Bill 197 would set a primary‑care investment target and retool payments, proponents say
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Summary
Proponents told the committee Bill 197 would strengthen primary care through a per‑person per‑month investment target, payment reform to move toward capitated PMPM payments, and workforce supports; the bill asks AHS for reports by Jan. 2027 and an operational plan by Jan. 1, 2028.
Presenter Jessa told the committee that Bill 197 is intended to increase sustainability and access to primary care by using three main levers: setting a primary‑care investment target, implementing primary‑care payment reform, and strengthening the primary‑care workforce.
“This bill both moves the needle on investing more in primary care and paying differently,” the presenter said, outlining how the measure would expand the Blueprint model so more insurers contribute to an add‑on payment for patient‑centered medical homes, require AHS to set a per‑member‑per‑month (PMPM) investment target, and direct work on transitioning from add‑on fee‑for‑service payments toward a capitated PMPM for core primary‑care services. She said the bill asks for a report by January 2027 and an operational plan no later than Jan. 1, 2028.
The presenter described three steps: first expanding which insurers are assessed for Blueprint add‑on payments (bringing in third‑party administrators and some ERISA/self‑insured arrangements to the extent permitted by federal law); second, designing an approach to replace some fee‑for‑service payments with prospective PMPM payments for core primary‑care services; and third, considering whether the model could reduce or eliminate patient cost‑sharing for primary‑care visits. She stated that Medicaid’s current contribution to Blueprint is $4.65 per person per month and that the Act 51 report and other state examples informed the bill’s design.
Committee members pressed several operational questions. They asked who should set the methodology for payment amounts — raising concerns that Blueprint and AHS have financial stakes that could influence rate setting — and whether the plan depends on participation in the AHEAD model (federal/state alignment for broader programs). The presenter said 197 was drafted to work with or without AHEAD but noted that Medicare/CMS contributions could vary depending on federal alignment.
Members also asked whether insurer assessments would raise consumer premiums; the presenter described the intent as reallocating existing premium dollars toward primary care rather than creating a new, additive premium charge, but emphasized the need for actuarial work and modeling to project premium impacts. Committee members discussed mechanisms to assess all payers, noting the claims tax as an existing mechanism that has precedent for applying to a broad set of payers.
The presenter confirmed the bill contains workforce and scholarship language, including removing the sunset on a medical‑student incentive scholarship program, and noted the bill intentionally limited direct appropriations to avoid slowing statutory progress while other workforce investments are handled in budget bills.
No formal committee action or vote appears in the transcript. The record indicates the committee will solicit additional information from AHS and from actuarial staff to refine cost and implementation details before further consideration.
