Relating to a pilot program to allow the Medicaid program to act as a third-party payor under direct primary care agreements

This bill requires the department of human services (DHS) to submit any Medicaid state plan amendment or waiver request necessary to the centers for Medicare and Medicaid services of the United States department of health and human services for approval to implement a pilot program relating to direct primary care agreements as specified in the bill. The request shall authorize DHS to develop and oversee a pilot program beginning January 1, 2021, and ending December 31, 2026, to allow Medicaid members in specified categories to receive primary care health services through a direct primary care arrangement with Medicaid acting as the third-party payor for such services. The eligible Medicaid member categories shall include childless adults, children under seven years of age, children seven years of age through years of age, parents, pregnant women, the elderly, and individuals with disabilities. Direct primary care agreements are authorized under Code chapter 135N. Such agreements are agreements between a direct provider and a direct patient, or the direct patient’s representative, in which the direct provider agrees to provide primary care health services for a specified period of time to the direct patient for a direct service charge. Code chapter 135N authorizes a direct provider to accept payment of a direct service charge for a direct patient either directly or indirectly from a third party. Under the bill, the Medicaid program would act as the third-party payor.