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 [email protected]

Pending
State Type Yearsort descending
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
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
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
SB 116 An Act To Amend Title 16 And Title 18 Of The Delaware Code Relating To The Primary Care Reform Collaborative

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.

Legislation 2019 Pending
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
Enacted
State Legislation Type Yearsort descending
Missouri Health Improvement Act of 2007

The Act included a provision that the Department of Social Services should create health improvement plans for all participants in MO HealthNet to include coordinated care plans and be enrolled in a health care home.

Missouri Health Homes Program
Legislation 2007 Enacted
Executive Order 2007-05

This Executive Order created the Pennsylvania Chronic Care Management, Reimbursement and Cost Reduction Commission, also known as the Chronic Care Commission. The Chronic Care Commission subsequently developed the framework for the Pennsylvania Chronic Care Initiative. 

Pennsylvania Chronic Care Initiative (CCI)
Regulation 2007 Enacted
Chapter 346, Session Laws of Colorado 2007

This legislation defined "medical home" and required the Colorado Department of Public Health and Environment (CDPHE) to increase the number of children served by medical homes. 

Legislation 2007 Enacted
2008 Health Care Reform

This legislation establishes standards for state certification of Health Care Homes and evaluating outcomes. It also requires that Health Care Homes receive care coordination payments from public and private health care purchasers.

Minnesota Health Care Homes (HCH)
Legislation 2008 Enacted
Chapter 1656, Session Laws of Oklahoma

The legislation created a Medical Home Task Force charged with studying PCMH implementation among commercial and public payers.

Legislation 2008 Enacted
Resolution 1058

The legislation supported the patient-centered medical home (PCMH) and encouraged all health systems in Oklahoma to study and implement principles of the PCMH.

Legislation 2008 Enacted
Chapter 595 of the 2009 Oregon Laws

The legislation established the Patient Centered Primary Care Home (PCPCH) Program by the Office for Oregon Health Policy and Research. This law created a learning collaborative to assist practices in developing the infrastructure for PCPCH. The law also allowed for changes in payment for practices who provide care in medical homes including payment for interpretive services and rewards for improvements in health quality.

Legislation 2009 Enacted
New Mexico House Bill 710

New Mexico passed HB 710 "Medical Home-Based Care Program and Insurance" directing the Human Services Department to apply for a Medicaid waiver or State Plan Amendment (SPA) to implement a medical home program and convene an insurance task force to explore incentives for a medical home-based managed care model.

Legislation 2009 Enacted
Legislative Bill 396

The legislation authorized the Nebraska Medical Home Pilot Program Act with the purpose of improving health care access and health outcomes for patients and containing costs in the Medicaid program. The act defined medical home for the state of Nebraska and authorized a two-year medical home pilot program.

Nebraska Patient-Centered Medical Home Pilot
Legislation 2009 Enacted
Appropriation for patient-centered medical home pilot

In the FY2010 budget, the Maine legislature appropriated $500,000 to partially fund a PCMH pilot in partnership with Maine Quality Forum (MQF), Maine Quality Counts, and the Maine Health Management Coalition with additional funding from an RWJ Foundation Aligning Forces for Quality grant.  

Maine Patient-Centered Medical Home Pilot
Legislation 2010 Enacted
Executive Order NO. 2010-10

Executive Order 2010-10 established the Idaho Medical Home Collaborative (Collaborative) to implement a patient-centered medical home (PCMH) model of care to address the transformation of Idaho’s health care system to a PCMH model

Idaho Medical Home Collaborative (IMHC)
2010 Enacted
House Bill 198, 128th General Assembly

The bill authorized the Patient Centered Medical Home Education Pilot Project.

Ohio PCMH Education Pilot Project
Legislation 2010 Enacted
North Carolina Session Law 2010-31

The legislation supports Community Care of North Carolina (CCNC) to continue serving as the anchor program in North Carolina for most of its health improvement and cost-containment efforts including Care Coordination for Children (CC4C), Dual-eligible initiative, Multi-payer Advanced Primary Care Practice Project (MAPCP), and Palliative Care Initiative, just to name a few.

Legislation 2010 Enacted
Article 5, Title 11 of the New York State Social Services Law, Section 364-m

The law gave the Commissioner of Health the authority to establish a Statewide PCMH program whereby providers who are recognized by the NCQA are eligible to receive additional payments for services provided to Medicaid FFS and managed care enrollees.

