State Primary Care Investment Initiatives

Colorado

Legislation - Enacted - 2019

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

Connecticut

Legislation - Enacted - 2022

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.

Executive Order - Enacted - 2020

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

Delaware

Legislation - Enacted - 2021

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.

Hawaii

Regulation - Enacted - 2021

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

Maine

Legislation - Enacted - 2019

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

Legislation - Enacted - 2022

Sets targets for investment in primary and behavioral healthcare. 

Maryland

Legislation - Enacted - 2022

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.

Massachusetts

Legislation - Enacted - 2023

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.

Legislation - Enacted - 2023

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.

Legislation - Enacted - 2023

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.

Legislation - Pending - 2023

SD 2233 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.

Legislation - Was Not Enacted - 2022

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).

Legislation - Was Not Enacted - 2022

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.

Nebraska

Legislation - Enacted - 2022

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.

New Jersey

Legislation - Enacted - 2021

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.

New Mexico

Legislation - Enacted - 2021

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

Oklahoma

Legislation - Enacted - 2022

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.

Oregon

Legislation - Enacted - 2015

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.

Legislation - Enacted - 2017

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.

Legislation - Was Not Enacted - 2019

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).

Rhode Island

Legislation - Enacted - 2004

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

Utah

Legislation - Enacted - 2022

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

Vermont

Legislation - Enacted - 2019

Was enacted

Legislation - Was Not Enacted - 2022

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.

Washington

Legislation - Enacted - 2019

$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

Legislation - Enacted - 2022

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.

West Virginia

Legislation - Enacted - 2019

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.

California

Legislation - Enacted as part of another bill - 2022

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.

Minnesota

Legislation - Pending - 2023

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.

Legislation - Was Not Enacted - 2022

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.

Legislation - Was Not Enacted - 2022

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;

Legislation - Was Not Enacted - 2022

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; 

Nevada

Legislation - Pending - 2022

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.

New York

New Yorks's legislation was vetoed. 
Legislation - Vetoed - 2022

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.

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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