State Legislation: PCMH and Advanced Primary Care

This page tracks state government activity and legislation that specifically supports PCMH and other innovative primary care delivery models by:

  • instituting uniform definitions and standards
  • authorizing new state programs
  • appropriating funds for new and existing programs 
  • mandating commercial payer participation in multi-payer programs

Several pieces of legislation included in the list below authorize, fund, or otherwise relate to PCMH or advanced primary care programs that PCPCC tracks on the Primary Care Innovations and PCMH Map. In such instances, we direct site visitors to the related program page on the Map under the description of the bill. If you are aware of any additional pieces of legislation that should be added to this page, please contact admin@pcpcc.org. 

Pending
State Type Année
Colorado HB19-1233 Investments In Primary Care To Reduce Health Costs

This bill establishes a primary care payment reform collaborative in the division of insurance in the department of regulatory agencies. It also requires the insurance commissioner to establish affordability standards for premiums, with added targets for carrier investments in primary care. Additionally, it requires the department of health care policy and financing and carriers who offer health benefit plans to state employees to set targets for investment in primary care.

 Legislation 2019 Pending
Hawaii HB 1444 Primary Care Payment Reform Collaborative

The purpose of this Act is to establish a task force known as the primary care payment reform collaborative to:

     (1)  Examine current levels of primary care spending in the State;

     (2)  Explore primary care spending mandates in other states;

     (3)  Examine alternative methods and models of enhancing primary care spending;

     (4)  Explore data collection issues related to understanding the State's primary care spending, including the capture of non-claims based primary care spending; and

     (5)  Generate recommendations to the legislature.

The collaborative shall develop annual recommendations to the legislature to strengthen the primary care system in the State.

 Legislation 2019 Pending
Massachusetts H. 1250

This broad health equity bill includes provisions requiring the Massachusetts Health Policy Commission to establish targets for primary care and behavioral health spending targets and provide analyses of progress toward those targets.

 Legislation 2023 Pending
Missouri HB 879: Primary Care Transparency Act

This bill establishes the Primary Care Transparency Act, which requires all health insurance carriers to report to the Director of the Department of Insurance, Financial Institutions and Professional Registration (DIFP) their total health care medical expenditures and their total primary care medical expenditures for the year by March 1st each year. By March 31st each year, the DIFP must submit a report to the General Assembly. All individual patient data reported under these provisions is confidential and must be reported in the aggregate.

 Legislation 2019 Pending
New York S. 1197

Establishes the primary care reform commission to review, examine, and make findings on the level of primary care spending by all payers in the context of all health care spending in the state and publish an annual report on the findings, and also make recommendations to increase and strengthen spending on primary care in the state and improve primary care infrastructure, taking care to avoid increasing costs to patients or the total cost of health care.

 Legislation 2023 Pending
New York S.B. 1127B

The bill proposes amendments to the NY State Insurance and Social Services Law, requiring plans and payors to annually report the percentage of overall healthcare spending allocated to primary care. Plans or payors reporting less than 12.5% on primary care services would need to submit plans to increase spending by 1% annually until meeting or exceeding the threshold to address underinvestment in primary care and improve overall health outcomes in New York.

 Legislation 2024 Pending
Oregon SB 765 A: Relating to Primary Care
Modifies definitions of "primary care" and "total medical expenditures" for purpose of reports on spending for primary care by insurance carriers, Public Employees' Benefit Board, Oregon Educators Benefit Board and coordinated care organizations. 
Requires all carriers, providing specified health insurance Public Employees' Benefit Board, Oregon Educators Benefit Board and coordinated care organizations to report on spending anticipated in upcoming year on primary care, and on use of alternative payment methodologies for reimbursing costs of primary care and on percentage of spending on primary care that uses alternative payment methodologies. Requires Department of Consumer and Business Services and Oregon Health Authority to prescribe by rule percentage of primary care expenditures that must be reimbursed using alternative payment methodologies.
 Legislation 2019 Pending
Pennsylvania SB 809

Establishes the Primary Care Investment Task Force which will take a detailed and objective look at where Pennsylvania stands when it comes to primary care investments compared to other states. Building off their findings, the task force will also identify what can be done to bolster investment in primary care.

