[House Report 118-170]
[From the U.S. Government Publishing Office]


118th Congress  }                                               {  Report
                        HOUSE OF REPRESENTATIVES
 1st Session    }                                               { 118-170

======================================================================



 
                 MEDICAID PRIMARY CARE IMPROVEMENT ACT

                                _______
                                

 September 1, 2023.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

Mrs. Rodgers of Washington, from the Committee on Energy and Commerce, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 3836]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 3836) to facilitate direct primary care 
arrangements under Medicaid, having considered the same, 
reports favorably thereon with an amendment and recommends that 
the bill as amended do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     2
Committee Action.................................................     3
Committee Votes..................................................     3
Oversight Findings and Recommendations...........................     5
New Budget Authority, Entitlement Authority, and Tax Expenditures     5
Congressional Budget Office Estimate.............................     5
Federal Mandates Statement.......................................     5
Statement of General Performance Goals and Objectives............     5
Duplication of Federal Programs..................................     5
Related Committee and Subcommittee Hearings......................     5
Committee Cost Estimate..........................................     6
Earmark, Limited Tax Benefits, and Limited Tariff Benefits.......     6
Advisory Committee Statement.....................................     6
Applicability to Legislative Branch..............................     6
Section-by-Section Analysis of the Legislation...................     6
Changes in Existing Law Made by the Bill, as Reported............     6

    The amendment is as follows:
    Strike all after the enacting clause and insert the 
following:

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--
          (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.

                          PURPOSE AND SUMMARY

    The bill would enact a rule of construction clarifying 
permissibility of direct primary care arrangements under 
Medicaid and direct the Secretary of Health and Human Services 
to convene at least one virtual open door meeting to seek input 
from stakeholders and to issue guidance to States on how a 
State may implement such arrangements.

                  BACKGROUND AND NEED FOR LEGISLATION

    According to the Association of American Medical Colleges, 
the United States is expected to have a primary care physician 
shortage ranging from 17,800 to as many as 77,100 by 2034.\1\ 
As the country grapples with the implications of such a 
shortage on access to care, it has become imperative to 
identify new avenues for the delivery of primary care to ensure 
that those in need can receive vital services.
---------------------------------------------------------------------------
    \1\Association of American Medical Colleges, The Complexities of 
Physician Supply and Demand: Projections from 2019 to 2034, 2021. 
https://www.aamc.org/media/54681/download?attachment
---------------------------------------------------------------------------
    A growing option for the delivery of primary care is 
``direct primary care,'' a delivery model where a provider 
receives a monthly lump sum amount to manage a patient's 
primary care. Every patient's needs are unique, and for some, 
direct primary care has proven to be helpful in managing needs 
and improving outcomes.
    Under current law, Medicaid is permitted to enter into 
different payment arrangements, including for direct primary 
care. However, while States have had similar arrangements in 
the past, no States currently take advantage of such 
opportunities. As such, the Medicaid Primary Care Improvement 
Act would clarify current law and increase awareness to State 
Medicaid programs about the opportunities to utilize direct 
primary care arrangements for Medicaid beneficiaries.

                            COMMITTEE ACTION

    On June 14, 2023, the Subcommittee on Health held a hearing 
on H.R. 3836. The hearing was titled ``Examining Proposals that 
Provide Access to Care for Patients and Support Research for 
Rare Diseases.'' The Subcommittee received testimony from:
           Dr. Elizabeth Cherot, MD, MBA, Senior Vice 
        President and Chief Medical Health Officer, March of 
        Dimes;
           Dr. Alexis A. Thompson, MD, MPH, Chief of 
        Division of Hematology, Elias Schwartz MD Endowed Chair 
        in Hematology, Children's Hospital of Philadelphia, 
        Professor of Pediatrics, University of Pennsylvania 
        Perelman School of Medicine;
           Dr. Meredithe McNamara, MD, MS, FAAP, 
        Assistant Professor, Yale School of Medicine;
           Dr. Miriam Grossman, MD, Child, Adolescent, 
        and Adult Psychiatrist
           Mr. George Manahan, Parkinson's Advocate and 
        Patient; and,
           Mr. Kevin O'Connor, Assistant to the General 
        President for Government Affairs and Political Action, 
        International Association of Fire Fighters.
    On July 13, 2023, the Subcommittee on Health met in open 
markup session and forwarded H.R. 3836, as amended, to the full 
Committee by a recorded vote of 28 yeas and 0 nays.
    On July 19, 2023, the full Committee on Energy and Commerce 
met in open markup session and ordered H.R. 3836, as amended, 
favorably reported to the House by a recorded vote of 51 yeas 
and 0 nays.

