This bill creates a primary care council representing key health stakeholders to develop and recommend a prospective payment model for primary care providers. It also requires entities to create primary care spend targets and creates incentives for evidence-based services such as integrated behavioral health.
The bill also creates a primary care stabilization fund to support these payments, with annual reporting and oversight by the health policy commission.
This legislation introduces a new primary care payment model with rising expenditure targets—with a final goal of 15% in 2030—aimed at increasing primary care investment while preventing overall health care cost growth.
It also creates an office within the health policy commission to develop a per-member-per-month capitated payment model that includes enhanced payments for quality services, improved access, and integration of behavioral health, and requires provider organizations to participate (with exemptions for some independent practices).
The bill also mandates annual reporting, performance improvement plans for underperforming entities, fair reimbursement for FQHCs and aligns payment standards across public and private payers.
This bill eliminates cost-sharing for Collaborative Care Model services in primary care settings under Medicaid, HMOs, nonprofit health services, and commercial insurers. The bill also requires the Maryland Health Care Commission to study the impact of eliminating cost-sharing.
This bill adds the Psychiatric Collaborative Care Model as a behavioral health delivery method to Kentucky’s health code and requires health plans providing mental health coverage to reimburse these services using the CPT codes established in federal regulation for this model.
Signed into law on April 12, 2026.
This bill funds Medicaid and protects Medicaid expansion through the current fiscal year and makes statutory changes to comply with H.R. 1 requirements, including work requirements, increased proof of compliance and monthly eligibility checks. It also increases all Medicaid copays to the maximum $35. The bill also requires audits of the Medicaid program to detect potential fraud, waste and abuse.
This bill establishes a Medicaid Fund to provide performance-based incentive payments for Medicaid providers and implements quality metrics for Medicaid providers.
This legislation extends Medicaid minimum reimbursement deadlines until July 1, 2027, and sets specific reimbursement rates for providers based on network participation. It also requires contracted entities to meet primary care spending thresholds of at least 11% of total health care expenses by the end of their fourth year. It also includes provisions for rural health clinics and value-based incentives for non-hospital providers, and other monitoring requirements.
This legislation creates the Oklahoma Health Care Cost Transparency Board to measure and evaluate statewide health care cost growth and primary care investment trends across commercial insurance, Medicaid, and Medicare. The Board will oversee the All Payer Claims Database, which collects and analyzes health care costs, utilization, and spending data from all payer types. It mandates that commercial insurers measure and report primary care spending, with a goal of achieving at least 11% of total medical spending dedicated to primary care by January 1, 2030. It will also publish an annual report on health care spending.
This bill establishes a Technical Advisory Committee to the HPC to perform the following duties:
o establishing adjustment factors as part of the redesigned health care cost growth benchmark;
o provide technical advice to HPC upon request;
o provide HPC with operational, policy, regulatory or legislative recommendations; and
o produce an annual report and other reports as requested by HPC.
It also changes the state’s health care cost growth benchmark from a single-year benchmark to a multi-year benchmark cycle measuring the average annual growth in total health care expenditures during a period of 3 consecutive calendar years
This bill strengthens primary care access by: