; and (2) taking into account such input, issue guidance to States on how a State may implement direct primary care arrangements (as defined in subsection (a)) under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ). (c) Report Not later than 2 years after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit to Congress a report containing— (1) an analysis of the extent to which States are contracting with independent physicians, independent physician practices, and primary care practices for purposes of furnishing medical assistance under State plans (or waivers of such plans) under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ); and (2) an analysis of quality of care and cost of care furnished to individuals enrolled under such title where such care is paid for under a direct primary care arrangement (as defined in subsection (a)) through a medicaid managed care organization (as so defined). (d) Rule of construction Nothing in this section shall be construed to alter statutory requirements under the State plan (or waiver of such plan) under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ) for cost-sharing requirements or be construed to limit medical assistance solely to those provided under a direct primary care arrangement.