H.R. 1162 — Medicaid Primary Care Improvement Act

This section provides the short title of the Act as the “Medicaid Primary Care Improvement Act.”

This section clarifies that title XIX of the Social Security Act, including Medicaid managed care under section 1903(m)(1)(A), does not prohibit a state from furnishing Medicaid medical assistance for primary care services through a direct primary care arrangement with a health care provider, including as part of a state-established value-based care arrangement. It defines a “direct primary care arrangement” as an arrangement under which an individual receives only primary care services from primary care practitioners and the sole compensation is a fixed periodic fee. This section directs the Secretary of Health and Human Services, not later than 1 year after enactment, to convene at least one virtual open door meeting with stakeholders, including primary care providers using the direct primary care model, state Medicaid agencies, and Medicaid managed care organizations, and then issue guidance to states on implementing direct primary care arrangements under Medicaid. This section also requires the Secretary, not later than 2 years after enactment, to submit a report to Congress analyzing (1) the extent to which states contract with independent physicians, independent physician practices, and primary care practices to furnish Medicaid medical assistance under state plans or waivers, and (2) the quality and cost of care for Medicaid enrollees whose care is paid for through a direct primary care arrangement via a Medicaid managed care organization. This section further clarifies that it does not alter Medicaid cost-sharing requirements or limit medical assistance solely to services provided under a direct primary care arrangement.