To increase the minimum disaster loan amount for which the Small Business Administration may require collateral, and for other purposes.
Analysis under review: This bill has generated analysis that may be too generic or incomplete. Clause-level evidence remains available below.
Summary
What This Bill Does
The Accelerating Kids' Access to Care Act makes it easier for children with complex medical conditions to access specialized healthcare providers across state lines. It also reforms how pharmacy benefit managers (PBMs) are paid under Medicaid to prevent them from profiting through hidden pricing spreads.
Who Benefits and How
Families with sick children benefit because their kids can more easily see out-of-state specialists without bureaucratic enrollment delays. Pharmacies benefit because PBMs must now pass through the full payment rather than skimming off a hidden spread. State Medicaid programs benefit from greater transparency in drug pricing, potentially reducing costs.
Who Bears the Burden and How
Pharmacy Benefit Managers (PBMs) face significant new restrictions on their business model - they can no longer profit from spread pricing and must disclose all costs and payments to states and the federal government. States must implement new enrollment processes for out-of-state providers within 3 years.
Key Provisions
- Requires states to allow out-of-state providers with limited fraud risk to enroll in Medicaid for 5-year periods with streamlined screening
- Bans spread pricing by PBMs in Medicaid, requiring transparent pass-through of drug costs to pharmacies
- Requires PBMs to disclose all costs, fees, discounts, and rebates to states and the Secretary
- Adds $88 million to the Medicaid Improvement Fund
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers.
At a Glance
What This Bill Does
Improve access to healthcare for children with complex medical conditions by streamlining out-of-state provider enrollment and preventing abusive pharmacy benefit manager pricing practices in Medicaid
Key Policy Areas
Healthcare, Medicaid, Pharmacy Benefits, Children's Health
Primary Purpose
Improve access to healthcare for children with complex medical conditions by streamlining out-of-state provider enrollment and preventing abusive pharmacy benefit manager pricing practices in Medicaid
Policy Domains
Accelerating Kids' Access to Care Act
Identified Gains
Contextual inference, no direct clause citation- Children with medically complex conditions
- Families seeking out-of-state pediatric care
- Pharmacies
- State Medicaid programs
- Healthcare providers serving Medicaid patients
Contextual inference, no direct clause citation
Identified Costs
Contextual inference, no direct clause citation- Pharmacy Benefit Managers (PBMs)
- Managed care entities
- State agencies administering Medicaid
Contextual inference, no direct clause citation
Sponsors
Legislative Progress
ReportedReported by Mr. Cardin, with an amendment
Mr. Kennedy introduced the following bill; which was read twice …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Congressional oversight committees, Government Accountability Office, Small Business Administration
Positive-direction: Congressional oversight committees
Negative-direction: Government Accountability Office, Small Business Administration
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "the_state"
- → State Medicaid Agency
- "the_secretary"
- → Secretary of Health and Human Services
Key Definitions
Terms defined in this bill
A pricing model where PBM payments to pharmacies are limited to ingredient cost plus professional dispensing fee, payments are passed through entirely to pharmacies, and PBM administrative fees reflect fair market value
A provider located in another state that has been determined to have limited fraud risk and is enrolled in Medicare or another state's Medicaid plan, and has not been excluded or terminated from federal healthcare programs
An individual under 21 years of age enrolled under the State Medicaid plan or waiver
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology