under subsection (d), to States for the purpose of updating 
and implementing the metrics developed under this sec-
tion. 
(d) APPROPRIATION.—There is appropriated to the 
Secretary, out of any funds in the Treasury not otherwise 
appropriated, $50,000,000 for fiscal year 2025, to remain 
available until expended, for the purpose of carrying out 
this section. 
SEC. 4. 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 period that be-
gins on the first day of the first month 
that begins after the date of enactment of 
the State Public Option 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-
rics and gynecology, but only if the 
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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 
such terms are defined in section 
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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-
ant, or certified nurse-midwife is paid 
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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 the 
additional period specified in paragraph (2),’’ 
after ‘‘2015,’’; and 
(C) by adding at the end the following: 
‘‘(2) ADDITIONAL
PERIOD.—For purposes of 
paragraph (1), the additional period specified in this 
paragraph is the period that begins on the date that 
is 1 year after the date of enactment of the State 
Public Option 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) in clause (xiii)— 
(i) by realigning the left margin so as 
to align with the left margin of clause (xii); 
and 
(ii) by striking the period at the end 
of clause (xiii) and inserting ‘‘; and’’; and 
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(C) by inserting after clause (xiii) the fol-
lowing: 
‘‘(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 approve payments described in sub-
clause (I) that are furnished through an agreed 
upon capitation, partial capitation, or other value- 
based payment arrangement if the capitation, partial 
capitation, or other value-based payment arrange-
ment is based on a reasonable methodology and the 
entity provides documentation to the State sufficient 
to enable the State and the Secretary to ensure com-
pliance with subclause (I).’’. 
(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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(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall take effect as if included in the enact-
ment of Public Law 111–148. 
SEC. 6. MEDICAID COVERAGE OF COMPREHENSIVE SEXUAL 
AND REPRODUCTIVE HEALTH CARE SERV-
ICES. 
(a) INCLUSION OF COMPREHENSIVE SEXUAL AND 
REPRODUCTIVE HEALTH CARE SERVICES AS MEDICAL 
ASSISTANCE.—Section 1905(a) of the Social Security Act 
(42 U.S.C. 1396d(a)), as amended by section 2(h), is fur-
ther amended— 
(1) in paragraph (30), by striking ‘‘and’’ at the 
end; 
(2) by redesignating paragraph (31) as para-
graph (32); and 
(3) by inserting after paragraph (30) the fol-
lowing new paragraph: 
‘‘(31) comprehensive sexual and reproductive 
health care services, including abortion services and 
abortion-related services; and’’. 
(b) REQUIRING COVERAGE OF COMPREHENSIVE SEX-
UAL AND REPRODUCTIVE HEALTH CARE SERVICES AS 
CONDITION
OF
STATE
PLAN
APPROVAL.—Section 
1902(a)(10)(A) of the Social Security Act (42 U.S.C. 
1396a(a)(10)(A)), as amended by subsections (a) and (h) 
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of section 2, is further amended, in the matter preceding 
clause (i), by striking ‘‘and (30)’’ and inserting ‘‘(30), and 
(31)’’. 
(c) CONFORMING AMENDMENTS.— 
(1) Section 1932(e)(1)(B) of the Social Security 
Act (42 U.S.C. 1396u–2(e)(1)(B)) is amended by 
striking ‘‘Clause (i)’’ and inserting ‘‘With respect to 
the period beginning before January 1, 2023, clause 
(i)’’. 
(2) Section 1937(b) of the Social Security Act 
(42 U.S.C. 1396u–7(b)) is amended by adding at 
the end the following new paragraph: 
‘‘(9) COVERAGE OF COMPREHENSIVE SEXUAL 
AND REPRODUCTIVE HEALTH SERVICES.—Notwith-
standing the previous provisions of this section, a 
State may not provide for medical assistance 
through enrollment of an individual with benchmark 
coverage or benchmark-equivalent coverage under 
this section unless such coverage includes medical 
assistance for comprehensive sexual and reproductive 
health care services, including abortion services and 
abortion-related services.’’. 
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(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to medical assistance 
furnished on or after January 1, 2025. 
Æ 
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