Medicaid Primary Care Improvement Act

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. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 03:02 Mar 07, 2024 Jkt 049200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3836.RFS H3836 kjohnson on DSK7ZCZBW3PROD with $$_JOB 2 HR 3836 RFS SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Medicaid Primary Care 2 Improvement Act’’. 3 SEC. 2. CLARIFYING THAT CERTAIN PAYMENT ARRANGE- 4 MENTS ARE ALLOWABLE UNDER THE MED- 5 ICAID PROGRAM. 6 (a) RULE OF CONSTRUCTION.—Nothing in title XIX 7 of the Social Security Act (42 U.S.C. 1396 et seq.) shall 8 be construed as prohibiting a State, under its State plan 9 (or waiver of such plan) under such title (including 10 through a medicaid managed care organization (as defined 11 in section 1903(m)(1)(A) of such Act)), from providing 12 medical assistance consisting of primary care services 13 through a direct primary care arrangement with a health 14 care provider, including as part of a value-based care ar- 15 rangement established by the State. For purposes of the 16 preceding sentence, the term ‘‘direct primary care ar- 17 rangement’’ means, with respect to any individual, an ar- 18 rangement under which such individual is provided med- 19 ical assistance consisting solely of primary care services 20 provided by primary care practitioners, if the sole com- 21 pensation for such care is a fixed periodic fee. 22 (b) GUIDANCE.—Not later than 1 year after the date 23 of the enactment of this Act, the Secretary of Health and 24 Human Services shall— 25 VerDate Sep 11 2014 03:02 Mar 07, 2024 Jkt 049200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3836.RFS H3836 kjohnson on DSK7ZCZBW3PROD with $$_JOB 3 HR 3836 RFS (1) convene at least one virtual open door meet- 1 ing to seek input from stakeholders, including pri- 2 mary care providers who practice under the direct 3 primary care model, state Medicaid agencies, and 4 Medicaid managed care organizations; and 5 (2) taking into account such input, issue guid- 6 ance to States on how a State may implement direct 7 primary care arrangements (as defined in subsection 8 (a)) under title XIX of the Social Security Act (42 9 U.S.C. 1396 et seq.). 10 (c) REPORT.—Not later than 2 years after the date 11 of the enactment of this Act, the Secretary of Health and 12 Human Services shall submit to Congress a report con- 13 taining— 14 (1) an analysis of the extent to which States 15 are contracting with independent physicians, inde- 16 pendent physician practices, and primary care prac- 17 tices for purposes of furnishing medical assistance 18 under State plans (or waivers of such plans) under 19 title XIX of the Social Security Act (42 U.S.C. 1396 20 et seq.); and 21 (2) an analysis of quality of care and cost of 22 care furnished to individuals enrolled under such 23 title where such care is paid for under a direct pri- 24 mary care arrangement (as defined in subsection 25 VerDate Sep 11 2014 03:02 Mar 07, 2024 Jkt 049200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3836.RFS H3836 kjohnson on DSK7ZCZBW3PROD with $$_JOB 4 HR 3836 RFS (a)) through a medicaid managed care organization 1 (as so defined). 2 (d) RULE OF CONSTRUCTION.—Nothing in this sec- 3 tion shall be construed to alter statutory requirements 4 under the State plan (or waiver of such plan) under title 5 XIX of the Social Security Act (42 U.S.C. 1396 et seq.) 6 for cost-sharing requirements or be construed to limit 7 medical assistance solely to those provided under a direct 8 primary care arrangement. 9 Passed the House of Representatives March 5, 2024. Attest: KEVIN F. MCCUMBER, Clerk. VerDate Sep 11 2014 03:02 Mar 07, 2024 Jkt 049200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3836.RFS H3836 kjohnson on DSK7ZCZBW3PROD with $$_JOB