[Congressional Record Volume 170, Number 144 (Tuesday, September 17, 2024)]
[House]
[Pages H5292-H5295]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                  ACCELERATING KID ACCESS TO CARE ACT

  Mrs. MILLER-MEEKS. Mr. Speaker, I move to suspend the rules and pass 
the bill (H.R. 4758) to amend title XIX of the Social Security Act to 
streamline enrollment under the Medicaid program of certain providers 
across State lines, and for other purposes, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 4758

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Accelerating Kids' Access to 
     Care Act''.

     SEC. 2. STREAMLINED ENROLLMENT PROCESS FOR ELIGIBLE OUT-OF-
                   STATE PROVIDERS UNDER MEDICAID AND CHIP.

       (a) In General.--Section 1902(kk) of the Social Security 
     Act (42 U.S.C. 1396a(kk)) is amended by adding at the end the 
     following new paragraph:
       ``(10) Streamlined enrollment process for eligible out-of-
     state providers.--
       ``(A) In general.--The State--
       ``(i) adopts and implements a process to allow an eligible 
     out-of-State provider to enroll under the State plan (or a 
     waiver of such plan) to furnish items and services to, or 
     order, prescribe, refer, or certify eligibility for items and 
     services for, qualifying individuals without the imposition 
     of screening or enrollment requirements in addition to those 
     imposed by the State in which the eligible out-of-State 
     provider is located; and
       ``(ii) provides that an eligible out-of-State provider that 
     enrolls as a participating provider in the State plan (or a 
     waiver of such plan) through such process shall be so 
     enrolled for a 5-year period, unless the provider is 
     terminated or excluded from participation during such period.
       ``(B) Definitions.--In this paragraph:
       ``(i) Eligible out-of-state provider.--The term `eligible 
     out-of-State provider' means, with respect to a State, a 
     provider--

       ``(I) that is located in any other State;
       ``(II) that--

       ``(aa) was determined by the Secretary to have a limited 
     risk of fraud, waste, and abuse for purposes of determining 
     the level of screening to be conducted under section 
     1866(j)(2), has been so screened under such section 
     1866(j)(2), and is enrolled in the Medicare program under 
     title XVIII; or
       ``(bb) was determined by the State agency administering or 
     supervising the administration of the State plan (or a waiver 
     of such plan) of such other State to have a limited risk of 
     fraud, waste, and abuse for purposes of determining the level 
     of screening to be conducted under paragraph (1) of this 
     subsection, has been so screened under such

[[Page H5293]]

     paragraph (1), and is enrolled under such State plan (or a 
     waiver of such plan); and

       ``(III) that has not been--

       ``(aa) excluded from participation in any Federal health 
     care program pursuant to section 1128 or 1128A;
       ``(bb) excluded from participation in the State plan (or a 
     waiver of such plan) pursuant to part 1002 of title 42, Code 
     of Federal Regulations (or any successor regulation), or 
     State law; or
       ``(cc) terminated from participating in a Federal health 
     care program or the State plan (or a waiver of such plan) for 
     a reason described in paragraph (8)(A).
       ``(ii) Qualifying individual.--The term `qualifying 
     individual' means an individual under 21 years of age who is 
     enrolled under the State plan (or waiver of such plan).
       ``(iii) State.--The term `State' means 1 of the 50 States 
     or the District of Columbia.''.
       (b) Conforming Amendments.--
       (1) Section 1902(a)(77) of the Social Security Act (42 
     U.S.C. 1396a(a)(77)) is amended by inserting ``enrollment,'' 
     after ``screening,''.
       (2) The subsection heading for section 1902(kk) of such Act 
     (42 U.S.C. 1396a(kk)) is amended by inserting ``Enrollment,'' 
     after ``Screening,''.
       (3) Section 2107(e)(1)(G) of such Act (42 U.S.C. 
     1397gg(e)(1)(G)) is amended by inserting ``enrollment,'' 
     after ``screening,''.
       (c) Effective Date.--The amendments made by this section 
     shall take effect on the date that is 3 years after the date 
     of enactment of this section.

     SEC. 3. PREVENTING THE USE OF ABUSIVE SPREAD PRICING IN 
                   MEDICAID.

