II 

118TH CONGRESS 

2D SESSION S. 5432 

To facilitate direct primary care arrangements under Medicaid. 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 5, 2024 

Mrs. BLACKBURN (for herself and Mr. KELLY) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To facilitate direct primary care arrangements under 

Medicaid. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medicaid Primary Care 

5 Improvement Act’’. 

6 SEC. 2. CLARIFYING THAT CERTAIN PAYMENT ARRANGE7 MENTS ARE ALLOWABLE UNDER THE MED8 ICAID PROGRAM. 

9 (a) IN GENERAL.—Nothing in title XIX of the Social 

10 Security Act (42 U.S.C. 1396 et seq.) shall be construed 

11 as prohibiting a State, under its State plan (or waiver of 


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1 such plan) under such title (including through a medicaid 

2 managed care organization), from providing medical as3 sistance consisting of primary care services through a di4 rect primary care arrangement with a health care pro5 vider, including as part of a value-based care arrangement 

6 established by the State. 

7 (b) DEFINITIONS.—In this Act: 

8 (1) DIRECT PRIMARY CARE ARRANGEMENT.— 

9 The term ‘‘direct primary care arrangement’’ means, 

10 with respect to any individual, an arrangement 

11 under which such individual is provided medical as12 sistance consisting solely of primary care services 

13 provided by primary care practitioners, if the sole 

14 compensation for such care is a fixed periodic fee. 

15 (2) MEDICAID MANAGED CARE ORGANIZA16 TION.—The term ‘‘medicaid managed care organiza17 tion’’ has the meaning given that term in section 

18 1903(m)(1)(A) of the Social Security Act (42 U.S.C. 

19 1396b(m)(1)(A)). 

20 (3) SECRETARY.—The term ‘‘Secretary’’ means 

21 the Secretary of Health and Human Services. 

22 (c) GUIDANCE.—Not later than 1 year after the date 

23 of enactment of this Act, the Secretary shall— 

24 (1) convene at least 1 virtual open door meeting 

25 to seek input from stakeholders, including primary 


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1 care providers who practice under the direct primary 

2 care model, state Medicaid agencies, and medicaid 

3 managed care organizations; and 

4 (2) taking into account such input, issue guid5 ance to States on how a State may implement direct 

6 primary care arrangements under title XIX of the 

7 Social Security Act (42 U.S.C. 1396 et seq.). 

8 (d) REPORT.—Not later than 2 years after the date 

9 of enactment of this Act, the Secretary shall submit to 

10 Congress a report containing— 

11 (1) an analysis of the extent to which States 

12 are contracting with independent physicians, inde13 pendent physician practices, and primary care prac14 tices for purposes of furnishing medical assistance 

15 under State plans (or waivers of such plans) under 

16 title XIX of the Social Security Act (42 U.S.C. 1396 

17 et seq.) through direct primary care arrangements; 

18 and 

19 (2) an analysis of quality of care and cost of 

20 care furnished to individuals enrolled under such 

21 title where such care is paid for under a direct pri22 mary care arrangement through a medicaid man23 aged care organization. 

24 (e) RULE OF CONSTRUCTION.—Nothing in this sec25 tion shall be construed to alter statutory requirements apVerDate Sep 11 2014 00:09 Dec 31, 2024 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S5432.IS S5432

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1 plicable to State plans (or waivers of such plans) under 

2 title XIX of the Social Security Act (42 U.S.C. 1396 et 

3 seq.), including requirements relating to cost-sharing and 

4 requirements relating to the amount, duration, and scope 

5 of medical assistance that is required to be made available 

6 to individuals who are eligible for such assistance under 

7 such a plan or waiver. 

Æ 


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