individuals with disabilities, 
and other low-income individuals. Without Medicaid 
coverage, many enrollees would be uninsured or lack 
coverage for services they need. 
(3) In 2014, the Medicaid program covered 
69,000,000 individuals, or 1 in every 5 Americans. 
This number will continue to grow, particularly since 
the Affordable Care Act significantly expanded eligi-
bility to millions of uninsured adults. 
(4) If all States expand their Medicaid pro-
grams, an estimated 7,000,000 women ages 18 to 64 
would gain coverage under Medicaid. 
(5) In 47 States and in the District of Colum-
bia, Medicaid pays up to 67 percent less than Medi-
care for the same primary care services. 
(6) Congress has recognized that low provider 
participation in Medicaid decreases access to health 
care. To address this problem, Congress acted to in-
crease Medicaid payments for certain primary care 
services to be not less than the Medicare payment 
rates for 2013 and 2014. 
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(7) As more Americans become insured and em-
powered participants in their own health care, de-
mand for primary care services is expected to in-
crease over the next few years. 
(8) According to a study published earlier this 
year in the New England Journal of Medicine, high-
er Medicaid payment rates have significantly in-
creased appointment availability for Medicaid enroll-
ees. 
(9) Six in 10 women ages 18 to 44 (58 percent) 
report they see an obstetrics and gynecology (OB/ 
GYN) physician on a regular basis. They are more 
likely to see their OB/GYN physician on a regular 
basis than any other type of provider. Given that 
women comprise the majority of Medicaid enrollees, 
it is critical that primary care providers, including 
OB/GYN physicians, receive sufficient reimburse-
ment to participate in Medicaid. 
(10) Nurse practitioners and other health pro-
fessionals deliver many primary care services. Apply-
ing Medicare’s rates for nurse practitioners and 
other health professionals encourages greater partici-
pation in Medicaid, thereby increasing access to pri-
mary care, particularly in underserved areas. 
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(11) The enhanced Medicaid reimbursement 
rate ensures providers have the financial capability 
to serve their patients’ primary care needs. Further-
more, adding nurse practitioners, physician assist-
ants, certified nurse-midwives, and OB/GYN physi-
cians serving in primary care settings increases ac-
cess to critical health care services for women and 
children nationwide. 
SEC. 3. RENEWAL OF APPLICATION OF MEDICARE PAY-
MENT RATE FLOOR TO PRIMARY CARE SERV-
ICES FURNISHED UNDER MEDICAID AND IN-
CLUSION 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 pay-
ment rate that would be applicable under such 
part if the conversion factor under section 
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1848(d) for the year involved were the conver-
sion factor under such section for 2009), and 
that is not less than the rate that would other-
wise 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 designa-
tion of family medicine, general internal 
medicine, or pediatric medicine; or 
‘‘(ii) furnished in the 2-year period 
that begins on the first day of the first 
month that begins after the date of enact-
ment of the Ensuring Access to Primary 
Care for Women & Children Act— 
‘‘(I) by a physician with a pri-
mary specialty designation of family 
medicine, general internal medicine, 
or pediatric medicine, but only if the 
physician self-attests that the physi-
cian is Board certified in family medi-
cine, general internal medicine, or pe-
diatric medicine; 
‘‘(II) by a physician with a pri-
mary specialty designation of obstet-
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rics and gynecology, but only if the 
physician self-attests that the physi-
cian is Board certified in obstetrics 
and gynecology; 
‘‘(III) by an advanced practice 
clinician, as defined by the Secretary, 
that works under the supervision of— 
‘‘(aa) a physician that satis-
fies the criteria specified in sub-
clause (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 de-
fined in section 1861(gg)) who is 
working in accordance with State 
law; 
‘‘(IV) by a rural health clinic, 
Federally qualified health center, or 
other health clinic that receives reim-
bursement on a fee schedule applica-
ble to a physician, a nurse practi-
tioner or a physician assistant (as 
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such terms are defined in section 
1861(aa)(5)(A)) who is working in ac-
cordance with State law, or a certified 
nurse-midwife (as defined in section 
1861(gg)) who is working in accord-
ance with State law, for services fur-
nished by a physician, nurse practi-
tioner, physician assistant, or certified 
nurse-midwife, or services furnished 
by an advanced practice clinician su-
pervised by a physician described in 
subclause (I)(aa) or (II)(aa), another 
advanced practice clinician, or a cer-
tified 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 
(as defined in section 1861(gg)) 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 assist-
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ant, or certified nurse-midwife is paid 
is not less than the amount that the 
nurse practitioner, physician assist-
ant, 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 in-
serting the following: 
‘‘(1) IN GENERAL.—Notwithstanding’’; 
(B) by inserting ‘‘or furnished during an 
additional period specified in paragraph (2),’’ 
after ‘‘2015,’’; and 
(C) by adding at the end the following: 
‘‘(2) ADDITIONAL PERIODS.—For purposes of 
paragraph (1), the following are additional periods: 
‘‘(A) The 2-year period that begins on the 
first day of the first month that begins after 
the date of enactment of the Ensuring Access 
to Primary Care for Women & Children Act.’’. 