Legislation 2010 Enacted
Maryland law Senate Bill 855/House Bill 929

The law requires the State’s five major carriers of fully insured health benefit products (Aetna, CareFirst, CIGNA, Coventry, and UnitedHealthcare) to participate in the Maryland Multi-Payer Patient-Centered Medical Home Program (MMPP).

Maryland Multi-payer Patient Centered Medical Home Program
Legislation 2010 Enacted
Vermont Act 48 (VT LEG 270379.1)

The Act put Vermont on a path toward an integrated health care delivery system with a budget regulated by the new Green Mountain Care Board, universally available health insurance coverage that is not linked to employment and a single system for administration of claims and payments to providers.

Legislation 2011 Enacted
S.B. 7, 82nd Legislature

The legislation called for a study by the Health and Human Services Commission (HHSC) to submit a report to the Texas Legislature regarding the commission's work to ensure that Medicaid managed care organizations promote the development of patient-centered medical homes (PCMH) for recipients of medical assistance and provide payment incentives for clinicians that meet the requirements of a PCMH as required under Section 533.0029, Government Code.

Legislation 2011 Enacted
NJ P.L. 2011, Chapter 114

In August 2011, Governor Christie signed this bill into law requiring the  Department of Medcial Assistance and Health Services (DMAHS) to establish a three year Medicaid Accountable Care Organization (ACO) demonstration project.

New Jersey Medicaid ACO demonstration project
Legislation 2011 Enacted
2011 S 770 – Rhode Island All-Payer Patient Centered Medical Home Act of 2011

The Act directed the Health Insurance Commissioner to create a Patient-Centered Medical Home Collaborative. The Collaborative conisted of various stakeholders including providers, insurers, patients, hospitals, and state agencies, and was required to develop a payment system that mandated all insurers to provide care coordination payments to PCMHs by July of 2012. The Act requires that the care coordination system be in place through at least July of 2016.

Care Transformation Collaborative of Rhode Island (CTC)
Legislation 2011 Enacted
Chapter 602 of the 2011 Oregon Laws

This law established the Oregon Integrated and Coordinated Health Care Delivery System. It requires the Oregon Health Authority (OHA) to establish standards for using PCPCHs within Coordinated Care Organizations (CCO) and requires CCOs to implement PCPCHs to the extent possible.

Legislation 2011 Enacted
Public Act No. 11-58

This act allows cities and towns to join the state employee health plan. In addition, a provision was included to "develop and implement patient-centered medical homes for the state employee plan and partnership plans... in a manner that will reduce the costs of such plans".

Connecticut Health Enhancement Program (HEP)
Legislation 2011 Enacted
New Hampshire Senate Bill 147

The legislation employs a Medicaid Care Management (MCM) model for administering the New Hampshire Medicaid program, which began in December 2013.

Legislation 2011 Enacted
Act 171 (H.559)

The act expresses legislative intent that access to and payments for community health teams should begin at least six months before a medical practice is scheduled to be scored for Blueprint recognition, that the Blueprint director increase payments to medical homes because of new qualification requirements, and that all health plans, including the multistate plans required under the ACA, should participate in the Blueprint for Health.

Vermont Blueprint for Health
Legislation 2012 Enacted
Chapter 224 of the Acts of 2012

Chapter 224 of the Acts of 2012 was enacted to slow the growth in state health care costs, improve quality of care and patient outcomes, and increase transparency and oversight of provider and payer price and cost data.

Legislation 2012 Enacted
The Patient-Centered Medical Home Act

This law requires the insurance commissioner to rely on a council of stakeholders to create standards for the program, qualify health care providers and insurers to participate, and promote the program.

Legislation 2013 Enacted
S.B. 58, 83rd Legislature, Regular Session, 201

The legislation charges HHSC with integrating behavioral and physical health services within the Medicaid managed care program.

Legislation 2013 Enacted
Public Act 098-104

The Act created Medicaid Accountable Care Entities (ACEs), which provide an innovative approach for achieving the triple aim (increasing quality of care, lowering costs, and improving population health outcomes) for the Medicaid population.

Accountable Care Entities (ACEs)
Legislation 2013 Enacted
West Virginia Public Employees Insurance Act

The Act called for the evaluation and administration of programs to improve quality, improve health status of members, develop innovative payment methodologies, manage health care delivery costs, evaluate effective benefit designs, evaluate cost sharing and benefit based programs, and adopt effective industry programs that can manage the long-term effectiveness and costs for the programs at the Public Employees Insurance Agency to include implementation and evaluation of medical homes.