       (a) In General.--Section 1927 of the Social Security Act 
     (42 U.S.C. 1396r-8) is amended--
       (1) in subsection (e), by adding at the end the following 
     new paragraph:
       ``(6) Transparent prescription drug pass-through pricing 
     required.--
       ``(A) In general.--A contract between the State and a 
     pharmacy benefit manager (referred to in this paragraph as a 
     `PBM'), or a contract between the State and a managed care 
     entity or other specified entity (as such terms are defined 
     in section 1903(m)(9)(D) and collectively referred to in this 
     paragraph as the `entity') that includes provisions making 
     the entity responsible for coverage of covered outpatient 
     drugs dispensed to individuals enrolled with the entity, 
     shall require that payment for such drugs and related 
     administrative services (as applicable), including payments 
     made by a PBM on behalf of the State or entity, is based on a 
     transparent prescription drug pass-through pricing model 
     under which--
       ``(i) any payment made by the entity or the PBM (as 
     applicable) for such a drug--

       ``(I) is limited to--

       ``(aa) ingredient cost; and
       ``(bb) a professional dispensing fee that is not less than 
     the professional dispensing fee that the State would pay if 
     the State were making the payment directly in accordance with 
     the State plan;

       ``(II) is passed through in its entirety (except as reduced 
     under Federal or State laws and regulations in response to 
     instances of waste, fraud, or abuse) by the entity or PBM to 
     the pharmacy or provider that dispenses the drug; and
       ``(III) is made in a manner that is consistent with 
     sections 447.502, 447.512, 447.514, and 447.518 of title 42, 
     Code of Federal Regulations (or any successor regulation) as 
     if such requirements applied directly to the entity or the 
     PBM, except that any payment by the entity or the PBM for the 
     ingredient cost of such drug purchased by a covered entity 
     (as defined in subsection (a)(5)(B)) may exceed the actual 
     acquisition cost (as defined in 447.502 of title 42, Code of 
     Federal Regulations, or any successor regulation) for such 
     drug if--

