H.R. 3836 — Introduced in House

I 118th CONGRESS 1st Session H. R. 3836 IN THE HOUSE OF REPRESENTATIVES June 6, 2023Mr. Crenshaw (for himself, Ms. Schrier, Mr. Smucker, and Mr. Blumenauer) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To facilitate direct primary care arrangements under Medicaid. 1. Short title This Act may be cited as the Medicaid Primary Care Improvement Act. 2. Findings Congress finds as follows: (1) Primary care services are able to reduce healthcare costs, emergency room visits, and hospitalizations. (2) Primary care creates increased patient satisfaction, physician engagement, and better patient outcomes. (3) The model of direct primary care can change patient usage patterns, with more personalized preventative care versus high-acuity episodic care. 3. Clarifying that certain payment arrangements are allowable under the Medicaid program (a) 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. (b) 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.). (c) 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— (1) 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 (2) 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). (d) 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.