Sec. 414. Extension of application of Medicare payment floor to primary care services furnished in Puerto Rico under Medicaid and application to additional providers
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Section 1902(a)(13) of the Social Security Act ( 42 U.S.C. 1396a(a)(13) ) is amended— in subparagraph (B), by striking ; and and inserting a semicolon; in subparagraph (C), by striking the semicolon at the end and inserting ; and ; and by adding at the end the following new subparagraph: 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 furnished in Puerto Rico on or after January 1, 2017— by a physician with a primary specialty designation of family medicine, general internal medicine, or pediatric medicine, but only if the physician self-attests that— the physician is Board certified in family medicine, general internal medicine, or pediatric medicine; or with respect to the most recently completed calendar year (or in the case of a newly eligible physician, the preceding month), 60 percent of all services the physician billed for under the State plan or a waiver under this title, or provided through a medicaid managed care organization (as defined in section 1903(m)(1)(A)), were for services described in subparagraph
(A)or
(B)of subsection (jj)(1); by a physician with a primary specialty designation of obstetrics and gynecology, but only if the physician self-attests that— the physician is Board certified in obstetrics and gynecology; and with respect to the most recently completed calendar year (or in the case of a newly eligible physician, the preceding month), 60 percent of all services the physician billed for under the State plan or a waiver under this title, or provided through a medicaid managed care organization (as defined in section 1903(m)(1)(A)), were for services described in subparagraph
(A)or
(B)of subsection (jj)(1); by an advanced practice clinician, as defined by the Secretary, that works under the supervision of— a physician that satisfies the criteria specified in clause
(i)or (ii); or 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)) who is working in accordance with State law, but only if the nurse practitioner, physician assistant, or certified nurse-midwife self-attests that, with respect to the most recently completed calendar year (or in the case of a newly eligible nurse practitioner, physician assistant, or certified nurse-midwife, the preceding month), 60 percent of all services the nurse practitioner, physician assistant, or certified nurse-midwife billed for under the State plan or a waiver under this title, or provided through a medicaid managed care organization (as defined in section 1903(m)(1)(A)), were for services described in subparagraph
(A)or
(B)of subsection (jj)(1); by a rural health clinic, Federally-qualified health center, or other health clinic that receives reimbursement on a fee schedule applicable to a physician, 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)) who is working in accordance with State law, for services furnished by a physician, nurse practitioner, physician assistant, or certified nurse-midwife, or services furnished by an advanced practice clinician supervised by a physician described in clause (i)(I) or (ii)(I), another advanced practice clinician, or a certified nurse-midwife, but only if the rural health clinic or Federally-qualified health center self-attests that 60 percent of all services billed for under the State plan or a waiver under this title, or provided through a medicaid managed care organization (as defined in section 1903(m)(1)(A)), were for services described in subparagraph
(A)or
(B)of subsection (jj)(1); or 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 (as defined in section 1861(gg)) 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, but only if the nurse practitioner, physician assistant, or certified nurse-midwife self-attests that, with respect to the most recently completed calendar year (or in the case of a newly eligible nurse practitioner, physician assistant, or certified nurse-midwife, the preceding month), 60 percent of all services the nurse practitioner, physician assistant, or certified nurse-midwife billed for under the State plan or a waiver under this title, or provided through a medicaid managed care organization (as defined in section 1903(m)(1)(A)), were for services described in subparagraph
(A)or
(B)of subsection (jj)(1); . Section 1905(dd) of the Social Security Act ( 42 U.S.C. 1396(dd) ) is amended— by inserting the following sentence after the first sentence: Notwithstanding subsection (b), with respect to the portion of the amounts expended for medical assistance for services described in section 1902(a)(13)(D) furnished in Puerto Rico on or after January 1, 2017, that is attributable to the amount by which the minimum payment rate required under such section (or, by application, section 1932(f)) exceeds the payment rate applicable to such services under the State plan as of July 1, 2009, the Federal medical assistance percentage shall be equal to 100 percent. ; and in the last sentence, by striking preceding sentence does not and inserting preceding sentences do not . Section 1932(f) of the Social Security Act ( 42 U.S.C. 1396u–2(f) ) is amended— by striking section 1902(a)(13)(C) and inserting subparagraph
(C)or
(D)of section 1902(a)(13) ; and by striking specified in such section and inserting specified in such subparagraphs .
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- 42 USC 1396u–2(f)
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Sec. 414
Extension of application of Medicare payment floor to primary care services furnished in Puerto Rico under Medicaid and application to additional providers
Cite42 USC 1396u–2(f)
Cites 3Cited by 0 across 0 sources