I 
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. BLU-
MENAUER) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce 
A BILL 
To facilitate direct primary care arrangements under 
Medicaid. 
Be it enacted by the Senate and House of Representa-
tives 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 hos-
pitalizations. 
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(2) Primary care creates increased patient sat-
isfaction, physician engagement, and better patient 
outcomes. 
(3) The model of direct primary care can 
change patient usage patterns, with more personal-
ized preventative care versus high-acuity episodic 
care. 
SEC. 3. CLARIFYING THAT CERTAIN PAYMENT ARRANGE-
MENTS ARE ALLOWABLE UNDER THE MED-
ICAID 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 ar-
rangement 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 sen-
tence, the term ‘‘direct primary care arrangement’’ means, 
with respect to any individual, an arrangement under 
which such individual is provided medical assistance con-
sisting solely of primary care services provided by primary 
care practitioners (as defined in section 1833(x)(2)(A) of 
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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 con-
taining— 
(1) an analysis of the extent to which States 
are contracting with independent physicians, inde-
pendent physician practices, and primary care prac-
tices 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 pri-
mary care arrangement (as defined in subsection 
(a)) through a medicaid managed care organization 
(as so defined). 
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(d) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to alter statutory limits on Med-
icaid enrollee cost-sharing or be construed to limit Med-
icaid services solely to those provided under a direct pri-
mary care arrangement. 
Æ 
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