IB 
Union Calendar No. 508 
118TH CONGRESS 
2D SESSION 
H. R. 4758 
[Report No. 118–610] 
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. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 19, 2023 
Mrs. TRAHAN (for herself and Mrs. MILLER-MEEKS) introduced the following 
bill; which was referred to the Committee on Energy and Commerce 
JULY 23, 2024 
Additional sponsors: Ms. CASTOR of Florida, Mr. FITZPATRICK, Ms. KUSTER, 
Mrs. CAMMACK, Mr. TONKO, Mr. BACON, Mr. VAN DREW, Ms. BLUNT 
ROCHESTER, Ms. ROSS, Ms. WEXTON, Mr. MCCAUL, Mr. SMUCKER, Ms. 
BARRAGA´N, Mr. KEATING, Mr. CA´RDENAS, Ms. CRAIG, Ms. WASSERMAN 
SCHULTZ, Mrs. FLETCHER, Mr. HUDSON, Ms. CARAVEO, Mr. JOHNSON 
of Ohio, Mr. YAKYM, Ms. DELBENE, Mr. JOYCE of Pennsylvania, Ms. 
MALLIOTAKIS, Mr. VALADAO, Ms. PINGREE, Mrs. CHERFILUS-MCCOR-
MICK, Mr. COHEN, Mr. D’ESPOSITO, Mr. RUPPERSBERGER, Mr. BANKS, 
Mr. WITTMAN, Mr. PHILLIPS, Mr. CROW, Ms. MATSUI, Mr. BILIRAKIS, 
Mr. LIEU, Mr. CRENSHAW, Mrs. KIM of California, Ms. WILD, Mr. 
LANGWORTHY, Mr. NEGUSE, Mr. MEUSER, Mr. ALFORD, Mr. MOLINARO, 
Mr. CONNOLLY, Ms. NORTON, Mr. COSTA, Mr. CARTER of Georgia, Mr. 
FINSTAD, Mr. SWALWELL, Mr. DAVIS of North Carolina, Mr. BURGESS, 
Ms. LEE of Florida, Ms. TITUS, Mr. KELLY of Pennsylvania, Mr. 
SCHNEIDER, Mrs. SPARTZ, Mr. SOTO, Ms. SCHRIER, Mr. CAREY, Mr. 
BALDERSON, Mr. LAMBORN, Mr. JACKSON of Illinois, Mr. RASKIN, Mr. 
CLEAVER, Mrs. HARSHBARGER, Mr. TRONE, Mrs. GONZA´LEZ-COLO´N, 
Ms. KELLY of Illinois, Mr. DUNN of Florida, Mr. POCAN, Mr. WILSON 
of South Carolina, Mr. BAIRD, Ms. SCANLON, Mr. LAWLER, Mr. 
HORSFORD, Mr. LUETKEMEYER, Mr. ALLRED, Mr. EVANS, Mr. KEAN of 
New Jersey, Mr. GARBARINO, Mr. GOLDMAN of New York, Mr. NUNN 
of Iowa, Mr. MORELLE, Mr. JAMES, Ms. DAVIDS of Kansas, Mr. MAG-
AZINER, Mr. NADLER, Ms. PETTERSEN, Ms. SALINAS, Mr. MULLIN, Ms. 
VerDate Sep 11 2014 
04:04 Jul 24, 2024
Jkt 049200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6652
E:\BILLS\H4758.RH
H4758
ssavage on LAPJG3WLY3PROD with BILLS
MOORE of Wisconsin, Mr. GRIJALVA, Mr. LEVIN, Ms. BUSH, Ms. BROWN, 
Ms. STANSBURY, Mr. HUFFMAN, Mr. MCGARVEY, Mr. MRVAN, Mr. 
HIMES, Mr. FROST, Ms. UNDERWOOD, Ms. TLAIB, Mr. OBERNOLTE, Ms. 
SHERRILL, Mr. THOMPSON of Pennsylvania, Mr. BUCSHON, Mr. NICKEL, 
Ms. BONAMICI, Mr. KIM of New Jersey, Mr. LYNCH, Ms. ADAMS, Mrs. 
MILLER of West Virginia, Mr. PANETTA, Mr. MANN, Ms. HOULAHAN, 
Mr. PAPPAS, Mr. PASCRELL, Mrs. WATSON COLEMAN, and Mr. GOMEZ 
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 
[Strike out all after the enacting clause and insert the part printed in italic] 
[For text of introduced bill, see copy of bill as introduced on July 19, 2023] 
A BILL 
To amend title XIX of the Social Security Act to streamline 
enrollment under the Medicaid program of certain pro-
viders across State lines, and for other purposes. 
VerDate Sep 11 2014 
04:04 Jul 24, 2024
Jkt 049200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6652
E:\BILLS\H4758.RH
H4758
ssavage on LAPJG3WLY3PROD with BILLS
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Accelerating Kids’ Ac-
cess to Care Act’’. 
SEC. 2. STREAMLINED ENROLLMENT PROCESS FOR ELIGI-
BLE OUT-OF-STATE PROVIDERS UNDER MED-
ICAID AND CHIP. 
(a) IN GENERAL.—Section 1902(kk) of the Social Se-
curity Act (42 U.S.C. 1396a(kk)) is amended by adding at 
the end the following new paragraph: 
‘‘(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 fur-
nished to Medicaid-eligible children with medi-
cally complex conditions that was developed con-
sistent 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 eligi-
VerDate Sep 11 2014 
04:04 Jul 24, 2024
Jkt 049200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6203
E:\BILLS\H4758.RH
H4758
ssavage on LAPJG3WLY3PROD with BILLS
bility for, items and services for qualifying 
individuals 
without 
the 
imposition 
of 
screening or enrollment requirements in ad-
dition 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 partici-
pating provider in the State plan (or a 
waiver of such plan) through such process 
shall be so enrolled for a 5-year period, un-
less the provider is terminated or excluded 
from participation during such period. 
‘‘(B) DEFINITIONS.—In this paragraph: 
‘‘(i) ELIGIBLE
OUT-OF-STATE
PRO-
VIDER.—The term ‘eligible out-of-State pro-
vider’ means, with respect to a State, a pro-
vider— 
‘‘(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 pur-
poses of determining the level of 
VerDate Sep 11 2014 
04:04 Jul 24, 2024
Jkt 049200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6203
E:\BILLS\H4758.RH
H4758
ssavage on LAPJG3WLY3PROD with BILLS
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 su-
pervising 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 partici-
pation in any Federal health care 
program pursuant to section 1128 
or 1128A; 
VerDate Sep 11 2014 
04:04 Jul 24, 2024
Jkt 049200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6203
E:\BILLS\H4758.RH
H4758
ssavage on LAPJG3WLY3PROD with BILLS
‘‘(bb) excluded from partici-
pation in the State plan (or a 
waiver of such plan) pursuant to 
part 1002 of title 42, Code of Fed-
eral Regulations (or any successor 
regulation), or State law; or 
‘‘(cc) terminated from par-
ticipating 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’ means an indi-
vidual under 21 years of age who is enrolled 
under the State plan (or waiver of such 
plan). 
‘‘(iii) STATE.—The term ‘State’ means 
1 of the 50 States or the District of Colum-
bia.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) Section 1902(a)(77) of the Social Security 
Act (42 U.S.C. 1396a(a)(77)) is amended by inserting 
‘‘enrollment,’’ after ‘‘screening,’’. 
VerDate Sep 11 2014 
04:04 Jul 24, 2024
Jkt 049200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6203
E:\BILLS\H4758.RH
H4758
ssavage on LAPJG3WLY3PROD with BILLS
(2) The subsection heading for section 1902(kk) 
of such Act (42 U.S.C. 1396a(kk)) is amended by in-
serting ‘‘ENROLLMENT,’’ after ‘‘SCREENING,’’. 
(3) Section 2107(e)(1)(G) of such Act (42 U.S.C. 
1397gg(e)(1)(G)) is amended by inserting ‘‘enroll-
ment,’’ after ‘‘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. 
SEC. 3. PREVENTING THE USE OF ABUSIVE SPREAD PRIC-
ING IN MEDICAID. 
(a) IN GENERAL.—Section 1927(e) of the Social Secu-
rity Act (42 U.S.C. 1396r–8(e)) is amended by adding at 
the end the following: 
‘‘(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’), or a contract 
between the State and a managed care entity or 
other specified entity (as such terms are defined 
in section 1903(m)(9)(D) and collectively re-
ferred to in this paragraph as the ‘entity’) that 
includes provisions making the entity responsible 
for coverage of covered outpatient drugs dis-
VerDate Sep 11 2014 
04:04 Jul 24, 2024
Jkt 049200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6203
E:\BILLS\H4758.RH
H4758
ssavage on LAPJG3WLY3PROD with BILLS
pensed to individuals enrolled with the entity, 
shall require that payment for such drugs and 
related administrative services (as applicable), 
including payments made by a PBM on behalf 
of the State or entity, is based on a transparent 
prescription drug pass-through pricing model 
under which— 
‘‘(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 
dis-
pensing 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 en-
tirety (except as reduced under Federal 
or State laws and regulations in re-
sponse to instances of waste, fraud, or 
abuse) by the entity or PBM to the 
pharmacy or provider that dispenses 
the drug; and 
VerDate Sep 11 2014 
04:04 Jul 24, 2024
Jkt 049200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6203
E:\BILLS\H4758.RH
H4758
ssavage on LAPJG3WLY3PROD with BILLS
‘‘(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 re-
quirements applied directly to the enti-
ty or the PBM, except that any pay-
ment by the entity or the PBM for the 
ingredient cost of such drug purchased 
by a covered entity (as defined in sub-
section (a)(5)(B)) may exceed the ac-
tual acquisition cost (as defined in 
447.502 of title 42, Code of Federal 
Regulations, or any successor regula-
tion) 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 ingre-
dient cost of such drug if such 
VerDate Sep 11 2014 
04:04 Jul 24, 2024
Jkt 049200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6203
E:\BILLS\H4758.RH
H4758
ssavage on LAPJG3WLY3PROD with BILLS
post-sale and post-invoice fees, discounts, or 
related adjustments such as direct and indi-
rect 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 di-
rect and indirect remuneration fees or as-
sessments (after allowing for an administra-
tive fee as described in clause (ii)) is not al-
lowable for purposes of claiming Federal 
matching payments under this title. 
‘‘(B) MAKING CERTAIN INFORMATION AVAIL-
ABLE.—The Secretary shall publish, not less fre-
quently than on an annual basis, information 
received by the Secretary pursuant to subpara-
graph (A)(i)(III)(cc). Such information shall be 
so published in an electronic and searchable for-
mat, such as through the 340B Office of Phar-
macy Affairs Information System (or a successor 
system).’’. 
VerDate Sep 11 2014 
04:04 Jul 24, 2024
Jkt 049200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6203
E:\BILLS\H4758.RH
H4758
ssavage on LAPJG3WLY3PROD with BILLS
(b) CONFORMING AMENDMENTS.—Section 1903(m) of 
such Act (42 U.S.C. 1396b(m)) is amended— 
(1) in paragraph (2)(A)(xiii)— 
(A) by striking ‘‘and (III)’’ and inserting 
‘‘(III)’’; 
(B) by inserting before the period at the end 
the following: ‘‘, and (IV) if the contract includes 
provisions making the entity responsible for cov-
erage of covered outpatient drugs, the entity shall 
comply 
with 
the 
requirements 
of 
section 
1927(e)(6)’’; and 
(C) by moving the left margin 4 ems to the 
left; and 
(2) by adding at the end the following new para-
graph: 
‘‘(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 enti-
ty (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 man-
aged care entities, other specified entities, or pharmacy ben-
VerDate Sep 11 2014 
04:04 Jul 24, 2024
Jkt 049200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6203
E:\BILLS\H4758.RH
H4758
ssavage on LAPJG3WLY3PROD with BILLS
efit 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 PRO-
CEDURE
ACT.—Implementation of the amendments 
made by this section shall be exempt from the require-
ments of section 553 of title 5, United States Code. 
(e) NONAPPLICATION
OF
PAPERWORK
REDUCTION 
ACT.—Chapter 35 of title 44, United States Code, shall not 
apply to any data collection undertaken by the Secretary 
of Health and Human Services under section 1927(f) of the 
Social Security Act (42 U.S.C. 1396r–8(f)), as amended by 
this section. 
SEC. 4. MEDICAID IMPROVEMENT FUND. 
Section 1941(b)(3)(A) of the Social Security Act (42 
U.S.C. 1396w–1(b)(3)(A)) is amended by striking ‘‘$0’’ and 
inserting ‘‘$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 
VerDate Sep 11 2014 
04:04 Jul 24, 2024
Jkt 049200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H4758.RH
H4758
ssavage on LAPJG3WLY3PROD with BILLS
State lines, and to prevent the use of abusive spread pric-
ing in Medicaid.’’. 
VerDate Sep 11 2014 
04:04 Jul 24, 2024
Jkt 049200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H4758.RH
H4758
ssavage on LAPJG3WLY3PROD with BILLS
VerDate Sep 11 2014 
04:04 Jul 24, 2024
Jkt 049200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H4758.RH
H4758
ssavage on LAPJG3WLY3PROD with BILLS
Union Calendar No. 508 
118TH CONGRESS 
2D SESSION 
H. R. 4758 
[Report No. 118–610] 
A BILL 
To amend title XIX of the Social Security Act to 
streamline enrollment under the Medicaid pro-
gram of certain providers across State lines, and 
for other purposes. 
JULY 23, 2024 
Reported with amendments, committed to the Committee 
of the Whole House on the State of the Union, and or-
dered to be printed 
VerDate Sep 11 2014 
04:04 Jul 24, 2024
Jkt 049200
PO 00000
Frm 00016
Fmt 6651
Sfmt 6651
E:\BILLS\H4758.RH
H4758
ssavage on LAPJG3WLY3PROD with BILLS