                            COMMITTEE VOTES

    The following reflects the record votes taken during the 
Committee consideration:


                 OVERSIGHT FINDINGS AND RECOMMENDATIONS

    Pursuant to clause 2(b)(1) of rule X and clause 3(c)(1) of 
rule XIII, the Committee held a hearing and made findings that 
are reflected in this report.

   NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX EXPENDITURES

    Pursuant to clause 3(c)(2) of rule XIII, the Committee 
finds that H.R. 3836 would result in no new or increased budget 
authority, entitlement authority, or tax expenditures or 
revenues.

                  CONGRESSIONAL BUDGET OFFICE ESTIMATE

    Pursuant to clause 3(c)(3) of rule XIII, at the time this 
report was filed, the cost estimate prepared by the Director of 
the Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974 was not available.

                       FEDERAL MANDATES STATEMENT

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

         STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

    Pursuant to clause 3(c)(4) of rule XIII, the general 
performance goal or objective of this legislation is to clarify 
that current law does not prohibit direct primary care 
arrangements within the Medicaid program, and to provide 
guidance for States that wish to incorporate direct primary 
care into their unique Medicaid system.

                    DUPLICATION OF FEDERAL PROGRAMS

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 3836 is known to be duplicative of another Federal 
program, including any program that was included in a report to 
Congress pursuant to section 21 of Public Law 111-139 or the 
most recent Catalog of Federal Domestic Assistance.

              RELATED COMMITTEE AND SUBCOMMITTEE HEARINGS

    Pursuant to clause 3(c)(6) of rule XIII, the following 
related hearing was used to develop or consider H.R. 3836:
           On June 14, 2023, the Subcommittee on Health 
        held a hearing titled ``Examining Proposals that 
        Provide Access to Care for Patients and Support 
        Research for Rare Diseases.'' The Subcommittee received 
        testimony from:
                   Dr. Elizabeth Cherot, MD, MBA, 
                Senior Vice President and Chief Medical Health 
                Officer, March of Dimes;
                   Dr. Alexis A. Thompson, MD, MPH, 
                Chief of Division of Hematology, Elias Schwartz 
                MD Endowed Chair in Hematology, Children's 
                Hospital of Philadelphia, Professor of 
                Pediatrics, University of Pennsylvania Perelman 
                School of Medicine;
                   Dr. Meredithe McNamara, MD, MS, 
                FAAP, Assistant Professor, Yale School of 
                Medicine;
                   Dr. Miriam Grossman, MD, Child, 
                Adolescent, and Adult Psychiatrist;
                   Mr. George Manahan, Parkinson's 
                Advocate and Patient; and,
                   Mr. Kevin O'Connor, Assistant to 
                the General President for Government Affairs 
                and Political Action, International Association 
                of Fire Fighters.

                        COMMITTEE COST ESTIMATE

    Pursuant to clause 3(d)(1) of rule XIII, the Committee 
adopts as its own the cost estimate prepared by the Director of 
the Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974. At the time this report was 
filed, the estimate was not available.

       EARMARK, LIMITED TAX BENEFITS, AND LIMITED TARIFF BENEFITS

    Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the 
Committee finds that H.R. 3836 contains no earmarks, limited 
tax benefits, or limited tariff benefits.

                      ADVISORY COMMITTEE STATEMENT

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

                  APPLICABILITY TO LEGISLATIVE BRANCH

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

             SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title

    Section provides that this Act may be cited as the 
``Medicaid Primary Care Improvement Act''.

Section 2. Clarifying that certain payment arrangements are allowable 
        under the Medicaid program

    Subsection (a) provides a Rule of Construction to clarify 
that current law permits Medicaid to reimburse for direct 
primary care arrangements.
    Subsection (b) directs the Department of Health and Human 
Services (HHS) to issue guidance to States on ways to implement 
direct primary care arrangements in Medicaid. Such guidance 
shall be based on input from stakeholders.
    Subsection (c) requires HHS to write a report to Congress, 
reviewing the utilization of direct primary care arrangements 
in Medicaid.
    Subsection (d) provides a Rule of Construction.

         CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

    This legislation does not amend any existing Federal 
statute.