Medicaid Primary Care Improvement Act

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1162 Introduced in House (IH)]

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119th CONGRESS
  1st Session
                                H. R. 1162

     To facilitate direct primary care arrangements under Medicaid.


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                    IN THE HOUSE OF REPRESENTATIVES

                           February 10, 2025

Mr. Crenshaw (for himself, Ms. Schrier, Mr. Smucker, and Ms. Pettersen) 
 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. CLARIFYING THAT CERTAIN PAYMENT ARRANGEMENTS ARE ALLOWABLE 
              UNDER THE MEDICAID PROGRAM.

    (a) Rule of Construction.--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)(1)(A) 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. 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, if the sole 
compensation for such care is a fixed periodic fee.
    (b) Guidance.--Not later than 1 year after the date of the 
enactment of this Act, the Secretary of Health and Human Services 
shall--
            (1) convene at least one virtual open door meeting to seek 
        input from stakeholders, including primary care providers who 
        practice under the direct primary care model, state Medicaid 
        agencies, and Medicaid managed care organizations; and
            (2) taking into account such input, 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 2 years 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 requirements under the State plan (or 
waiver of such plan) under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) for cost-sharing requirements or be construed to 
limit medical assistance solely to those provided under a direct 
primary care arrangement.
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