Medicaid Primary Care Improvement Act

Medicaid Primary Care Improvement Act

This bill specifies that state Medicaid programs are authorized to provide primary care services through direct primary care arrangements (i.e., arrangements in which primary care providers receive a fixed periodic fee for their services).

The Centers for Medicare & Medicaid Services must (1) convene at least one virtual stakeholder meeting and issue related guidance on how state Medicaid programs may implement direct primary care arrangements, and (2) report on the extent to which state Medicaid programs contract with independent providers and on the quality and cost of care under direct primary care arrangements that are offered through Medicaid managed care organizations.

[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3836 Introduced in House (IH)]

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118th CONGRESS
  1st Session
                                H. R. 3836

     To facilitate direct primary care arrangements under Medicaid.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              June 6, 2023

     Mr. Crenshaw (for himself, Ms. Schrier, Mr. Smucker, and Mr. 
 Blumenauer) introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
     To facilitate direct primary care arrangements under Medicaid.

    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 ``Medicaid Primary Care Improvement 
Act''.

SEC. 2. FINDINGS.

    Congress finds as follows:
            (1) Primary care services are able to reduce healthcare 
        costs, emergency room visits, and hospitalizations.
            (2) Primary care creates increased patient satisfaction, 
        physician engagement, and better patient outcomes.
            (3) The model of direct primary care can change patient 
        usage patterns, with more personalized preventative care versus 
        high-acuity episodic care.

SEC. 3. CLARIFYING THAT CERTAIN PAYMENT ARRANGEMENTS ARE ALLOWABLE 
              UNDER THE MEDICAID PROGRAM.

    (a) In General.--Nothing in title XIX of the Social Security Act 
(42 U.S.C. 1396 et seq.) shall be construed as prohibiting a State, 
under its State plan (or waiver of such plan) under such title 
(including through a medicaid managed care organization (as defined in 
section 1903(m) of such Act)), from providing medical assistance 
consisting of primary care services through a direct primary care 
arrangement with a health care provider, including as part of a value-
based care arrangement established by the State (or such organization). 
For purposes of the preceding sentence, the term ``direct primary care 
arrangement'' means, with respect to any individual, an arrangement 
under which such individual is provided medical assistance consisting 
solely of primary care services provided by primary care practitioners 
(as defined in section 1833(x)(2)(A) of the Social Security Act, 
determined without regard to clause (ii) thereof), if the sole 
compensation for such care is a fixed periodic fee.
    (b) Guidance.--The Secretary of Health and Human Services shall 
issue guidance to States on how a State may implement direct primary 
care arrangements (as defined in subsection (a)) under title XIX of the 
Social Security Act (42 U.S.C. 1396 et seq.).
    (c) Report.--Not later than 1 year after the date of the enactment 
of this Act, the Secretary of Health and Human Services shall submit to 
Congress a report containing--
            (1) an analysis of the extent to which States are 
        contracting with independent physicians, independent physician 
        practices, and primary care practices for purposes of 
        furnishing medical assistance under State plans (or waivers of 
        such plans) under title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.); and
            (2) an analysis of quality of care and cost of care 
        furnished to individuals enrolled under such title where such 
        care is paid for under a direct primary care arrangement (as 
        defined in subsection (a)) through a medicaid managed care 
        organization (as so defined).
    (d) Rule of Construction.--Nothing in this section shall be 
construed to alter statutory limits on Medicaid enrollee cost-sharing 
or be construed to limit Medicaid services solely to those provided 
under a direct primary care arrangement.
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