IIB 
118TH CONGRESS 
2D SESSION 
H. R. 4758 
IN THE SENATE OF THE UNITED STATES 
SEPTEMBER 18, 2024 
Received; read twice and referred to the Committee on Finance 
AN ACT 
To amend title XIX of the Social Security Act to streamline 
enrollment under the Medicaid program of certain pro-
viders across State lines, and to prevent the use of abu-
sive spread pricing in Medicaid. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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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.—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-
bility 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 partici-
pating provider in the State plan (or a 
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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 
provider’ means, with respect to a State, a 
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 sec-
tion 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 
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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 para-
graph (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; 
‘‘(bb) excluded from partici-
pation in the State plan (or a 
waiver of such plan) pursuant to 
part 1002 of title 42, Code of 
Federal Regulations (or any suc-
cessor regulation), or State law; 
or 
‘‘(cc) terminated from par-
ticipating in a Federal health 
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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 en-
rolled under the State plan (or waiver of 
such plan). 
‘‘(iii) 
STATE.—The 
term 
‘State’ 
means 1 of the 50 States or the District 
of Columbia.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) Section 1902(a)(77) of the Social Security 
Act (42 U.S.C. 1396a(a)(77)) is amended by insert-
ing ‘‘enrollment,’’ after ‘‘screening,’’. 
(2) 
The 
subsection 
heading 
for 
section 
1902(kk) of such Act (42 U.S.C. 1396a(kk)) is 
amended 
by 
inserting 
‘‘ENROLLMENT,’’ 
after 
‘‘SCREENING,’’. 
(3) Section 2107(e)(1)(G) of such Act (42 
U.S.C. 1397gg(e)(1)(G)) is amended by inserting 
‘‘enrollment,’’ after ‘‘screening,’’. 
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(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 of the Social Secu-
rity Act (42 U.S.C. 1396r–8) is amended— 
(1) in subsection (e), by adding at the end the 
following new paragraph: 
‘‘(6) TRANSPARENT PRESCRIPTION DRUG PASS- 
THROUGH PRICING REQUIRED.— 
‘‘(A) IN
GENERAL.—A contract between 
the State and a pharmacy benefit manager (re-
ferred 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 col-
lectively referred to in this paragraph as the 
‘entity’) that includes provisions making the en-
tity responsible for coverage of covered out-
patient drugs dispensed 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 
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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 would pay if the 
State were making the payment 
directly in accordance with the 
State plan; 
‘‘(II) is passed through in its en-
tirety (except as reduced under Fed-
eral 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 
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(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 Serv-
ice Act; 
‘‘(bb) such payment for the 
ingredient cost of such drug does 
not exceed the maximum pay-
ment that would have been made 
by the entity or the PBM for the 
ingredient cost of such drug if 
such drug had not been pur-
chased by such covered entity; 
and 
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‘‘(cc) such covered entity re-
ports to the Secretary (in a form 
and manner specified by the Sec-
retary), 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 ex-
cess; 
‘‘(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 re-
flects the fair market value (as defined by 
the Secretary) of such services; 
‘‘(iii) the entity or the PBM (as appli-
cable) makes available to the State, and 
the Secretary upon request in a form and 
manner specified by the Secretary, all costs 
and payments related to covered outpatient 
drugs and accompanying administrative 
services (as described in clause (ii)) in-
curred, received, or made by the entity or 
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the PBM, broken down (as specified by the 
Secretary), to the extent such costs and 
payments are attributable to an individual 
covered outpatient drug, by each such 
drug, including any ingredient costs, pro-
fessional dispensing fees, administrative 
fees (as described in clause (ii)), post-sale 
and post-invoice fees, discounts, or related 
adjustments such as direct and indirect re-
muneration fees, and any and all other re-
muneration; 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 enti-
ty, 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 claim-
ing Federal matching payments under this 
title. 
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‘‘(B) 
MAKING
CERTAIN
INFORMATION 
AVAILABLE.—The Secretary shall publish, not 
less frequently than on an annual basis, infor-
mation 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).’’; and 
(2) in subsection (k), by adding at the end the 
following new paragraph: 
‘‘(12) PHARMACY
BENEFIT
MANAGER.—The 
term ‘pharmacy benefit manager’ means any person 
or entity that, either directly or through an inter-
mediary, acts as a price negotiator or group pur-
chaser on behalf of a State, managed care entity (as 
defined in section 1903(m)(9)(D)), or other specified 
entity (as so defined), and may also more broadly 
manage aspects of the prescription drug benefits 
provided by a State, managed care entity, or other 
specified entity, including the processing and pay-
ment of claims for prescription drugs, the perform-
ance of drug utilization review, the processing of 
drug prior authorization requests, the managing of 
appeals or grievances related to the prescription 
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drug benefits, contracting with pharmacies, control-
ling the cost of covered outpatient drugs, or the pro-
vision of services related thereto. Such term includes 
any person or entity that acts as a price negotiator 
(with regard to payment amounts to pharmacies and 
providers for a covered outpatient drug or the net 
cost of the drug) or group purchaser on behalf of a 
State, managed care entity, or other specified entity, 
including such a person or entity that carries out 1 
or more of the other activities described in the pre-
ceding sentence, irrespective of whether such person 
or entity calls itself a pharmacy benefit manager.’’. 
(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 in-
cludes provisions making the entity responsible 
for coverage of covered outpatient drugs, the 
entity shall comply with the requirements of 
section 1927(e)(6)’’; and 
(C) by moving the left margin 2 ems to the 
left; and 
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(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 ac-
cordance 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 phar-
macy benefit managers that have an effective date begin-
ning 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 oth-
erwise. 
(2) NONAPPLICATION OF ADMINISTRATIVE PRO-
CEDURE ACT.—Implementation of the amendments 
made by this section shall be exempt from the re-
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quirements 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 Sec-
retary of Health and Human Services under section 
1927(e) 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 ‘‘$69,000,000’’. 
Passed the House of Representatives September 17, 
2024. 
Attest: 
KEVIN F. MCCUMBER, 
Clerk. 
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