Kids’ Access to Primary Care Act of 2021
Bill: H.R.1025 | Sponsor: Rep. Schrier, Kim (D-WA)
Policy area: Health

Summary:
Kids' Access to Primary Care Act of 2021
This bill modifies payments for Medicaid primary care services. Specifically, the bill applies a Medicare payment rate floor to Medicaid primary care services that are provided after the date of enactment of the bill and extends the payment rate to additional types of practitioners (e.g., obstetricians).
The Centers for Medicare & Medicaid Services must conduct a study on the number of children enrolled in Medicaid, the number of providers receiving payment for primary care services, and associated payment rates before and after the bill's implementation.

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.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Kids' Access to Primary Care Act of 
2021''.

SEC. 2. RENEWAL OF APPLICATION OF MEDICARE PAYMENT RATE FLOOR TO 
              PRIMARY CARE SERVICES FURNISHED UNDER MEDICAID AND 
              INCLUSION 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 payment rate that would be applicable 
                under such part if the conversion factor under section 
                1848(d) for the year involved were the conversion 
                factor under such section for 2009), and that is not 
                less than the rate that would otherwise 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 designation 
                        of family medicine, general internal medicine, 
                        or pediatric medicine; or
                            ``(ii) furnished during the period 
                        beginning on the first day of the first month 
                        beginning after the date of the enactment of 
                        the Kids' Access to Primary Care Act of 2021--
                                    ``(I) by a physician with a primary 
                                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 gynecology, 
                                respectively;
                                    ``(II) by a physician with a 
                                primary specialty designation of a 
                                family medicine subspecialty, an 
                                internal medicine subspecialty, a 
                                pediatric subspecialty, or a 
                                subspecialty of obstetrics and 
                                gynecology, without regard to the board 
                                that offers the designation for such a 
                                subspecialty, but only if the physician 
                                self-attests that the physician is 
                                board-certified in such a subspecialty;
                                    ``(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 defined 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 
                                reimbursement on a fee schedule 
                                applicable to a physician described in 
                                subclause (I) or (II), an advanced 
                                practice clinician described in 
                                subclause (III), or a nurse 
                                practitioner, physician assistant, or 
                                certified nurse-midwife described in 
                                subclause (III)(bb), for services 
                                furnished by--
                                            ``(aa) such a physician, 
                                        nurse practitioner, physician 
                                        assistant, or certified nurse-
                                        midwife, 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 
                                procedures that ensure that the portion 
                                of the payment for such services that 
                                the nurse practitioner, physician 
                                assistant, or certified nurse-midwife 
                                is paid is not less than the amount 
                                that the nurse practitioner, physician 
                                assistant, 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 inserting 
                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 enactment of the Kids' Access to Primary Care 
        Act of 2021.''.
    (b) Improved Targeting of Primary Care.--
            (1) In general.--Section 1902(jj) of the Social Security 
        Act (42 U.S.C. 1396a(jj)) is amended--
                    (A) by redesignating paragraphs (1) and (2) as 
                subparagraphs (A) and (B), respectively, and moving the 
                margin of each such subparagraph, as so redesignated, 2 
                ems to the right;
                    (B) by striking ``For purposes of'' and inserting 
                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 Entities.--
            (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
                            (ii) by striking the period at the end and 
                        inserting ``; and''; and
                    (C) by inserting after clause (xiii) the following:
            ``(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 
        Secretary by regulation, (II) the entity shall, upon request, 
        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 subclause (I) that are furnished through an agreed-upon 
        capitation, partial capitation, or other value-based payment 
        arrangement if the agreed-upon capitation, partial capitation, 
        or other value-based payment arrangement is based on a 
        reasonable methodology 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. 1396u-2(f)) is amended by inserting 
        ``and clause (xiv) of section 1903(m)(2)(A)'' before the 
        period.
            (3) Effective date.--The amendments made by this subsection 
        shall apply with respect to contracts entered into on or after 
        the date of the enactment of this Act.

SEC. 3. STUDY.

    (a) In General.--Not later than the date that is one year and one 
month after the date of the enactment of this Act, the Secretary of 
Health and Human Services shall conduct a study--
            (1) comparing the number of children enrolled in a State 
        plan under title XIX of the Social Security Act (42 U.S.C. 1396 
        et seq.) (or a waiver of such plan) during the 12-month period 
        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 number of 
        children so enrolled during the 12-month period beginning on 
        such first day;
            (2) comparing the number of health care providers receiving 
        payments for primary care services under the Medicaid program 
        under such title during the 12-month period 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 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 period beginning on 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, across States, using the indexes 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 national average for such services.
            (2) A Medicaid-to-Medicare fee index, comparing 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.).
            (3) A Medicaid fee change index, comparing fees for primary 
        care services under the Medicaid program under such title 
        during the 12-month period 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 purposes of this section, 
there is authorized to be appropriated $200,000 for fiscal year 2022, 
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 accordance with the guidelines of the American 
Academy of Pediatrics entitled, ``Bright Futures: Guidelines for Health 
Supervision of Infants, Children, and Adolescents''.
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