I 
113TH CONGRESS 
2D SESSION 
H. R. 5723 
To amend title XIX of the Social Security Act to extend the application 
of the Medicare payment rate floor to primary care services furnished 
under Medicaid and to apply the rate floor to additional providers of 
primary care services. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 17, 2014 
Ms. CASTOR of Florida 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 extend 
the application of the Medicare payment rate floor to 
primary care services furnished under Medicaid and to 
apply the rate floor to additional providers of primary 
care services. 
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 ‘‘Ensuring Access to 
Primary Care for Women & Children Act’’. 
SEC. 2. FINDINGS. 
Congress finds as follows: 
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(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 2013, the Medicaid program covered 
62,000,000 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. Enrollment in 
Medicaid and the Children’s Health Insurance Pro-
gram is projected to increase by 12,800,000 by 
2016. 
(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) Multiple studies have concluded that higher 
Medicaid payment rates would increase the prob-
ability of primary care providers accepting new Med-
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icaid patients, and would further support current 
Medicaid providers. 
(7) 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. 
(8) 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. 
(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 mid-level 
health professionals deliver many primary care serv-
ices. Applying Medicare’s rates for nurse practi-
tioners and mid-level health professionals encourages 
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greater participation in Medicaid, thereby increasing 
access to primary care, particularly in underserved 
areas. 
(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. EXTENSION OF APPLICATION OF MEDICARE PAY-
MENT RATE FLOOR TO PRIMARY CARE SERV-
ICES FURNISHED UNDER MEDICAID AND AP-
PLICATION TO ADDITIONAL PROVIDERS. 
(a) 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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