I 118TH CONGRESS 1ST SESSION H. R. 2884 To facilitate direct primary care arrangements under Medicaid. IN THE HOUSE OF REPRESENTATIVES APRIL 26, 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- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Medicaid Primary Care 4 Improvement Act’’. 5 SEC. 2. FINDINGS. 6 Congress finds as follows: 7 (1) Primary care services are able to reduce 8 healthcare costs, emergency room visits, and hos- 9 pitalizations. 10 VerDate Sep 11 2014 02:40 May 05, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2884.IH H2884 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •HR 2884 IH (2) Primary care creates increased patient sat- 1 isfaction, physician engagement, and better patient 2 outcomes. 3 (3) The model of direct primary care can 4 change patient usage patterns, with more personal- 5 ized preventative care versus high-acuity episodic 6 care. 7 SEC. 3. CLARIFYING THAT CERTAIN PAYMENT ARRANGE- 8 MENTS ARE ALLOWABLE UNDER THE MED- 9 ICAID PROGRAM. 10 (a) IN GENERAL.—Nothing in title XIX of the Social 11 Security Act (42 U.S.C. 1396 et seq.) shall be construed 12 as prohibiting a State, under its State plan (or waiver of 13 such plan) under such title (including through a medicaid 14 managed care organization (as defined in section 1903(m) 15 of such Act)), from providing medical assistance consisting 16 of primary care services through a direct primary care ar- 17 rangement with a health care provider, including as part 18 of a value-based care arrangement established by the State 19 (or such organization). For purposes of the preceding sen- 20 tence, the term ‘‘direct primary care arrangement’’ means, 21 with respect to any individual, an arrangement under 22 which such individual is provided medical assistance con- 23 sisting solely of primary care services provided by primary 24 care practitioners (as defined in section 1833(x)(2)(A) of 25 VerDate Sep 11 2014 02:40 May 05, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2884.IH H2884 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •HR 2884 IH the Social Security Act, determined without regard to 1 clause (ii) thereof), if the sole compensation for such care 2 is a fixed periodic fee. 3 (b) REPORT.—Not later than 1 year after the date 4 of the enactment of this Act, the Secretary of Health and 5 Human Services shall submit to Congress a report con- 6 taining an analysis of the extent to which States are con- 7 tracting with independent physicians, independent physi- 8 cian practices, and primary care practices for purposes of 9 furnishing medical assistance under State plans (or waiv- 10 ers of such plans) under title XIX of the Social Security 11 Act (42 U.S.C. 1396 et seq.). 12 (c) RULE OF CONSTRUCTION.—Nothing in this sec- 13 tion shall be construed to alter statutory limits on Med- 14 icaid enrollee cost-sharing or be construed to limit Med- 15 icaid services solely to those provided under a direct pri- 16 mary care arrangement. 17 Æ VerDate Sep 11 2014 02:40 May 05, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6301 E:\BILLS\H2884.IH H2884 pbinns on DSKJLVW7X2PROD with $$_JOB