Legislation 2013 Enacted
House Bill 1655

The law establishes a Patient-Centered Medical Home Advisory Council, provides powers and duties of the council, and provides for the development of a plan to implement a statewide medical home model. 

Legislation 2014 Enacted
Executive Order NO. 2014-02

This Executive Order creates the Idaho Healthcare Coalition (IHC). The IHC is charged with building upon the work of the previously established Idaho Medical Home Collaborative (Executive Order No. 2010-10) to facilitate and support the transformation of primary care practices to the PCMH model, develop regional collaboratives to support practices in transformation, and integrate PCMHs with the medical neighborhood that includes hospitals, behavioral health and other community support services.

2014 Enacted
Montana Health and Economic Livelihood Partnership (HELP) Act

This law expands Medicaid eligibility for low-income individuals in Montana. The legislation also strengthens existing programs that manage the way members obtain approval for medical services and establishes additional programs designed to reduce costs and improve medical outcomes. The efforts may include but are not limited to patient-centered medical homes and ACOs. [This act] terminates June 30, 2019

Legislation 2015 Enacted
Oregon Senate Bill 934 - Relating to payments for primary care; creating new provisions; and amending ORS

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.
 
PASSED - Effective date, January 1, 2018. 
Legislation 2017 Enacted
Senate Bill 227

This Act promotes the use of primary care by doing the following:

1. Creating a Primary Care Reform Collaborative under the Delaware Health Care Commission.

2. Requiring all health insurance providers to participate in the Delaware Health Care Claims Database.

3. Requiring individual, group, and State employee insurance plans to reimburse primary care physicians, certified nurse practitioners, physician assistants, and other front-line practitioners for chronic care management and primary care at no less than the physician Medicare rate for the next 3 years.

Legislation 2018 Enacted
Senate Bill 53, House Bill 89

This bill proposes to require the Green Mountain Care Board to determine the proportion of health care spending currently allocated to primary care, recommend the proportion that should be allocated to primary care going forward, and project the avoided costs that would likely result if that proportion were achieved.  

It would then direct certain payers to provide a plan for achieving the allocation of primary care recommended for them by the Board.

The House and Senate bills differ slightly, with the House bill specifying that primary care be allocated 12 percent or more of spending by 2025.

Legislation 2019 Enacted
SB 641 Primary Care Support Program

This bill creates the Primary Care Support Program within the Bureau of Public Health within the Department of Health and Human Resources. The program will provide technical and organizational assistance to community-based primary care services. It will also create and administer a Primary Care Grant Fund to grant money to federally qualified health centers and federally qualified health center look-alikes, and secure federal medical assistance percentage funding. Federally qualified health center look-alikes already receiving grant funding at the time this program is created will continue to receive grant funding annually. Upon approval by the secretary of the department, federally qualified health centers in need of immediate financial assistance may be granted funding annually. All funds designated to federally qualified health centers may be transferred to Medicaid for the purpose of securing federal medical assistance percentage funding. Additionally, the secretary may use certain portions of funds within this account for activities in support of rural and primary care.


This bill also creates a special revenue fund in the State Treasury to be known as the Primary Care Support Fund into which all appropriations, payments, and interest to the fund created herein shall be deposited, to be held and disbursed according to law.

The Primary Care Support Program will 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. 

Legislation 2019 Enacted
SP 421: An Act To Establish Transparency in Primary Health Care Spending

This bill requires insurers to report primary care expenditures to the Maine Health Data Organization and for the Maine Quality Forum to use this data to report annually to the Department of Health and Human Services and the Legislature the percentage of total medical expenditures paid for primary care by commercial insurers, the MaineCare program, Medicare, the organization that administers health insurance for state employees and the Maine Education Association benefits trust respectively, the average of the percentage of total medical expenses paid for primary care across all organizations and the methods used by these organizations to pay for primary care. This bill also requires the Maine Quality Forum to conduct a study on best practices in health care spending reporting and submit its findings to the Department of Health and Human Services and the Joint Standing Committee on Health and Human Services.

Legislation 2019 Enacted
Expired
State Type Yearsort descending
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
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
Substitute Senate Bill 5891

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

Legislation 2009 Expired
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
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
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
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
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
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
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
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