(b) IMPROVED TARGETING OF PRIMARY CARE.—Sec-
tion 1902(jj) of the Social Security Act (42 U.S.C. 
1396a(jj)) is amended— 
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(1) by redesignating paragraphs (1) and (2) as 
subparagraphs (A) and (B), respectively and realign-
ing the left margins accordingly; 
(2) by striking ‘‘For purposes of’’ and inserting 
the following: 
‘‘(1) IN GENERAL.—For purposes of’’; and 
(3) 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.’’. 
(c) ENSURING PAYMENT BY MANAGED CARE ENTI-
TIES.— 
(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) by realigning the left margin of clause 
(xiii) so as to align with the left margin of 
clause (xii) and by striking the period at the 
end of clause (xiii) and inserting ‘‘; and’’; and 
(C) by inserting after clause (xiii) the fol-
lowing: 
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‘‘(xiv) such contract provides that (I) payments 
to providers specified in section 1902(a)(13)(C) for 
primary care services defined in section 1902(jj) 
that are furnished during a year or period specified 
in section 1902(a)(13)(C) and section 1905(dd) 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, 
sufficient to enable the State and the Secretary to 
ensure compliance with subclause (I), and (III) the 
Secretary shall deem payments described in sub-
clause (I) that are furnished through an agreed 
upon capitation, partial capitation, or other value- 
based payment arrangement to comply with sub-
clause (I) if the capitation, partial capitation, or 
other value-based payment arrangement is based on 
a reasonable methodology and the entity provides 
documentation of the methodology to the Sec-
retary.’’. 
(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. 
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SEC. 4. IMPROVING QUALITY AND VALUE FOR MEDICAID 
BENEFICIARIES. 
(a) GAO STUDY.—Not later than 1 year after the 
date of enactment of this Act, the Comptroller General 
of the United States shall submit to Congress a report 
that examines the use of alternative payment models in 
State Medicaid programs and identifies opportunities for 
disseminating successful payment models among such pro-
grams. 
(b) FUNDING
THE
DEVELOPMENT
OF
QUALITY 
MEASURES.—The first sentence of section 1139B(e) of 
the Social Security Act (42 U.S.C. 1320b–9b(e)) is 
amended by inserting ‘‘, and for fiscal year 2016, 
$15,000,000,’’ before ‘‘for the purpose’’. 
(c) DEVELOPING QUALITY MEASURES FOR BENE-
FICIARIES WITH DISABILITIES.—Section 1139B(b)(5) of 
the Social Security Act (42 U.S.C. 1320b–9b(b)(5)) is 
amended by adding at the end the following: 
‘‘(C) QUALITY
MEASURES
SPECIFIC
TO 
ADULT INDIVIDUALS WITH DISABILITIES.—The 
Secretary, acting through the Administrator for 
the Centers for Medicare & Medicaid Services 
and the Director of the Agency for Healthcare 
Research and Quality, shall develop adult 
health quality measures that are specific to 
adult individuals with disabilities and shall in-
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clude those measures in the Medicaid Quality 
Measurement Program. In developing such 
measures, priority shall be given to developing 
quality measures that assess the impact on 
adult individuals with disabilities of existing 
programs and to the development of quality 
measures that assess the impact of new service 
delivery innovations on such individuals.’’. 
Æ 
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