#aah? ,,congress  #b;d ,session  ,h4 ,r4
 #chcf  ,,an ,,act  ,to facilitate      
direct prim>y c>e arrangem5ts "u        
,m$icaid4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,m$icaid ,prim>y ,c>e      
,improvem5t ,act4  #b4 ,cl>ify+ t c]ta9 
paym5t arrangem5ts are all[able "u !    
m$icaid program  7a7 ,rule ( con/ruction
 ,no?+ 9 title ,,xix ( ! ,social        
,security ,act 7#db ,u4,s4,c4 #acif et  
seq47 %all be con/ru$ z prohibit+ a     
,/ate1 "u its ,/ate plan 7or waiv] ( su*
 plan7 "u su* title 7includ+ ?r\gh a    
m$icaid manag$ c>e organization 7z def9$
 9 section #aijc7m77#a77;,a7 ( su*      
,act771 f provid+ m$ical assi/ance      
consi/+ ( prim>y c>e s]vices ?r\gh a    
direct prim>y c>e arrangem5t ) a heal?  
c>e provid]1 includ+ z "p ( a value-bas$
 c>e arrangem5t e/abli%$ by ! ,/ate4 ,= 
purposes ( ! prec$+ s5t5ce1 ! t]m direct
 prim>y c>e arrangem5t means1 ) respect 
to any individual1 an arrangem5t "u :i* 
su* individual is provid$ m$ical        
assi/ance consi/+ solely ( prim>y c>e   

s]vices provid$ by prim>y c>e           
practition]s1 if ! sole comp5sation =   
su* c>e is a fix$ p]iodic fee4  7b7     
,guidance ,n lat] ?an #a ye> aft] ! date
 ( ! enactm5t ( ?is ,act1 ! ,secret>y ( 
,heal? & ,human ,s]vices %all-- 7#a7    
conv5e at lea/ "o virtual op5 door meet+
 to seek input f /akehold]s1 includ+    
prim>y c>e provid]s :o practice "u !    
direct prim>y c>e model1 /ate ,m$icaid  
ag5cies1 & ,m$icaid manag$ c>e          
organizations2 &  7#b7 tak+ into acc\nt 
su* input1 issue guidance to ,/ates on  
h[ a ,/ate may implem5t direct prim>y   
c>e arrangem5ts 7z def9$ 9 subsection   
7a77 "u title ,,xix ( ! ,social         
,security ,act 7#db ,u4,s4,c4 #acif et  
seq474  7c7 ,report ,n lat] ?an #b ye>s 
aft] ! date ( ! enactm5t ( ?is ,act1 !  
,secret>y ( ,heal? & ,human ,s]vices    
%all submit to ,congress a report       
conta9+--  7#a7 an analysis ( ! ext5t to
 :i* ,/ates are contract+ ) indep5d5t   
physicians1 indep5d5t physician         
practices1 & prim>y c>e practices =     

purposes ( furni%+ m$ical assi/ance "u  
,/ate plans 7or waiv]s ( su* plans7 "u  
title ,,xix ( ! ,social ,security ,act  
7#db ,u4,s4,c4 #acif et seq472 &  7#b7  
an analysis ( quality ( c>e & co/ ( c>e 
furni%$ to individuals enroll$ "u su*   
title :]e su* c>e is paid = "u a direct 
prim>y c>e arrangem5t 7z def9$ 9        
subsection 7a77 ?r\gh a m$icaid manag$  
c>e organization 7z s def9$74  7d7 ,rule
 ( con/ruction ,no?+ 9 ?is section %all 
be con/ru$ to alt] /atutory requirem5ts 
"u ! ,/ate plan 7or waiv] ( su* plan7 "u
 title ,,xix ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #acif et seq47 = co/-%>+ 
requirem5ts or be con/ru$ to limit      
m$ical assi/ance solely to ^? provid$ "u
 a direct prim>y c>e arrangem5t4  ,pass$
 ! ,h\se ( ,repres5tatives ,m>* #e1     
#bjbd4;,cl]k4