I
119THCONGRESS
1
STSESSION H. R. 1162
To facilitate direct primary care arrangements under Medicaid.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY10, 2025
Mr. C
RENSHAW (for himself, Ms. SCHRIER, Mr. SMUCKER, and Ms.
P
ETTERSEN) introduced the following bill; which was referred to the
Committee 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. CLARIFYING THAT CERTAIN PAYMENT ARRANGE-6
MENTS ARE ALLOWABLE UNDER THE MED-7
ICAID PROGRAM. 8
(a) R
ULE OFCONSTRUCTION.—Nothing in title XIX 9
of the Social Security Act (42 U.S.C. 1396 et seq.) shall 10
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be construed as prohibiting a State, under its State plan 1
(or waiver of such plan) under such title (including 2
through a medicaid managed care organization (as defined 3
in section 1903(m)(1)(A) of such Act)), from providing 4
medical assistance consisting of primary care services 5
through a direct primary care arrangement with a health 6
care provider, including as part of a value-based care ar-7
rangement established by the State. For purposes of the 8
preceding sentence, the term ‘‘direct primary care ar-9
rangement’’ means, with respect to any individual, an ar-10
rangement under which such individual is provided med-11
ical assistance consisting solely of primary care services 12
provided by primary care practitioners, if the sole com-13
pensation for such care is a fixed periodic fee. 14
(b) G
UIDANCE.—Not later than 1 year after the date 15
of the enactment of this Act, the Secretary of Health and 16
Human Services shall— 17
(1) convene at least one virtual open door meet-18
ing to seek input from stakeholders, including pri-19
mary care providers who practice under the direct 20
primary care model, state Medicaid agencies, and 21
Medicaid managed care organizations; and 22
(2) taking into account such input, issue guid-23
ance to States on how a State may implement direct 24
primary care arrangements (as defined in subsection 25
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(a)) under title XIX of the Social Security Act (42 1
U.S.C. 1396 et seq.). 2
(c) R
EPORT.—Not later than 2 years after the date 3
of the enactment of this Act, the Secretary of Health and 4
Human Services shall submit to Congress a report con-5
taining— 6
(1) an analysis of the extent to which States 7
are contracting with independent physicians, inde-8
pendent physician practices, and primary care prac-9
tices for purposes of furnishing medical assistance 10
under State plans (or waivers of such plans) under 11
title XIX of the Social Security Act (42 U.S.C. 1396 12
et seq.); and 13
(2) an analysis of quality of care and cost of 14
care furnished to individuals enrolled under such 15
title where such care is paid for under a direct pri-16
mary care arrangement (as defined in subsection 17
(a)) through a medicaid managed care organization 18
(as so defined). 19
(d) R
ULE OFCONSTRUCTION.—Nothing in this sec-20
tion shall be construed to alter statutory requirements 21
under the State plan (or waiver of such plan) under title 22
XIX of the Social Security Act (42 U.S.C. 1396 et seq.) 23
for cost-sharing requirements or be construed to limit 24
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medical assistance solely to those provided under a direct 1
primary care arrangement. 2
Æ
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