[Congressional Record Volume 170, Number 39 (Tuesday, March 5, 2024)]
[House]
[Pages H798-H800]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                 MEDICAID PRIMARY CARE IMPROVEMENT ACT

  Mr. GUTHRIE. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 3836) to facilitate direct primary care arrangements under 
Medicaid, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 3836

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Medicaid Primary Care 
     Improvement Act''.

     SEC. 2. CLARIFYING THAT CERTAIN PAYMENT ARRANGEMENTS ARE 
                   ALLOWABLE UNDER THE MEDICAID PROGRAM.

       (a) Rule of Construction.--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)(1)(A) 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. 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, if the sole compensation for such care is a 
     fixed periodic fee.
       (b) Guidance.--Not later than 1 year after the date of the 
     enactment of this Act, the Secretary of Health and Human 
     Services shall--

[[Page H799]]

       (1) convene at least one virtual open door meeting to seek 
     input from stakeholders, including primary care providers who 
     practice under the direct primary care model, state Medicaid 
     agencies, and Medicaid managed care organizations; and
       (2) taking into account such input, 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 2 years 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 requirements under the State 
     plan (or waiver of such plan) under title XIX of the Social 
     Security Act (42 U.S.C. 1396 et seq.) for cost-sharing 
     requirements or be construed to limit medical assistance 
     solely to those provided under a direct primary care 
     arrangement.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Kentucky (Mr. Guthrie) and the gentlewoman from Washington (Ms. 
Schrier) each will control 20 minutes.
  The Chair recognizes the gentleman from Kentucky.


                             General Leave

  Mr. GUTHRIE. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days in which to revise and extend their remarks 
and include extraneous material on the bill.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Kentucky?
  There was no objection.
  Mr. GUTHRIE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I am proud to support the work today of Congressman 
Crenshaw, a fierce advocate for primary care access for patients in 
this country.
  Primary care is the backbone of our healthcare system, and we know 
that investing now in connecting Americans to primary care will keep 
people healthier and save money along the way.
  The Medicaid Primary Care Improvement Act is a straightforward bill 
that will help clarify current law to ensure that States have the tools 
and flexibility needed to offer primary care services in a variety of 
manners and settings through the Medicaid program.
  One way to deliver primary care that shows promise is called direct 
primary care. Direct primary care clinics have been expanding around 
the country, and allow patients to pay a set amount per month for 
access to a primary care doctor to help address the basic need of 
healthcare.
  This legislation makes sure that the State could explore an option 
like this for Medicaid enrollees in their State. It is a simple yet 
effective bill, and I believe it will lead to better outcomes and save 
taxpayers dollars in the long run.
  Mr. Speaker, I urge all of my colleagues to join me in supporting 
this bill, and I reserve the balance of my time.
  Ms. SCHRIER. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in support of H.R. 3836, the Medicaid Primary 
Care Improvement Act, sponsored by Representative Crenshaw from Texas 
and myself.
  As a primary care physician and a Congresswoman, I am excited to see 
the Medicaid Primary Care Improvement Act come to the floor today.
  Allowing Medicaid to utilize the direct primary care model is a huge 
shift in the way that Medicaid patients and doctors interact for the 
better. Direct primary care is structurally different than traditional 
care models, because it is not designed around fee-for-service billing, 
but, rather, focused entirely on providing patients the best care 
possible.
  This is made possible by having Medicaid pay an affordable monthly 
fee that, in turn, allows doctors with a set number of patients the 
time and flexibility to provide the best possible care and the ability 
to schedule appointments that are the right length in order to provide 
all of the support those patients need for optimal health.
  Some appointments might take 90 minutes. Some might take 10. In the 
direct primary care model, doctors have a number of patients, or a 
patient panel, that they are responsible for caring for, and a smaller 
patient population means more time spent on things like education, 
preventative care measures, and being able to talk through and address 
critical topics like nutrition, exercise, stress, and social 
determinants of health that can't always be thoroughly addressed during 
a typical time-limited primary care appointment.
  In turn, this means better patient understanding of and involvement 
in their own healthcare, fewer visits to the emergency room, and 
ideally better outcomes. Other trials of direct primary care have shown 
exactly those outcomes.
  Dr. Garrison Bliss is a pioneer in this effort, starting up the first 
direct primary care practice in Washington State in 1997. His last year 
in practice was 2020, the year we were met with COVID. He had just 450 
patients with the average patient in their midsixties. Their age put 
them at an increased risk for COVID morbidity and mortality, and 
patients in this age group generally require more care or just a 
smaller-sized panel.
  Not a single one of his patients died from COVID during that first 
year, when we still didn't have vaccinations or treatments and we were 
still learning about the disease. He credits this to the fact that he 
could reach them, and they could reach him readily and have 
conversations about their care and talk with them about their COVID 
concerns.
  He could send out newsletters directly with pertinent information. If 
his patients had a question about whether or not to go to the emergency 
room, he was available to give advice by being there for his patients. 
Consulting with him prevented ER visits with no compromise in care.
  This model of care deserves to have more pilots around the country, 
hopefully with similar results, better outcomes, lower costs, tighter 
relationships between doctor and patient, and improved patient and 
physician satisfaction.
  If these benefits are consistently achieved, then all people, no 
matter their level of income or insurance, deserve the option of a 
direct primary care model, including Medicaid.
  I encourage all of my colleagues to vote ``yes'' on H.R. 3836.
  Mr. Speaker, I have no further speakers, and I reserve the balance of 
my time.
  Mr. GUTHRIE. Mr. Speaker, I yield 3 minutes to the gentleman from 
Texas (Mr. Crenshaw), a strong proponent of this bill, and one of the 
strongest proponents in Congress for primary care.
  Mr. CRENSHAW. Mr. Speaker, I rise today in support of my bill, the 
Medicaid Primary Care Improvement Act.
  I thank both the chair and the ranking member for their support. I 
also thank Representative Schrier for being such an excellent co-lead 
and advocate; and Representatives Smucker, Blumenauer, and Pettersen, 
who continue to also champion direct primary care.

