The Medicaid Primary Care Improvement Act allows states to reimburse primary care doctors through direct primary care arrangements, where patients pay doctors a fixed periodic fee in exchange for access to primary care services covered by Medicaid. The bill clarifies that this payment model is permitted under current Medicaid law and can be offered both directly by states and through Medicaid managed care organizations. The legislation affects Medicaid patients, primary care providers, state Medicaid agencies, and insurance organizations that manage Medicaid plans. Within one year of enactment, the Secretary of Health and Human Services must hold stakeholder meetings and issue guidance to states on implementing these arrangements, and within two years must report to Congress on how many states are using direct primary care contracts and what quality and cost outcomes result. The bill does not change existing Medicaid rules about cost-sharing or the scope of services that must be covered.
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