H.R. 3836 — what changed
Medicaid Primary Care Improvement Act
From Introduced in House to Reported in House. 1 section amended and 1 removed between Introduced in House and Reported in House.
Sec. 2 Clarifying that certain payment arrangements are allowable under the medicaid program
added
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.
removed
Congress finds as follows:
changed
Guidance— Primary care services are able to reduce healthcare costs, emergency room visits, Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and hospitalizations.Human Services shall—
added
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
added
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.).
changed
Report— Primary care creates increased patient satisfaction, physician engagement, Not later than 2 years after the date of the enactment of this Act, the Secretary of Health and better patient outcomes.Human Services shall submit to Congress a report containing—
added
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
added
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).
changed
Rule of construction— The model 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 can change patient usage patterns, with more personalized preventative care versus high-acuity episodic care.arrangement.
Sec. 3 Clarifying that certain payment arrangements are allowable under the Medicaid program
removed
removed
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.
removed
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.).
removed
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—
removed
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
removed
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).
removed
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.