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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 5432 Introduced in Senate (IS)]

<DOC>

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.

    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) 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), 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.
    (b) Definitions.--In this Act:
            (1) Direct primary care arrangement.--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.
            (2) Medicaid managed care organization.--The term 
        ``medicaid managed care organization'' has the meaning given 
        that term in section 1903(m)(1)(A) of the Social Security Act 
        (42 U.S.C. 1396b(m)(1)(A)).
            (3) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
    (c) Guidance.--Not later than 1 year after the date of enactment of 
this Act, the Secretary shall--
            (1) convene at least 1 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 under title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.).
    (d) Report.--Not later than 2 years after the date of enactment of 
this Act, the Secretary 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.) through direct primary care arrangements; 
        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 
        through a medicaid managed care organization.
    (e) Rule of Construction.--Nothing in this section shall be 
construed to alter statutory requirements applicable to State plans (or 
waivers of such plans) under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.), including requirements relating to cost-sharing 
and requirements relating to the amount, duration, and scope of medical 
assistance that is required to be made available to individuals who are 
eligible for such assistance under such a plan or waiver.
                                 <all>
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