The bill would set a minimum Medicaid payment rate for certain primary care services. The rate would be at least the Medicare Part B rate, or a higher rate based on a 2009 payment formula, and no lower than the Medicaid rate that would otherwise apply. Eligible providers would include certain board-certified physicians and subspecialists, nurse practitioners, physician assistants, certified nurse-midwives, supervised advanced practice clinicians, and some clinics. Emergency department services would not count as primary care services for this payment rule. Medicaid managed care contracts would have to meet payment requirements and provide records showing compliance. The bill also directs the Secretary of Health and Human Services to study changes in children enrolled in Medicaid, providers receiving primary care payments, and state payment rates.
For families enrolled in Medicaid, the bill would change payment rules for certain primary care services. It does not state that a person’s eligibility or access to care would change. The study would compare enrollment and provider numbers before and after the payment changes. The payment rules would begin in the first month starting after the bill’s enactment.
The bill authorizes $200,000 for fiscal year 2026 for the study, available until spent. It does not specify other costs.
No publicly available information.
No publicly available information.