I 
116TH CONGRESS 
2D SESSION 
H. R. 6159 
To amend title XIX of the Social Security Act to renew the application 
of the Medicare payment rate floor to primary care services furnished 
under the Medicaid program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 9, 2020 
Ms. SCHRIER (for herself, Ms. CASTOR of Florida, and Mr. FITZPATRICK) in-
troduced the following bill; which was referred to the Committee on En-
ergy and Commerce 
A BILL 
To amend title XIX of the Social Security Act to renew 
the application of the Medicare payment rate floor to 
primary care services furnished under the Medicaid pro-
gram, and for other purposes. 
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 ‘‘Kids’ Access to Pri-
mary Care Act of 2020’’. 
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SEC. 2. 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 
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-
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tion of family medicine, general internal 
medicine, or pediatric medicine; or 
‘‘(ii) furnished during the period be-
ginning on the first day of the first month 
beginning after the date of the enactment 
of the Kids’ Access to Primary Care Act of 
2020— 
‘‘(I) by a physician with a pri-
mary specialty designation of family 
medicine, general internal medicine, 
pediatric medicine, or obstetrics and 
gynecology, but only if the physician 
self-attests that the physician is 
board-certified in family medicine, 
general internal medicine, pediatric 
medicine, or obstetrics and gyne-
cology, respectively; 
‘‘(II) by a physician with a pri-
mary specialty designation of a family 
medicine subspecialty, an internal 
medicine subspecialty, a pediatric sub-
specialty, or a subspecialty of obstet-
rics and gynecology, without regard to 
the board that offers the designation 
for such a subspecialty, but only if the 
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physician self-attests that the physi-
cian is board-certified in such a sub-
specialty; 
‘‘(III) by an advanced practice 
clinician, as defined by the Secretary, 
that works under the supervision of— 
‘‘(aa) a physician described 
in subclause (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)(2)) 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 described in sub-
clause (I) or (II), an advanced prac-
tice clinician described in subclause 
(III), or a nurse practitioner, physi-
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cian assistant, or certified nurse-mid-
wife described in subclause (III)(bb), 
for services furnished by— 
‘‘(aa) 
such 
a 
physician, 
nurse practitioner, physician as-
sistant, or certified nurse-mid-
wife, respectively; or 
‘‘(bb) an advanced practice 
clinician supervised by such a 
physician, 
nurse 
practitioner, 
physician assistant, or certified 
nurse-midwife; or 
‘‘(V) by a nurse practitioner, 
physician assistant, or certified nurse- 
midwife 
described 
in 
subclause 
(III)(bb), in accordance with proce-
dures that ensure that the portion of 
the payment for such services that the 
nurse practitioner, physician assist-
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;’’. 
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(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 beginning on the first day 
of the first month beginning after the date of the en-
actment of the Kids’ Access to Primary Care Act of 
2020.’’. 
(b) IMPROVED TARGETING OF PRIMARY CARE.— 
(1) IN GENERAL.—Section 1902(jj) of the So-
cial Security Act (42 U.S.C. 1396a(jj)) is amend-
ed— 
(A) by redesignating paragraphs (1) and 
(2) as subparagraphs (A) and (B), respectively, 
and moving the margin of each such subpara-
graph, as so redesignated, 2 ems to the right; 
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(B) by striking ‘‘For purposes of’’ and in-
serting the following: 
‘‘(1) IN GENERAL.—For purposes of’’; and 
(C) 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.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply with respect to primary 
care services provided on or after the first day of the 
period described in subparagraph (C)(ii) of section 
1902(a)(13) of the Social Security Act (42 U.S.C. 
1396a(a)(13)), as amended by section 2. 
(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 moving the margin of such 
clause 2 ems to the left; and 
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(ii) by striking the period at the end 
and inserting ‘‘; and’’; and 
(C) by inserting after clause (xiii) the fol-
lowing: 
‘‘(xiv) such contract provides that (I) payments 
to health care providers specified in section 
1902(a)(13)(C) for furnishing primary care services 
defined in section 1902(jj) during a year or period 
specified in section 1902(a)(13)(C) are at least equal 
to the amounts set forth and required by the Sec-
retary by regulation, (II) the entity shall, upon re-
quest, provide documentation to the State that is 
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 agreed-upon capi-
tation, partial capitation, or other value-based pay-
ment arrangement is based on a reasonable method-
ology and the entity provides documentation to the 
State that is sufficient to enable the State and the 
Secretary to ensure compliance with subclause (I).’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
1932(f) of the Social Security Act (42 U.S.C. 
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1902(a)(13) of such Act (42 U.S.C. 1396a(a)(13)), 
as amended by section 2, to the number of health 
care providers receiving such payments during the 
12-month period beginning on such first day; and 
(3) comparing health care provider payment 
rates for primary care services under the Medicaid 
program under such title during the 12-month pe-
riod beginning on the first day of the period de-
scribed 
in 
subparagraph 
(C)(ii) 
of 
section 
1902(a)(13) of such Act (42 U.S.C. 1396a(a)(13)), 
as amended by section 2, across States, using the in-
dexes described in subsection (b). 
(b) INDEXES DESCRIBED.—The indexes described in 
this subsection are each of the following: 
(1) A Medicaid fee index, comparing each 
State’s average fee for primary care services under 
the Medicaid program under such title to the na-
tional average for such services. 
(2) A Medicaid-to-Medicare fee index, com-
paring each State’s average fee for primary care 
services under the Medicaid program under such 
title to the fee for such services under the Medicare 
program under title XVIII of such Act (42 U.S.C. 
1395 et seq.). 
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(3) A Medicaid fee change index, comparing 
fees for primary care services under the Medicaid 
program under such title during the 12-month pe-
riod preceding the first day of the period described 
in subparagraph (C)(ii) of section 1902(a)(13) of 
such Act (42 U.S.C. 1396a(a)(13)), as amended by 
section 2, to the fees for such services during the 
12-month period beginning on such first day. 
(c) AUTHORIZATION OF APPROPRIATIONS.—For pur-
poses of this section, there is authorized to be appro-
priated $200,000 for fiscal year 2021, to be available until 
expended. 
SEC. 4. SENSE OF CONGRESS REGARDING USE OF BRIGHT 
FUTURES GUIDELINES. 
It is the sense of Congress that health care providers 
should provide early and periodic screening, diagnostic, 
and treatment services (as defined in section 1905(r) of 
the Social Security Act (42 U.S.C. 1396d(r)) in accord-
ance with the guidelines of the American Academy of Pe-
diatrics entitled, ‘‘Bright Futures: Guidelines for Health 
Supervision of Infants, Children, and Adolescents’’. 
Æ 
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