  Mr. Speaker, a lot of attention gets paid to the Members who come 
down here and raise their voices and scream and yell about all the 
things they are really mad at because they want the public to know how 
mad they are. Every once in a while, we can raise our voices and wave 
our arms for some good things that we all work on together just to 
improve people's healthcare.
  This bill is just that. It is a first step for addressing one of the 
most important issues in healthcare, which is access. We can promise 
people health insurance, and we can add more money to it, but it 
doesn't necessarily translate into actual access to a provider.
  Direct primary care is one of the easiest and most direct ways to 
deliver primary care to patients. It is a payment model that makes 
sense to patients because it is simple. It is unlimited access to 
primary care providers by paying a monthly fee. It is a win-win for 
both patients and doctors because it simplifies and guarantees that 
relationship.
  It keeps patients out of costly emergency rooms. It saves money for 
the

[[Page H800]]

entire healthcare system. It encourages more efficient preventative 
medicine, as well. This means treating prediabetes before it becomes 
diabetes. This means treating heart issues before they become heart 
disease.
  The market has already created direct primary care, and it is a model 
that actually thrives in districts like mine, where we have doctors 
like my friend, Dr. Glenn Davis, whose direct primary care practice 
saves businesses lots of money on their premium payments and also 
delivers quality care to patients, but, as usual, the government has 
not caught up.
  This bill removes the uncertainty about whether Medicaid can pay for 
direct primary care access and empowers States with the necessary 
guidance to provide direct primary care for vulnerable patients who 
need it most.
  It is a game changer because many Medicaid patients aren't accessing 
primary care right now. They are more likely to show up at an ER than 
schedule regular visits with a primary care physician, and ER costs 
keep going up because too many people are not getting the preventative 
care that they need.
  Why? Well, because the truth is a lot of primary care doctors simply 
can't serve Medicaid patients due to low reimbursement rates. If we 
allow States to tailor their Medicare programs for direct primary care, 
which this bill does, we can fundamentally change this dynamic.
  Our legislation is straightforward, and it has zero cost. It 
clarifies that current laws don't prohibit direct primary care 
arrangements while offering guidance for States that want to use direct 
primary care in their Medicaid programs, just like my home State of 
Texas.
  Mr. Speaker, I genuinely hope that we can push this forward in a 
truly bipartisan way.
  Ms. SCHRIER. Mr. Speaker, I have no further speakers. I am prepared 
to close, and I reserve the balance of my time.
  Mr. GUTHRIE. Mr. Speaker, I yield 2 minutes to the gentleman from 
Pennsylvania (Mr. Smucker), a member of the Ways and Means Committee 
and a good friend of mine.
  Mr. SMUCKER. Mr. Speaker, I thank Mr. Guthrie for yielding.
  Mr. Speaker, I rise today in support of this bill, the Medicaid 
Primary Care Improvement Act, which I am proud to be an original 
cosponsor of.
  Now, we have heard of the many benefits of direct primary care. 
Certainly, I have seen that in my community, where we have many 
patients accessing their care through doctors providing direct primary 
care, which is receiving primary care services for a simple, flat 
monthly fee. We have seen that it keeps patients out of emergency 
rooms, improves health outcomes, and it yields savings. I also believe 
it will yield savings to the Medicaid program in this case.
  This bill clarifies that State Medicaid programs may include direct 
primary care arrangements and, as I said, will help vulnerable 
beneficiaries access low-cost and high-quality healthcare services.
  I think giving States that flexibility is a great step in the right 
direction as well. When State Medicaid programs innovate on behalf of 
their patients, especially with something like this--leveraging value-
based care delivery models like direct primary care--I think patients 
and taxpayers will be the winners.
  I would also mention a bill that I have introduced, the Primary Care 
Enhancement Act, which would allow patients or individuals with health 
savings accounts to access primary care and have that cost be included 
as a qualified expense in the HSA. This will be another way to expand 
access to primary care.
  Mr. Speaker, I thank Mr. Guthrie for yielding time, and I thank Mr. 
Crenshaw for his important work on this bill. I encourage my colleagues 
to vote ``yes.''
  Ms. SCHRIER. Mr. Speaker, whatever we can do to expand affordable 
care, improve healthcare, strengthen the doctor-patient relationship, 
and bring down costs is a win for our constituents. That is why I am 
excited to sponsor this bill, the Medicaid Primary Care Improvement 
Act, that allows the use of direct primary care.
  Mr. Speaker, I encourage my colleagues to vote for this bill, and I 
yield back the balance of my time.
  Mr. GUTHRIE. Mr. Speaker, I appreciate Dr. Schrier and all the work 
that she has done, all the work that the two gentlemen who spoke as 
primary sponsors have done on this bill. It is a good bill.
  Mr. Speaker, in closing, I urge my colleagues to support H.R. 3836, 
and I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Kentucky (Mr. Guthrie) that the House suspend the rules 
and pass the bill, H.R. 3836, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

                          ____________________