       ``(aa) such drug was subject to an agreement under section 
     340B of the Public Health Service Act;
       ``(bb) such payment for the ingredient cost of such drug 
     does not exceed the maximum payment that would have been made 
     by the entity or the PBM for the ingredient cost of such drug 
     if such drug had not been purchased by such covered entity; 
     and
       ``(cc) such covered entity reports to the Secretary (in a 
     form and manner specified by the Secretary), on an annual 
     basis and with respect to payments for the ingredient costs 
     of such drugs so purchased by such covered entity that are in 
     excess of the actual acquisition costs for such drugs, the 
     aggregate amount of such excess;
       ``(ii) payment to the entity or the PBM (as applicable) for 
     administrative services performed by the entity or PBM is 
     limited to an administrative fee that reflects the fair 
     market value (as defined by the Secretary) of such services;
       ``(iii) the entity or the PBM (as applicable) makes 
     available to the State, and the Secretary upon request in a 
     form and manner specified by the Secretary, all costs and 
     payments related to covered outpatient drugs and accompanying 
     administrative services (as described in clause (ii)) 
     incurred, received, or made by the entity or the PBM, broken 
     down (as specified by the Secretary), to the extent such 
     costs and payments are attributable to an individual covered 
     outpatient drug, by each such drug, including any ingredient 
     costs, professional dispensing fees, administrative fees (as 
     described in clause (ii)), post-sale and post-invoice fees, 
     discounts, or related adjustments such as direct and indirect 
     remuneration fees, and any and all other remuneration; and
       ``(iv) any form of spread pricing whereby any amount 
     charged or claimed by the entity or the PBM (as applicable) 
     that exceeds the amount paid to the pharmacies or providers 
     on behalf of the State or entity, including any post-sale or 
     post-invoice fees, discounts, or related adjustments such as 
     direct and indirect remuneration fees or assessments (after 
     allowing for an administrative fee as described in clause 
     (ii)) is not allowable for purposes of claiming Federal 
     matching payments under this title.
       ``(B) Making certain information available.--The Secretary 
     shall publish, not less frequently than on an annual basis, 
     information received by the Secretary pursuant to 
     subparagraph (A)(i)(III)(cc). Such information shall be so 
     published in an electronic and searchable format, such as 
     through the 340B Office of Pharmacy Affairs Information 
     System (or a successor system).''; and
       (2) in subsection (k), by adding at the end the following 
     new paragraph:
       ``(12) Pharmacy benefit manager.--The term `pharmacy 
     benefit manager' means any person or entity that, either 
     directly or through an intermediary, acts as a price 
     negotiator or group purchaser on behalf of a State, managed 
     care entity (as defined in section 1903(m)(9)(D)), or other 
     specified entity (as so defined), and may also more broadly 
     manage aspects of the prescription drug benefits provided by 
     a State, managed care entity, or other specified entity, 
     including the processing and payment of claims for 
     prescription drugs, the performance of drug utilization 
     review, the processing of drug prior authorization requests, 
     the managing of appeals or grievances related to the 
     prescription drug benefits, contracting with pharmacies, 
     controlling the cost of covered outpatient drugs, or the 
     provision of services related thereto. Such term includes any 
     person or entity that acts as a price negotiator (with regard 
     to payment amounts to pharmacies and providers for a covered 
     outpatient drug or the net cost of the drug) or group 
     purchaser on behalf of a State, managed care entity, or other 
     specified entity, including such a person or entity that 
     carries out 1 or more of the other activities described in 
     the preceding sentence, irrespective of whether such person 
     or entity calls itself a pharmacy benefit manager.''.
       (b) Conforming Amendments.--Section 1903(m) of such Act (42 
     U.S.C. 1396b(m)) is amended--
       (1) in paragraph (2)(A)(xiii)--
       (A) by striking ``and (III)'' and inserting ``(III)'';
       (B) by inserting before the period at the end the 
     following: ``, and (IV) if the contract includes provisions 
     making the entity responsible for coverage of covered 
     outpatient drugs, the entity shall comply with the 
     requirements of section 1927(e)(6)''; and
       (C) by moving the left margin 2 ems to the left; and
       (2) by adding at the end the following new paragraph:
       ``(10) No payment shall be made under this title to a State 
     with respect to expenditures incurred by the State for 
     payment for services provided by an other specified entity 
     (as defined in paragraph (9)(D)(iii)) unless such services 
     are provided in accordance with a contract between the State 
     and such entity which satisfies the requirements of paragraph 
     (2)(A)(xiii).''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to contracts between States and managed care 
     entities, other specified entities, or pharmacy benefit 
     managers that have an effective date beginning on or after 
     the date that is 18 months after the date of enactment of 
     this Act.
       (d) Implementation.--
       (1) In general.--Notwithstanding any other provision of 
     law, the Secretary of Health and Human Services may implement 
     the amendments made by this section by program instruction or 
     otherwise.
       (2) Nonapplication of administrative procedure act.--
     Implementation of the amendments made by this section shall 
     be exempt from the requirements of section 553 of title 5, 
     United States Code.
       (e) Nonapplication of Paperwork Reduction Act.--Chapter 35 
     of title 44, United States Code, shall not apply to any data 
     collection undertaken by the Secretary of Health and Human 
     Services under section 1927(e) of the Social Security Act (42 
     U.S.C. 1396r-8(f)), as amended by this section.

     SEC. 4. MEDICAID IMPROVEMENT FUND.

       Section 1941(b)(3)(A) of the Social Security Act (42 U.S.C. 
     1396w-1(b)(3)(A)) is amended by striking ``$0'' and inserting 
     ``$69,000,000''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentlewoman from 
Iowa (Mrs. Miller-Meeks) and the gentleman from New Jersey (Mr. 
Pallone) each will control 20 minutes.
  The Chair recognizes the gentlewoman from Iowa.


                             General Leave

  Mrs. MILLER-MEEKS. Mr. Speaker, I ask unanimous consent that all 
Members may have 5 legislative days in which to revise and extend their 
remarks and include extraneous material in the Record on the bill.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from Iowa?
  There was no objection.
  Mrs. MILLER-MEEKS. Mr. Speaker, I yield myself such time as I may 
consume.

[[Page H5294]]

