[House Report 118-170]
[From the U.S. Government Publishing Office]
118th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 118-170
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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.
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\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
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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.