Medicaid Primary Care Improvement Act

Bill: 118-hr-3836
Sponsor: full_name: Rep. Crenshaw, Dan [R-TX-2]
Introduced: 2023-06-06
Policy area: Health
Subjects: Congressional oversight

Health care costs and insurance

Medicaid
Latest action: action_date: 2024-03-06
text: Received in the Senate and Read twice and referred to the Committee on Finance.

Summaries:
action_date: 2023-06-06
action_desc: Introduced in House
text: <p><b>Medicaid Primary Care Improvement Act</b></p> <p>This bill specifies that state Medicaid programs are authorized to provide primary care services through direct primary care arrangements (i.e., arrangements in which primary care providers receive a fixed periodic fee for their services).</p> <p>The Centers for Medicare &amp; Medicaid Services must (1) issue guidance on how state Medicaid programs may implement direct primary care arrangements, and (2) report on the extent to which state Medicaid programs contract with independent providers and on the quality and cost of care under direct primary care arrangements that are offered through Medicaid managed care organizations.</p>

action_date: 2023-09-01
action_desc: Reported to House
text: <p><b>Medicaid Primary Care Improvement Act</b></p> <p>This bill specifies that state Medicaid programs are authorized to provide primary care services through direct primary care arrangements (i.e., arrangements in which primary care providers receive a fixed periodic fee for their services).</p> <p>The Centers for Medicare &amp; Medicaid Services must (1) convene at least one virtual stakeholder meeting and issue related guidance on how state Medicaid programs may implement direct primary care arrangements, and (2) report on the extent to which state Medicaid programs contract with independent providers and on the quality and cost of care under direct primary care arrangements that are offered through Medicaid managed care organizations.</p>

action_date: 2024-03-05
action_desc: Passed House
text: <p><b>Medicaid Primary Care Improvement Act</b></p> <p>This bill specifies that state Medicaid programs are authorized to provide primary care services through direct primary care arrangements (i.e., arrangements in which primary care providers receive a fixed periodic fee for their services).</p> <p>The Centers for Medicare &amp; Medicaid Services must (1) convene at least one virtual stakeholder meeting and issue related guidance on how state Medicaid programs may implement direct primary care arrangements, and (2) report on the extent to which state Medicaid programs contract with independent providers and on the quality and cost of care under direct primary care arrangements that are offered through Medicaid managed care organizations.</p>

tv_txt: IIB 118th CONGRESS 2d Session H. R. 3836 IN THE SENATE OF THE UNITED STATES March 6, 2024 Received; read twice and referred to the Committee on Finance AN ACT To facilitate direct primary care arrangements under Medicaid.

1. Short title This Act may be cited as the Medicaid Primary Care Improvement Act . 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.

Passed the House of Representatives March 5, 2024. Kevin F. McCumber, Clerk.

tv_txt: IB 118th CONGRESS 2d Session H. R. 3836 IN THE HOUSE OF REPRESENTATIVES AN ACT To facilitate direct primary care arrangements under Medicaid.

1. Short title This Act may be cited as the Medicaid Primary Care Improvement Act . 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.

Passed the House of Representatives March 5, 2024. Cheryl L. Johnson, Clerk.

tv_txt: IB Union Calendar No. 134 118th CONGRESS 1st Session H. R. 3836 [Report No. 118–170] IN THE HOUSE OF REPRESENTATIVES June 6, 2023 Mr. Crenshaw (for himself, Ms. Schrier , Mr. Smucker , and Mr. Blumenauer ) introduced the following bill; which was referred to the Committee on Energy and Commerce September 1, 2023 Additional sponsor: Ms. Pettersen September 1, 2023 Reported with an amendment, committed to the Committee of the Whole House on the State of the Union, and ordered to be printed Strike out all after the enacting clause and insert the part printed in italic For text of introduced bill, see copy of bill as introduced on June 6, 2023 A BILL To facilitate direct primary care arrangements under Medicaid.

1. Short title This Act may be cited as the Medicaid Primary Care Improvement Act . 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.

September 1, 2023 Reported with an amendment, committed to the Committee of the Whole House on the State of the Union, and ordered to be printed

tv_txt: I 118th CONGRESS 1st Session H. R. 3836 IN THE HOUSE OF REPRESENTATIVES June 6, 2023 Mr. Crenshaw (for himself, Ms. Schrier , Mr. Smucker , and Mr. Blumenauer ) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To facilitate direct primary care arrangements under Medicaid.

1. Short title This Act may be cited as the Medicaid Primary Care Improvement Act . 2. Findings Congress finds as follows: (1) Primary care services are able to reduce healthcare costs, emergency room visits, and hospitalizations. (2) Primary care creates increased patient satisfaction, physician engagement, and better patient outcomes. (3) The model of direct primary care can change patient usage patterns, with more personalized preventative care versus high-acuity episodic care. 3. 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 (as defined in section 1903(m) 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 (or such organization). 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 (as defined in section 1833(x)(2)(A) of 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 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 limits on Medicaid enrollee cost-sharing or be construed to limit Medicaid services solely to those provided under a direct primary care arrangement.