S 760 — Kids’ Access to Primary Care Act of 2025

Summary

Kids' Access to Primary Care Act of 2025This 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.

Bill Text

• Introduced Introduced in Senate Current html February 26, 2025

Compared against current U.S. Code AI-generated reading aid — verify against the official bill.

The bill amends existing law to renew the Medicare payment rate floor for primary care services under Medicaid and includes additional types of providers eligible for these payments.

• 42 U.S.C. 1396a(a)(13)

  subparagraph (C) → (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 2025-- (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 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 described in subclause (III)(bb) 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;

  This change establishes a new payment structure for primary care services under Medicaid that sets a minimum payment rate and includes additional qualifying providers.

• 42 U.S.C. 1396d(dd)

  Notwithstanding → (1) In general.--Notwithstanding

  This change provides clarification and structure to the existing language to improve understanding of the provisions regarding payments for services.

• 42 U.S.C. 1396d(dd)

  2015, → or furnished during the additional period specified in paragraph (2),

  This expands the applicability of the payment provisions to a wider range of service dates.

• 42 U.S.C. 1396a(jj)

  For purposes of → (1) In general.--For purposes of

  This amendment introduces a clearer introduction for the definitions relating to primary care services.

• 42 U.S.C. 1396a(jj)

  excluding that term → 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.

  This change specifies exclusions from what constitutes primary care services, clarifying the definition.

• 42 U.S.C. 1396b(m)(2)(A)

  and → and clause (xiv) of section 1903(m)(2)(A)

  This addition ensures that managed care entities are also compliant with the new primary care service payment requirements.

Action History

1. February 26, 2025

   Introduced in Senate

2. February 26, 2025

   Read twice and referred to the Committee on Finance.

Sponsors

• Patty Murray · Primary
• Raphael G. Warnock · Cosponsor
• Cory A. Booker · Cosponsor
• Richard Blumenthal · Cosponsor
• Ben Ray Luján · Cosponsor
• Jeff Merkley · Cosponsor
• Peter Welch · Cosponsor

Subjects