  Mr. Speaker, I rise today in strong support of my legislation, H.R. 
4758, the Accelerating Kids' Access to Care Act.
  Mr. Speaker, for many families facing rare and severe pediatric 
conditions, accessing out-of-State care can be a daunting and lengthy 
process. The barriers are not just logistical, but also administrative, 
leading to unnecessary delays that can be detrimental to a child's 
health and even life threatening.
  The Accelerating Kids' Access to Care Act addresses this issue by 
streamlining the enrollment process for out-of-State pediatric 
providers under Medicaid, meaning that, if a child needs to travel out 
of State to receive care, bureaucratic hurdles won't stand in their 
way.
  More specifically, the Accelerating Kids' Access to Care Act will 
enable States to adopt a simplified process for out-of-State providers 
to enroll in their Medicaid programs. This change will reduce delays 
and prevent the denial of care due to administrative inefficiencies.
  It will also ensure that, once enrolled, providers remain active for 
5 years, unless otherwise terminated, which brings stability and 
consistency to care delivery.
  In addition, the bill includes provisions to combat abusive pricing 
practices in Medicaid, ensuring transparency and fairness in the cost 
of prescription drugs. By enforcing transparent pricing models by 
banning spread pricing, we can protect both the integrity of Medicaid 
dollars and the interests of families relying on this essential 
program.
  This bipartisan piece of legislation is supported by over 215 
organizations, including the Children's Hospital Association and the 
Leukemia & Lymphoma Society, reflecting a broad consensus on its 
importance.
  Mr. Speaker, I thank the gentlewoman from Massachusetts (Mrs. Trahan) 
and Senators Grassley and Bennet for their work on this bill, and I ask 
all of my colleagues to join us in supporting this vital piece of 
legislation.
  Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise today in support of H.R. 4758, the Accelerating 
Kids' Access to Care Act, sponsored by the gentlewoman from 
Massachusetts (Mrs. Trahan) and the gentlewoman from Iowa (Mrs. Miller-
Meeks).
  Mr. Speaker, H.R. 4758 will ensure that children enrolled in Medicaid 
who need specialized care from out-of-State providers can receive that 
care without undue delay.
  Children with complex medical needs often require care that can only 
be provided by specialists in States other than the one in which they 
live, and it is unacceptable that these children may have to wait 
months to receive the care they need, making their condition worse and 
adding unnecessary stress and burden to their already overwhelmed 
families.
  These delays stem from complicated processes that prevent out-of-
State Medicaid providers from quickly enrolling in the child's home 
State Medicaid program. H.R. 4758 will streamline that process to 
ensure children can more quickly get the care that they need.
  This bill also includes a prohibition on so-called spread pricing by 
pharmacy benefit managers in the Medicaid program. Spread pricing 
occurs when pharmacy benefit managers keep a portion of the amount paid 
to them for prescription drugs, charging Medicaid an excess amount for 
the drug. I will be pleased to see this wasteful spending come to an 
end, frankly.
  Mr. Speaker, I thank the gentlewoman from Massachusetts (Mrs. Trahan) 
for her leadership on this important bill. I urge all of my colleagues 
to vote ``yes,'' and I reserve the balance of my time.
  Mrs. MILLER-MEEKS. Mr. Speaker, I yield 5 minutes to the gentleman 
from Georgia (Mr. Carter).
  Mr. CARTER of Georgia. Mr. Speaker, I thank the gentlewoman for 
yielding.
  Mr. Speaker, I rise today to express my support for the Accelerating 
Kids' Access to Care Act, which will help families access lifesaving 
care for children with complex medical conditions.
  In Georgia, we are blessed to have world-class children's hospitals 
that care for kids across the country. However, in some cases, patients 
with rare and complex diseases have to travel out of State to receive 
specialized care when the services they need are not available in their 
own State.
  The process is difficult and full of red tape, often delaying 
children and their families from receiving the care they desperately 
need and, in some cases, blocking access to care altogether.
  The Accelerating Kids' Access to Care Act will allow States to 
streamline the process for out-of-State pediatric care providers to 
enroll in another State's Medicaid program, while also providing 
important guardrails. This is a commonsense policy that will help 
children with complex medical conditions access critical care.
  Mr. Speaker, I am also pleased to see the bipartisan amendment 
includes crucial pharmacy benefit manager reforms for my Drug Price 
Transparency and Medicaid Act. This provision would prohibit spread 
pricing in Medicaid and clarify that States should reimburse PBMs 
contracting with Medicaid managed care organizations for an 
administrative fee for managing the pharmacy benefit for Medicaid 
beneficiaries.
  This will save taxpayers millions of dollars and will protect 
patients, pharmacies, and others from middleman tactics that drive up 
prescription drug prices.
  Mr. Speaker, I commend the gentlewoman from Iowa (Mrs. Miller-Meeks) 
and the gentlewoman from Massachusetts (Mrs. Trahan) for working on 
this issue, and I urge my colleagues to support the Accelerating Kids' 
Access to Care Act.
  Mr. PALLONE. Mr. Speaker, I yield such time as she may consume to the 
gentlewoman from Massachusetts (Mrs. Trahan), the main author of this 
bill.
  Mrs. TRAHAN. Mr. Speaker, I thank the gentleman from New Jersey (Mr. 
Pallone) for yielding.
  Mr. Speaker, I express my sincere gratitude to Ranking Member 
Pallone, Chair Rodgers, Ranking Member Eshoo, Chairman Guthrie, 
Congresswoman Miller-Meeks, and my colleagues on the Energy and 
Commerce Committee for their unanimous support of this important 
bipartisan, bicameral legislation.
  When medical professionals determine that clinical care is necessary 
to treat a child battling a rare disease, there should be no reason 
that administrative burdens get in the way. However, that is exactly 
what happens far too often to children with complex medical needs.
  In fact, when children with serious health conditions lack access to 
the specialized care that they need in their home State, parents can be 
forced to navigate the complicated process of working with healthcare 
providers and State Medicaid officials to arrange for out-of-State 
care.
  Unfortunately, those same parents are often met with burdensome 
requirements that can lead to significant delays for children in 
desperate need of care. In some cases, it can prevent access to care 
entirely.
  Mr. Speaker, the Accelerating Kids' Access to Care Act is urgently 
needed to eliminate this red tape and ensure that children receive 
appropriate, often lifesaving care that they deserve.
  Mr. Speaker, to highlight the importance of getting this bipartisan 
legislation over the finish line, I highlight a story from a patient 
who was negatively impacted by the onerous and time-consuming Medicaid 
provider screening and enrollment process.
  Almost 3 years ago, a baby, who I will name Lily, was born in a rural 
State with her esophagus in two separate segments and connected 
abnormally to her windpipe. Since this condition requires a 
particularly complicated procedure to correct it, doctors explained to 
the family that there are only two places in the country where it could 
be done. One of them was Boston Children's Hospital, in my home State 
of Massachusetts.
  Mr. Speaker, like most parents, Lily's mom and dad were immediately 
ready to travel to Boston, where the surgeons were standing by to 
perform the lifesaving operation. Instead, Lily, who was a Medicaid 
recipient, was waiting for her home State to enroll the eight providers 
at Boston Children's Hospital who had the expertise to perform this 
complex surgery.

