I 
119TH CONGRESS 
1ST SESSION H. R. 1162 
To facilitate direct primary care arrangements under Medicaid. 
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 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. CLARIFYING THAT CERTAIN PAYMENT ARRANGE-
MENTS ARE ALLOWABLE UNDER THE MED-
ICAID PROGRAM. 
(a) RULE OF CONSTRUCTION.—Nothing in title XIX 
of the Social Security Act (42 U.S.C. 1396 et seq.) shall 
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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 ar-
rangement established by the State. For purposes of the 
preceding sentence, the term ‘‘direct primary care ar-
rangement’’ means, with respect to any individual, an ar-
rangement under which such individual is provided med-
ical assistance consisting solely of primary care services 
provided by primary care practitioners, if the sole com-
pensation 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 meet-
ing to seek input from stakeholders, including pri-
mary 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 guid-
ance to States on how a State may implement direct 
primary care arrangements (as defined in subsection 
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(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 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). 
(d) RULE OF CONSTRUCTION.—Nothing in this sec-
tion 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 
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