Ensuring Access to Primary Care for Women & Children Act

II 116TH CONGRESS 2D SESSION S. 4088 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 SENATE OF THE UNITED STATES JUNE 25, 2020 Mr. BROWN (for himself, Mrs. MURRAY, Mr. LEAHY, Ms. BALDWIN, Mr. SCHATZ, Ms. STABENOW, Mr. MURPHY, and Mr. MERKLEY) introduced the following bill; which was read twice and referred to the Committee on Finance 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- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Ensuring Access to 4 Primary Care for Women & Children Act’’. 5 VerDate Sep 11 2014 00:27 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S4088.IS S4088 kjohnson on DSK79L0C42PROD with BILLS 2 •S 4088 IS SEC. 2. RENEWAL OF APPLICATION OF MEDICARE PAY- 1 MENT RATE FLOOR TO PRIMARY CARE SERV- 2 ICES FURNISHED UNDER MEDICAID AND IN- 3 CLUSION OF ADDITIONAL PROVIDERS. 4 (a) RENEWAL OF PAYMENT FLOOR; ADDITIONAL 5 PROVIDERS.— 6 (1) IN GENERAL.—Section 1902(a)(13) of the 7 Social Security Act (42 U.S.C. 1396a(a)(13)) is 8 amended by striking subparagraph (C) and inserting 9 the following: 10 ‘‘(C) payment for primary care services (as 11 defined in subsection (jj)) at a rate that is not 12 less than 100 percent of the payment rate that 13 applies to such services and provider under part 14 B of title XVIII (or, if greater, the payment 15 rate that would be applicable under such part 16 if the conversion factor under section 1848(d) 17 for the year involved were the conversion factor 18 under such section for 2009), and that is not 19 less than the rate that would otherwise apply to 20 such services under this title if the rate were 21 determined without regard to this subpara- 22 graph, and that are— 23 ‘‘(i) furnished in 2013 and 2014, by a 24 physician with a primary specialty designa- 25 VerDate Sep 11 2014 00:27 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S4088.IS S4088 kjohnson on DSK79L0C42PROD with BILLS 3 •S 4088 IS tion of family medicine, general internal 1 medicine, or pediatric medicine; or 2 ‘‘(ii) furnished in the 2-year period 3 that begins on the first day of the first 4 month that begins after the date of enact- 5 ment of the Ensuring Access to Primary 6 Care for Women & Children Act or during 7 any other additional period specified with 8 respect to the State under section 9 1905(dd)(2)— 10 ‘‘(I) by a physician with a pri- 11 mary specialty designation of family 12 medicine, general internal medicine, 13 or pediatric medicine, but only if the 14 physician self-attests that the physi- 15 cian is Board certified in family medi- 16 cine, general internal medicine, or pe- 17 diatric medicine; 18 ‘‘(II) by a physician with a pri- 19 mary specialty designation of obstet- 20 rics and gynecology, but only if the 21 physician self-attests that the physi- 22 cian is Board certified in obstetrics 23 and gynecology; 24 VerDate Sep 11 2014 00:27 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S4088.IS S4088 kjohnson on DSK79L0C42PROD with BILLS 4 •S 4088 IS ‘‘(III) by an advanced practice 1 clinician, as defined by the Secretary 2 (except that the Secretary shall define 3 such term for purposes of this sub- 4 paragraph to exclude a provider de- 5 scribed in subclause (I), (II), or (V)), 6 that works under the supervision of— 7 ‘‘(aa) a physician that satis- 8 fies the criteria specified in sub- 9 clause (I) or (II); or 10 ‘‘(bb) a nurse practitioner or 11 a physician assistant (as such 12 terms are defined in section 13 1861(aa)(5)(A)) who is working 14 in accordance with State law, or 15 a certified nurse-midwife (as de- 16 fined in section 1861(gg)) who is 17 working in accordance with State 18 law; 19 ‘‘(IV) by a rural health clinic, 20 Federally-qualified health center, or 21 other health clinic that receives reim- 22 bursement on a fee schedule applica- 23 ble to a physician, a nurse practi- 24 tioner or a physician assistant (as 25 VerDate Sep 11 2014 00:27 