Section 1 Short title
This Act may be cited as the “Medicaid Primary Care Improvement Act”.
Medicaid Primary Care Improvement Act
A BILL
To facilitate direct primary care arrangements under Medicaid.
Sec. 2 Findings
Congress finds as follows:
Primary care services are able to reduce healthcare costs, emergency room visits, and hospitalizations.
Primary care creates increased patient satisfaction, physician engagement, and better patient outcomes.
The model of direct primary care can change patient usage patterns, with more personalized preventative care versus high-acuity episodic care.
Sec. 3 Clarifying that certain payment arrangements are allowable under the Medicaid program
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.
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 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.).
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.