S. 760: Kids’ Access to Primary Care Act of 2025

The Kids’ Access to Primary Care Act of 2025 aims to improve access to primary care for children by updating payment rates under the Medicaid program. Here are the key points of the legislation:

Primary Care Payment Floor

The bill proposes to renew and enhance the application of a payment rate floor for primary care services provided under Medicaid. Specifically:

• The payment for primary care services must be at least 100% of the rate set for those services under Medicare (specifically, under part B of title XVIII, which covers physician services).
• The updated payment rates would apply to services provided by a variety of healthcare professionals, including:
• Physicians designated in family medicine, general internal medicine, pediatric medicine, and obstetrics and gynecology who self-attest to being board-certified in their specialties.
• Advanced practice clinicians (like nurse practitioners) and other specified health providers working under supervision or agreement with the aforementioned physicians.
• Health clinics such as rural health clinics and Federally-qualified health centers that comply with certain reimbursement structures.

Improved Targeting of Primary Care

The Act includes provisions to better focus on primary care services, specifying that primary care services provided in emergency departments are excluded from this payment floor.

Managed Care Entity Compliance

It mandates managed care organizations to ensure that healthcare providers are compensated according to the established payment rates for primary care services. This includes:

• Documenting compliance with payment standards.
• Providing details on payment arrangements such as capitation and other value-based payment methods.

Study Requirements

Within 13 months of the bill's enactment, the Secretary of Health and Human Services must conduct a study to:

• Compare the number of children enrolled in Medicaid before and after the implementation of the new payment rates.
• Compare the number of healthcare providers receiving payments for primary care services over the same period.
• Examine payment rates for primary care services across various states to assess fairness and equality in compensation.

Funding Authorization

The bill authorizes the appropriation of $200,000 for the fiscal year 2026 to implement the studies and administrative tasks required by the legislation.

Effective Dates

The amendments to payment standards and other provisions would be applicable starting from the first day of the month following the enactment of this Act.

Relevant Companies

None found.