Medicaid Primary Care Improvement Act
Sponsored By: Senator Marsha Blackburn
Introduced
Summary
Allows direct primary care arrangements in Medicaid. This bill would clarify that states may provide primary care services in Medicaid through direct primary care arrangements where primary care practitioners are paid a fixed periodic fee. It would require the HHS Secretary to hold at least one virtual open-door meeting within 1 year to gather stakeholder input and issue guidance. It would also require a report to Congress within 2 years analyzing how states use these arrangements and the quality and cost of care when paid through Medicaid managed care organizations.
Show full summary
- States: Would let state Medicaid agencies use direct primary care arrangements in their state plans, waivers, or through Medicaid managed care organizations.
- Primary care providers: Could enable independent physicians and small primary care practices to contract with Medicaid for primary care paid by a fixed periodic fee and participate in value-based arrangements.
- Medicaid managed care organizations: Would be able to pay for primary care through fixed-fee direct primary care contracts and face a required federal analysis of cost and quality when they do so.
- Medicaid enrollees and families: Preserves existing statutory rules on cost-sharing and the amount, duration, and scope of Medicaid services so covered protections remain in place.
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Bill Overview
Analyzed Economic Effects
1 provisions identified: 1 benefits, 0 costs, 0 mixed.
Allow direct primary care in Medicaid
If enacted, States could provide primary care under Medicaid through direct primary care arrangements. A direct primary care arrangement would give only primary care from primary care practitioners and be paid by a fixed periodic fee. States or Medicaid managed care organizations could use these arrangements, including as part of value-based care. The HHS Secretary would hold at least one virtual stakeholder meeting and issue guidance within 1 year. The Secretary would also report to Congress within 2 years on state use, costs, and quality. The bill would not let these arrangements change existing State plan rules on cost-sharing or the amount, duration, and scope of required Medicaid benefits.
Sponsors & CoSponsors
Sponsor
Marsha Blackburn
TN • R
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
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