State Primary Care Investment Initiatives

Requires the Office of Value-Based Health Care Delivery to establish mandatory minimums for payment innovations, including alternative payment models, and evaluate annually whether primary care spending is increasing in compliance with the established mandatory minimums for payment innovations.

Enacted

This 2022 California Health and Human Services Budget bill established the California Office of Health Care Affordability, required ongoing reporting, and established a process to set targets for primary care spend in the state.

Enacted

Tasks Insurance Commissioner with 1) forming a collaborative (the Colorado Primary Care Payment Reform Collaborative) to advise on increasing primary care spend 2) issue rules to set affordability standards, including PC spend targets

Enacted

Establishes an Office of Health Care Strategy Office to develop an annual health care cost growth benchmark and primary care spending target. Develops and adopts health care quality benchmarks. Develops strategies, in consultation with stakeholders, to meet such benchmarks and targets developed. Enhances the transparency of provider entities. Monitors the development of accountable care organizations and  patient-centered medical homes in the state. Monitors the adoption of alternative payment methodologies in the state. Legislation enacted as a provision of 2022 state budget legislation.

Enacted

Monitoring healthcare spending growth, setting initial annual benchmarks for primary care investments. Progressively increase primary care spending goals to reach a target of 10% by 2025

Enacted

This Act expands the membership of the Primary Care Reform Collaborative and creates an Office of Value-Based Health Care Delivery in the Department of Insurance to reduce health care costs by increasing the availability of high quality, cost-efficient health insurance products that have stable, predictable, and affordable rates. The Office of Value-Based Health Care Delivery will work with the Primary Care Reform Collaborative and the State benchmarking process.

 

Enacted

Hawaii requires Medicaid Managed Care Organizations to report on and increase the percentage of medical expenditures devoted to primary care.

Enacted

Defines primary care and details how primary care spending report will transpire in Maine moving forward. 

Enacted

Sets targets for investment in primary and behavioral healthcare. 

Enacted

Requiring the Maryland Health Care Commission to provide a report, beginning December 1, 2024, and each year thereafter, to the Governor and the General Assembly containing an analysis of primary care investment, ways to improve the quality of and access to primary care services, and any findings and recommendations; requiring the Commission to establish a workgroup to develop the report to include an interpretation of the results of the required analysis and to make recommendations; etc.

Enacted

Establishes a Center for Health Information and Analysis (CHIA) charged with a range of duties, incuding analyzing health costs and utilization in the Massachusetts. On September 20, 2022, CHIA subsequently released the first report on primary care and behavioral health spending in Massachusetts.

Enacted

This omnibus appropriations legislation would require a report on primary care spending and establish a Health Care Affordability Board that may consider establishing quality and primary care spending standards.

Enacted

This legislation establishes a Primary Care Investment Council, charged with measuring primary care spending in Nebraska recommend an appropriate level of primary care investment across public and private payers, and recommend steps to attain that target. The Council is futher instructed to issue a report to the Governor and Legislative Council on an annual basis, starting in 2023 and continuing through 2028.

Enacted

This legislation included a provision requiring an annual report on trends and drivers in spending in the health insurance market.  Subsequent reports have included information on primary care spend as a portion of overall spend.

Enacted

Provisions of the 2021-2022 state appropriations legislation establish a requirement that Medicaid Managed Care Organizations report the percentage of total medical expenditures devoted to primary care.  Requires the State Department of Pension and Benefits to report on primary care spending for state-run health plans, such as the state employees' plan.

Enacted

The bill establishes the New Mexico Health Care Authority in July 2024. Also amends the Primary Care Council's duties to:
- Analyze the proportion of health care delivery expenditures allocated to primary care statewide annually.
- Develop a five-year plan to determine how primary care investment could increase access to primary care and improve the quality of primary care services while also lowering the costs of primary care delivery.
- Review national and state models of optimal primary care investment to increase access to and improve the quality of primary care services. 

 

Enacted

Establishes a primary care council, charged with analyzing primary care spend as a proportion of health care spending yearly, making recommendations for policy to recommend policies, regulations and legislation to increase access to primary care, improving the quality of primary care services and lowering the cost of primary care delivery while reducing overall health care costs;  Council must present a 5 year plan to the Secretary

Enacted

Charges the North Carolina Primary Care Payment Reform Task Force with developing a definition of primary care that is applicable to the NC Medicaid program and commercial insurance, measuring how much insurance plans spend on primary care, determining the quality of the primary care delivery system in North Carolina, studying the primary care payment landscape in states that implement a minimum primary care spend, and collecting data to inform a primary care investment target for insurance plans.

Enacted

SB 563 affirmed requirements for reporting of the percentage of health care expenses by each contracted entity on primary care services and that no later than the fourth year of a contract with the Medicaid program must devote at least 11% to primary care.

Enacted

Requires Oklahoma state Medicaid managed care entitities to report on the percent of medical expenditures devoted to primary care.  Requires managed care entities to increase primary care expenditures to a minimum of 11% of medical expenditures within four years.

Enacted

Requires most large health plans, Public Employees' Benefit Board and the Oregon Educators Benefit Board to report on the percentage of total medical expenditures devoted to primary care.

Enacted

Requires coordinated care organization, Public Employees' Benefit Board and Oregon Educators Benefit Board to spend at least 12 percent of total medical expenditures on primary care by January 1, 2023. Requires Department of Consumer and Business Services to establish requirements for carrier to submit plan for increasing spending on primary care as percentage of total medical expenditures if carrier is spending less than 12 percent of total medical expenditures. Extends sunset on Primary Care Transformation Initiative.

Enacted

Authorizes Insurance Commissioner to set minimum PC spending target for state-regulated insurers; engage in practice transformation activities, as part of promoting Affordability Standards

Enacted

Requires the Health Data Committee to annually issue a report on primary care spending within the state of Utah. 

Enacted

This legislation directed.the Green Mountain Care Board and Department of Vermont Health Access to identify which health care providers and services constitute primary care, determine the percentage of health care spending currently allocated to primary care by certain public and private payers and by Vermont’s health care system overall, and report the percentages and related information to the General Assembly.

Enacted

Was enacted

Enacted

This bill required the state Department of Health and Human Resources to contract with the Virginia Center for Health Innovation for actions necessary to facilitate and continue the work of the Virginia Task Force on Primary Care. The purpose of the task force is to enhance the financing, quality and delivery of primary care in the Commonwealth.

Enacted

$110,000 of the general fund—state appropriation for fiscal  year 2020 is provided solely for the office of financial management to determine annual primary care medical expenditures in Washington, by insurance carrier, in total and as a percentage of total medical expenditure. Where feasible, this determination must also be broken  down by relevant characteristics such as whether expenditures were B4 for in-patient or out-patient care, physical or mental health, by type of provider, and by payment mechanism

Enacted

Charges the state’s Health Care Cost Transparency Board with measuring and reporting on primary care expenditures and progress toward increasing spending to 12% of total healthcare expenditures.

Enacted

Establishes a Primary Care Support Program within the Department of Health and Human Resources, that would, among other duties, conduct and make available upon request an annual primary care report which shall consist of total West Virginia Medicaid primary care expenditures as a percentage of total West Virginia Medicaid expenditures.

Enacted as part of another bill

Establishes the Office of Health Care Affordability (office) within the Office of Statewide Health Planning and Development (OSHPD). The office shall measure and promote a sustained systemwide investment in primary care and behavioral health. In furtherance of this goal, the office shall measure the percentage of total healthcare expenditures allocated to primary care and behavioral health and set spending benchmarks. Spending benchmarks for primary care shall consider current and historic underfunding of primary care services.. Establishes, within the office, the Health Care Affordability Advisory Board (board) and sets forth the composition and duties of the board, as defined, which includes "Measure and promote sustained systemwide investment in primary care and behavioral health". The office will also begin tracking the percentage of healthcare expenditures allocated to primary and behavioral healthcare. It will also help clarify and define what professionals are considered primary care. A version of this legislation was enacted as part of the 2022 budget.

Enacted as part of another bill

Amends states all-payer claims database statute to require submission of value-based, non-claims-based payments to providers. State analysis of the data must permit calculation and reporting of the amount of those non-claims-based payments relative to overall health care payments, as well as the percentage of those payments that go to primary care.

Elements of this bill were enacted as part of SF2995

Enacted as part of another bill

This omnibus appropriations legislation would require the Commissioner of Health to provide a one-time report on primary care spending and establish a Health Care Affordability Commission with broader responsibility to establish broader health spending and outcome targets for the state.

Elements of this bill were incorporated in the final budget bill,SF 2995.

Enacted as part of another bill

S 595 would establish a Primary Care Payment Reform Task Force charged with defining primary care, reporting on current primary care spend, and identify data systems to inform establishment of a primary care investment target for the state.  A version of this bill was enacted as part of S. 259, the 2023 Appropriations Bill.

Introduced/Under Consideration

S. 750 would establish a multistakeholder Primary Care Board with a goal of increasing primary care spend to 12-15% of overall health care expenditures. The bill would also require all insurers in the state to offer a prospective, per member per month Primary Care 4 You payment to all primary care practices.  The payment would be adjusted for clinical and social risk and practice capacity. Monthly prospective payments would be paid from a Primary Care Trust, rather than individual plans.