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S4088.IS S4088 kjohnson on DSK79L0C42PROD with BILLS 5 •S 4088 IS such terms are defined in section 1 1861(aa)(5)(A)) who is working in ac- 2 cordance with State law, or a certified 3 nurse-midwife (as defined in section 4 1861(gg)) who is working in accord- 5 ance with State law, for services fur- 6 nished by a physician, nurse practi- 7 tioner, physician assistant, or certified 8 nurse-midwife, or services furnished 9 by an advanced practice clinician su- 10 pervised by a physician described in 11 subclause (I) or (II), another ad- 12 vanced practice clinician, a nurse 13 practitioner, physician assistant, or a 14 certified nurse-midwife; or 15 ‘‘(V) by a nurse practitioner or a 16 physician assistant (as such terms are 17 defined in section 1861(aa)(5)(A)) 18 who is working in accordance with 19 State law, or a certified nurse-midwife 20 (as defined in section 1861(gg)) who 21 is working in accordance with State 22 law, in accordance with procedures 23 that ensure that the portion of the 24 payment for such services that the 25 VerDate Sep 11 2014 00:27 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S4088.IS S4088 kjohnson on DSK79L0C42PROD with BILLS 6 •S 4088 IS nurse practitioner, physician assist- 1 ant, or certified nurse-midwife is paid 2 is not less than the amount that the 3 nurse practitioner, physician assist- 4 ant, or certified nurse-midwife would 5 be paid if the services were provided 6 under part B of title XVIII;’’. 7 (2) CONFORMING AMENDMENTS.—Section 8 1905(dd) of the Social Security Act (42 U.S.C. 9 1396d(dd)) is amended— 10 (A) by striking ‘‘Notwithstanding’’ and in- 11 serting the following: 12 ‘‘(1) IN GENERAL.—Notwithstanding’’; 13 (B) by inserting ‘‘or furnished during a pe- 14 riod that is an additional period with respect to 15 the State, as specified in paragraph (2),’’ after 16 ‘‘2015,’’; and 17 (C) by adding at the end the following: 18 ‘‘(2) ADDITIONAL PERIODS.—For purposes of 19 paragraph (1): 20 ‘‘(A) The 2-year period that begins on the 21 first day of the first month that begins after 22 the date of enactment of the Ensuring Access 23 to Primary Care for Women & Children Act 24 VerDate Sep 11 2014 00:27 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S4088.IS S4088 kjohnson on DSK79L0C42PROD with BILLS 7 •S 4088 IS shall be an additional period with respect to all 1 States. 2 ‘‘(B) Any public health emergency period 3 (as defined in paragraph (3)) with respect to a 4 State shall be an additional period with respect 5 to such State. 6 ‘‘(3) PUBLIC HEALTH EMERGENCY PERIOD.— 7 For purposes of paragraph (2), the term ‘public 8 health emergency period’ means, with respect to a 9 State, a period that— 10 ‘‘(A) begins on the date on which a public 11 health emergency is declared with respect to the 12 State by the Secretary pursuant to section 319 13 of the Public Health Service Act; and 14 ‘‘(B) ends on the last day of the sixth 15 month that begins on or after the date on which 16 such declaration expires.’’. 17 (b) IMPROVED TARGETING OF PRIMARY CARE.—Sec- 18 tion 1902(jj) of the Social Security Act (42 U.S.C. 19 1396a(jj)) is amended— 20 (1) by redesignating paragraphs (1) and (2) as 21 subparagraphs (A) and (B), respectively and realign- 22 ing the left margins accordingly; 23 (2) by striking ‘‘For purposes of’’ and inserting 24 the following: 25 VerDate Sep 11 2014 00:27 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S4088.IS S4088 kjohnson on DSK79L0C42PROD with BILLS 8 •S 4088 IS ‘‘(1) IN GENERAL.—For purposes of’’; and 1 (3) by adding at the end the following: 2 ‘‘(2) EXCLUSIONS.—Such term does not include 3 any services described in subparagraph (A) or (B) of 4 paragraph (1) if such services are provided in an 5 emergency department of a hospital.’’. 6 (c) ENSURING PAYMENT BY MANAGED CARE ENTI- 7 TIES.— 8 (1) IN GENERAL.