 Legislation 2023 Pending
Expired
State Type Année
Arkansas Health Care Independence Act

The Health Care Independence Act requires Qualified Health Plans (QHPs) offered on the Arkansas exchange to participate in the Arkansas Payment Improvement Initiative, which includes assignment to a primary care clinician, support for PCMH and access of clinical performance data for providers.

 Legislation 2013 Expired
California Chapter 346, Session Laws of Colorado 2007

This law established that all enrollees in the California Bridge to Reform Demonstration must be assigned to a medical home. 

 Legislation 2010 Expired
California California - AB-2895 Primary Care Spending Transparency Act
This bill, the Primary Care Spending Transparency Act, would require a health care service plan or health insurer that reports rate information, as specified, to annually report the percentage of expenses the health care service plan or health insurer allocated to primary care, among other things.
 
The bill would require the Department of Managed Health Care and the Department of Insurance to annually compile and post a report with that information on their Internet Web sites, beginning January 1, 2020, and would require the departments to include their reports as discussion items at specified public meetings.
 
The bill would require the Department of Managed Health Care and the Department of Insurance to convene the Primary Care Payment Reform Collaborative no later than January 1, 2020, to propose revisions to the types of primary care data collected from health care service plans and health insurers, as well as to advise and assist in developing specified best practices. 
 Legislation 2018 Expired
Colorado Colorado - HB18-1365 Primary Care Infrastructure Creation

The bill establishes a primary care payment reform collaborative in the primary care office in the department of public health and environment. To facilitate the collaborative's work, the administrator of the all-payer health claims database is to report data on primary care spending by private health insurers, insurers providing state employee health benefit plans, and the department of health care policy and financing under the state medicaid program and the children's basic health plan.

 Legislation 2018 Expired
Delaware Delaware Senate Bill 199

This legislation ensures adequate spending in primary care. First, by setting Medicare rates as a baseline for primary care reimbursement. This is a short term fix to stem additional primary care failure and consolidation in Delaware. It also requires that over a period of years that the overall spend of plans into primary care increase gradually to reach the 12% investment mark, but without increasing the total spend so that premiums rise as a result of this reallocation. This legislation extends to individual, group, State employee, and public assistance plans.

 Legislation 2018 Expired
Idaho Idaho Statutes, Title 31, Chapter 35

The legislation provides medical home services to "medically indigent" populations and appropriate reimbursement to the medical home provider.

 Legislation 2009 Expired
Iowa Iowa Senate File 446

This legislation authorized health care delivery and payment system reforms including the expanded use of medical homes and ACOs. The law stipulates "Any integrated care model implemented on or after July 1, 2013, that delivers health care to medical assistance program recipients shall incorporate medical homes as its foundation."

 Legislation 2013 Expired
Nebraska Participation Agreement

This Participation Agreement is predicated on LB239 - Adopt the Nebraska All-Payer Patient-Centered Medical Home Act, proposed by Senator Wightman. The voluntary agreement provides an opportunity for insurance companies and providers to agree to support and promote the creation of PCMHs in Nebraska through the use of consistent requirements and measurements. Through their signing of this agreement, insurers in Nebraska must commit to incorporating a payment mechanism that recognizes value beyond fee-for-service payment. The agreement expires in January 2016. 

 2014 Expired
Washington Substitute Senate Bill 5891

This bill established several medical home reimbursement pilot projects including a multi-payer medical home demonstration project.

 Legislation 2009 Expired
Washington Substitute House Bill 2549

This bill authorized the creation of the state's first medical home learning collaborative for qualified primary care practices serving children and adults.

 Legislation 2008 Expired
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