[[Page H5295]]

  Her State, confused about the rules concerning out-of-State provider 
enrollment, wouldn't authorize the surgery that Lily desperately 
needed. Over the next 7 months, Lily's surgery was delayed and 
rescheduled over 3 times. As she waited, she lived with a floppy airway 
that could have collapsed at any moment.
  Mr. Speaker, clearly the stakes are far too high to allow 
bureaucratic hurdles to stand in the way of urgent medical care for 
children like Lily. Failing to address this issue will have severe and 
far-reaching consequences, not only on children who are battling 
complications that could be addressed with immediate care, but also 
their families, who are forced to endure significant financial and 
emotional strain when the care is delayed.
  What is worse is that these delays also lead to a greater reliance on 
emergency services and drive up overall healthcare costs.
  Passage of the Accelerating Kids' Access to Care Act is instrumental 
in fixing this issue. This bipartisan legislation will get us one step 
closer to ensuring that no child on Medicaid has to endure unnecessary 
delays when they need critical care outside of their home State.
  That is why I am so grateful to my colleagues on both sides of the 
aisle and in both Chambers who were instrumental in drafting the 
advancement of this legislation, including Congresswoman Miller-Meeks 
and Senators Grassley and Bennet.
  Mr. Speaker, that is why I urge Members on both sides of the aisle to 
join us in passing this strong, bipartisan, and potentially lifesaving 
legislation.

                              {time}  1945

  Mrs. MILLER-MEEKS. Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I think we heard from Representative Trahan 
why this is so important. I urge all colleagues to vote for it on a 
bipartisan basis, and I yield back the balance of my time.
  Mrs. MILLER-MEEKS. Mr. Speaker, this bipartisan, bicameral 
legislation is critical in making sure that kids have the access to 
lifesaving care that they need without burdensome overregulation.
  Mr. Speaker, I encourage a ``yes'' vote on this bill, and I yield 
back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentlewoman from Iowa (Mrs. Miller-Meeks) that the House suspend the 
rules and pass the bill, H.R. 4758, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  The title of the bill was amended so as to read: ``A bill to amend 
title XIX of the Social Security Act to streamline enrollment under the 
Medicaid program of certain providers across State lines, and to 
prevent the use of abusive spread pricing in Medicaid.''.
  A motion to reconsider was laid on the table.

                          ____________________