—Section 1903(m)(2)(A) of 9 the Social Security Act (42 U.S.C. 1396b(m)(2)(A)) 10 is amended— 11 (A) in clause (xii), by striking ‘‘and’’ after 12 the semicolon; 13 (B) by realigning the left margin of clause 14 (xiii) so as to align with the left margin of 15 clause (xii) and by striking the period at the 16 end of clause (xiii) and inserting ‘‘; and’’; and 17 (C) by inserting after clause (xiii) the fol- 18 lowing: 19 ‘‘(xiv) such contract provides that (I) payments 20 to providers specified in section 1902(a)(13)(C) for 21 primary care services defined in section 1902(jj) 22 that are furnished during a year or period specified 23 in section 1902(a)(13)(C) and section 1905(dd) are 24 at least equal to the amounts set forth and required 25 VerDate Sep 11 2014 00:27 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S4088.IS S4088 kjohnson on DSK79L0C42PROD with BILLS 9 •S 4088 IS by the Secretary by regulation, (II) the entity shall, 1 upon request, provide documentation to the State, 2 sufficient to enable the State and the Secretary to 3 ensure compliance with subclause (I), and (III) the 4 Secretary shall approve payments described in sub- 5 clause (I) that are furnished through an agreed 6 upon capitation, partial capitation, or other value- 7 based payment arrangement if the capitation, partial 8 capitation, or other value-based payment arrange- 9 ment is based on a reasonable methodology and the 10 entity provides documentation to the State sufficient 11 to enable the State and the Secretary to ensure com- 12 pliance with subclause (I).’’. 13 (2) CONFORMING AMENDMENT.—Section 14 1932(f) of the Social Security Act (42 U.S.C. 15 1396u–2(f)) is amended by inserting ‘‘and clause 16 (xiv) of section 1903(m)(2)(A)’’ before the period. 17 SEC. 3. IMPROVING QUALITY AND VALUE FOR MEDICAID 18 BENEFICIARIES. 19 (a) GAO STUDY.—Not later than 3 years after the 20 date of enactment of this Act, the Comptroller General 21 of the United States shall submit to Congress a report 22 that examines the effects of the payment rate floor for 23 primary care services under Medicaid provided under sec- 24 tion 1902(a)(13)(C) of the Social Security Act (42 U.S.C. 25 VerDate Sep 11 2014 00:27 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S4088.IS S4088 kjohnson on DSK79L0C42PROD with BILLS 10 •S 4088 IS 1396a(a)(13)(C)) on beneficiary access to such services, 1 including any recommendations for how the payment rate 2 floor for such services could be more effective. 3 (b) FUNDING THE DEVELOPMENT OF QUALITY 4 MEASURES.—The first sentence of section 1139B(e) of 5 the Social Security Act (42 U.S.C. 1320b–9b(e)) is 6 amended by inserting ‘‘, and for fiscal year 2016, 7 $15,000,000,’’ before ‘‘for the purpose’’. 8 (c) DEVELOPING QUALITY MEASURES FOR BENE- 9 FICIARIES WITH DISABILITIES.—Section 1139B(b)(5) of 10 the Social Security Act (42 U.S.C. 1320b–9b(b)(5)) is 11 amended by adding at the end the following: 12 ‘‘(D) QUALITY MEASURES SPECIFIC TO 13 ADULT INDIVIDUALS WITH DISABILITIES.—The 14 Secretary, acting through the Administrator for 15 the Centers for Medicare & Medicaid Services 16 and the Director of the Agency for Healthcare 17 Research and Quality, shall develop adult 18 health quality measures that are specific to 19 adult individuals with disabilities and shall in- 20 clude those measures in the Medicaid Quality 21 Measurement Program. In developing such 22 measures, priority shall be given to developing 23 quality measures that assess the impact on 24 adult individuals with disabilities of existing 25 VerDate Sep 11 2014 00:27 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S4088.IS S4088 kjohnson on DSK79L0C42PROD with BILLS 11 •S 4088 IS programs and to the development of quality 1 measures that assess the impact of new service 2 delivery innovations on such individuals.’’. 3 Æ VerDate Sep 11 2014 00:27 Jul 08, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6301 E:\BILLS\S4088.IS S4088 kjohnson on DSK79L0C42PROD with BILLS