H.R. 1433 — Kids’ Access to Primary Care Act of 2025

This section establishes the short title as the “Kids’ Access to Primary Care Act of 2025.”

This section revises the Medicaid state plan payment floor for primary care services under 42 U.S.C. § 1396a(a)(13)(C) and extends it beyond the 2013-2014 temporary period to services furnished during the first month beginning after enactment of the Kids’ Access to Primary Care Act of 2025 and thereafter. It requires payment at not less than 100 percent of the Medicare Part B rate for the service and physician, or, if greater, the rate that would apply using the 2009 Medicare conversion factor, and not less than the otherwise applicable Medicaid rate. It also expands the providers eligible for the floor to include: (1) physicians in family medicine, general internal medicine, pediatric medicine, and obstetrics and gynecology who self-attest to board certification in those specialties; (2) physicians in family medicine, internal medicine, pediatric, and obstetrics and gynecology subspecialties who self-attest to board certification; (3) advanced practice clinicians supervised by specified physicians, nurse practitioners, physician assistants, or certified nurse-midwives; (4) rural health clinics, federally qualified health centers, and other health clinics paid under a physician fee schedule for services furnished by those practitioners; and (5) nurse practitioners, physician assistants, and certified nurse-midwives paid under procedures that ensure their share of payment is not less than what they would receive under Medicare Part B. It also excludes from the definition of primary care services any such services furnished in a hospital emergency department, and applies that exclusion to services furnished on or after the same effective date.

This section directs the Secretary of Health and Human Services to conduct, not later than 13 months after enactment, a study of Medicaid primary care payment changes made by section 2. The study must compare, for the 12 months before and the 12 months after the first day of the period described in section 1902(a)(13)(C)(ii) of the Social Security Act, (1) the number of children enrolled in Medicaid State plans or waivers, (2) the number of health care providers receiving Medicaid primary care payments, and (3) primary care payment rates across States using three indexes: a Medicaid fee index, a Medicaid-to-Medicare fee index, and a Medicaid fee change index. This section authorizes $200,000 for FY2026, to remain available until expended.

This section expresses the sense of Congress that health care providers should furnish early and periodic screening, diagnostic, and treatment services under section 1905(r) of the Social Security Act (42 U.S.C. 1396d(r)) in accordance with the American Academy of Pediatrics’ “Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents.” As background, early and periodic screening, diagnostic, and treatment services are a Medicaid benefit for individuals under age 21 that covers preventive screenings, diagnostic services, and medically necessary treatment.