Accelerating Kids’ Access to Care Act

Accelerating Kids' Access to Care Act

This bill requires state Medicaid programs to establish a process through which qualifying out-of-state providers may temporarily treat children without undergoing additional screening requirements. It also requires pass-through pricing models for covered drugs under Medicaid.

Specifically, states must establish a process through which qualifying providers may enroll for five years as participating providers to treat individuals under the age of 21 without undergoing additional screening requirements, unless the state has an agreement with other states that governs coverage of children with medically complex conditions that is in accordance with specified guidance from the Centers for Medicare & Medicaid Services (CMS).

A qualifying provider (1) must not have been excluded or terminated from participating in a federal health care program or state Medicaid program; and (2) must have been successfully enrolled in Medicare or a state Medicaid program based on a determination that the provider posed a limited risk of fraud, waste, or abuse.

In addition, the bill requires pass-through pricing models, and prohibits spread-pricing, for payment arrangements with pharmacy benefit managers under Medicaid.

Written by the nonpartisan Congressional Research Service. All summary versions on Congress.gov