Passed Both Chambers

The bill modifies and repeals reporting provisions related to the Department of Health and Human Services. Specifically, it repeals the requirement to publish annually a report on primary care spending within Utah.

Passed Chamber of Origin

Primary care spending would be subject to measurement, analysis and annual reporting under this broader legislation establishing health care spending growth benchmarks for the state.

Pending

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.

Pending

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.

Pending

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.

Pending

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.

Vetoed

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.

Was Not Enacted

This Act expands the membership of the Primary Care Reform Collaborative and creates an Office of Value-Based Health Care Delivery in the Department of Insurance to reduce health care costs by increasing the availability of high quality, cost-efficient health insurance products that have stable, predictable, and affordable rates. The Office of Value-Based Health Care Delivery will work with the Primary Care Reform Collaborative and the State benchmarking process.

Was Not Enacted

Providers and insurers, including MassHealth, will be required to increase spending on behavioral health and primary care by 30% over three years.

Calendar year 2019 spending will serve as the baseline; provider and insurer performance against the target will be based on expenditures through calendar year 2024. The legislation does not prescribe how providers and insurers must achieve the target, instead leaving decision-making to the discretion of the individual provider and insurer organization. Providers and insurers will be required to report their progress on an annual basis through existing processes overseen by the Center for Health Information Analysis (CHIA) and the Health Policy Commission (HPC).

Was Not Enacted

For the 3-year period ending with calendar year 2024, the aggregate primary care expenditure target for each of the 3 years shall be equal to a 30 per cent increase above aggregate primary care baseline expenditures, and the primary care expenditure target for each of the 3 years shall be equal to a 30 per cent increase above primary care baseline expenditures.

Was Not Enacted

To provide the legislature with information needed to meet the evolving health care needs of Minnesotans, the commissioner shall report to the legislature by February 15, 2023, on the volume and distribution of health care spending across payment models used by health plan companies and third-party administrators, with a particular focus on value-based care models and primary care spending.

Was Not Enacted

establishing the Health Care Affordability Board and Health Care Affordability Advisory Council; requiring monitoring of and recommendations related to health care market trends; establishing the health care spending growth target program; requiring reports; providing for civil penalties; requiring certain transfers of funds;

Was Not Enacted

A bill for an act relating to health; modifying data collected under the all-payer claims database and uses of this data; requiring the commissioner of health to study and report on systems used by health plan companies and third-party administrators to pay health care providers; 

Was Not Enacted

Requires the state's Medicaid Coordinated Care Organizations (CCOs), state-run educators' and public employees' plans and state-regulated health insurance carriers to annually report the percentage of total medical expenditures planned to be spent on primary care, the percentage of spending on primary care that will be made using APMs, and the types of APMs used. Requires CCOs, no later than January 1, 2023 to spend at least 12 percent of total medical expenditures on primary care. Requires the Oregon Health Authority (OHA) to take into account anticipated primary care spending and use of alternative payment methodologies (APMs) when determining CCO global budgets. Requires CCOs, state educators' and public employees health plans, and insurance carriers, no later than January 1, 2023, to reimburse a certain percentage of all primary care costs through APMs.  This percentage will be established by Oregon Health Authority and Department of Consumer and Business Services (DCBS).

Was Not Enacted

This bill proposes to require health insurers, the State Employees’ Health Benefit Plan, and the health plans offered to school employees to increase the percentage of total health care spending they allocate to primary care to at least 15 percent and would require the next all-payer model agreement with the federal government to include a provision requiring annual increases in primary care spending in Medicare.

Was Not Enacted

Would require health insurers, the State Employees’ Health Benefit Plan, and the health plans offered to school employees to increase the percentage of total healthcare spending they allocate to primary care to at least 12% and require that Medicaid primary care reimbursement rates match Medicare levels.

Was Not Enacted

Requires commercial plans covering 500 or more lives, the State Employees Benefit plan and the Green Mountain Care Board to increase the proportion of health care spending allocated to primary care by 1% a year until reaching 12%.

Was Not Enacted

This multi-issue bill includes provisions to increase primary care payments and spending. It requires that Medicaid matches 100% of the amount that Medicare pays its providers and that state and large health insurers increase their annual spending on primary care until the total reaches at least 12% of overall health care spending.

State Primary Care Investment Initiatives

A filterable web tool for tracking state-level primary care investment legislation.

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Primary Care Investment Map

An interactive map view of state-based investment initiatives grouped by state.

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Primary Care Investment Resources and Links

A growing list of resources and links relating to Primary Care investment, including sample legislative language addressing key design issues

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