Ensuring Access to Primary Care for Women & Children Act
Bill: S.1833 | Sponsor: Sen. Brown, Sherrod (D-OH)
Policy area: Health

Summary:
Ensuring Access to Primary Care for Women & Children Act
This bill temporarily applies a Medicare payment rate floor to Medicaid primary care services that are provided after the date of enactment of the bill or during a public health emergency, extends the payment rate to additional types of practitioners (e.g., obstetricians), and establishes other requirements with respect to payment for such services.

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 Representatives 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. 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 provider 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 in the 2-year period that 
                        begins on the first day of the first month that 
                        begins after the date of enactment of the 
                        Ensuring Access to Primary Care for Women & 
                        Children Act or during any other additional 
                        period specified with respect to the State 
                        under section 1905(dd)(2)--
                                    ``(I) by a physician with a primary 
                                specialty designation of family 
                                medicine, general internal medicine, or 
                                pediatric medicine, but only if the 
                                physician self-attests that the 
                                physician is Board certified in family 
                                medicine, general internal medicine, or 
                                pediatric medicine;
                                    ``(II) by a physician with a 
                                primary specialty designation of 
                                obstetrics and gynecology, but only if 
                                the physician self-attests that the 
                                physician is Board certified in 
                                obstetrics and gynecology;
                                    ``(III) by an advanced practice 
                                clinician, as defined by the Secretary 
                                (except that the Secretary shall define 
                                such term for purposes of this 
                                subparagraph to exclude a provider 
                                described in subclause (I), (II), or 
                                (V)), that works under the supervision 
                                of--
                                            ``(aa) a physician that 
                                        satisfies the criteria 
                                        specified 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)) 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, 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, for services 
                                furnished by a physician, nurse 
                                practitioner, physician assistant, or 
                                certified nurse-midwife, or services 
                                furnished by an advanced practice 
                                clinician supervised by a physician 
                                described in subclause (I) or (II), 
                                another advanced practice clinician, a 
                                nurse practitioner, physician 
                                assistant, or a certified 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 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 a period 
                that is an additional period with respect to the State, 
                as specified in paragraph (2),'' after ``2015,''; and
                    (C) by adding at the end the following:
            ``(2) Additional periods.--For purposes of paragraph (1):
                    ``(A) The 2-year period that begins on the first 
                day of the first month that begins after the date of 
                enactment of the Ensuring Access to Primary Care for 
                Women & Children Act shall be an additional period with 
                respect to all States.
                    ``(B) Any public health emergency period (as 
                defined in paragraph (3)) with respect to a State shall 
                be an additional period with respect to such State.
            ``(3) Public health emergency period.--For purposes of 
        paragraph (2), the term `public health emergency period' means, 
        with respect to a State, a period that--
                    ``(A) begins on the date on which a public health 
                emergency is declared with respect to the State by the 
                Secretary pursuant to section 319 of the Public Health 
                Service Act; and
                    ``(B) ends on the last day of the sixth month that 
                begins on or after the date on which such declaration 
                expires.''.
    (b) Improved Targeting of Primary Care.--Section 1902(jj) of the 
Social Security Act (42 U.S.C. 1396a(jj)) is amended--
            (1) by redesignating paragraphs (1) and (2) as 
        subparagraphs (A) and (B), respectively, and realigning 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 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 realigning the left margin so as to 
                        align with the left margin of clause (xii); 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 
        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 subclause (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 arrangement is based 
        on a reasonable methodology and the entity provides 
        documentation to the State 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.

SEC. 3. IMPROVING QUALITY AND VALUE FOR MEDICAID BENEFICIARIES.

    (a) GAO Study.--Not later than 3 years after the date of enactment 
of this Act, the Comptroller General of the United States shall submit 
to Congress a report that examines the effects of the payment rate 
floor for primary care services under Medicaid provided under section 
1902(a)(13)(C) of the Social Security Act (42 U.S.C. 1396a(a)(13)(C)) 
on beneficiary access to such services, including any recommendations 
for how the payment rate floor for such services could be more 
effective.
    (b) Funding the Development of Quality Measures.--The first 
sentence of section 1139B(e) of the Social Security Act (42 U.S.C. 
1320b-9b(e)) is amended by inserting ``, and for fiscal year 2022, 
$15,000,000,'' before ``for the purpose''.
    (c) Developing Quality Measures for Beneficiaries With 
Disabilities.--Section 1139B(b)(5) of the Social Security Act (42 
U.S.C. 1320b-9b(b)(5)) is amended by adding at the end the following:
                    ``(D) Quality measures specific to adult 
                individuals with disabilities.--The Secretary, acting 
                through the Administrator for the Centers for Medicare 
                & Medicaid Services and the Director of the Agency for 
                Healthcare Research and Quality, shall develop adult 
                health quality measures that are specific to adult 
                individuals with disabilities and shall include those 
                measures in the Medicaid Quality Measurement Program. 
                In developing such measures, priority shall be given to 
                developing quality measures that assess the impact on 
                adult individuals with disabilities of existing 
                programs and to the development of quality measures 
                that assess the impact of new service delivery 
                innovations on such individuals.''.
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