Equality in Medicare and Medicaid Treatment Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 3910 To amend title XI of the Social Security Act to improve access to care for all Medicare and Medicaid beneficiaries through models tested under the Center for Medicare and Medicaid Innovation, and for other purposes. IN THE HOUSE OF REPRESENTATIVES JULY 23, 2019 Mr. LEWIS (for himself, Mr. LARSON of Connecticut, Ms. SEWELL of Ala- bama, Mr. DOGGETT, Mr. EVANS, Mr. PASCRELL, Mr. GOMEZ, Mr. SUOZZI, and Ms. SA´NCHEZ) introduced the following bill; which was re- ferred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently de- termined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend title XI of the Social Security Act to improve access to care for all Medicare and Medicaid beneficiaries through models tested under the Center for Medicare and Medicaid Innovation, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Equality in Medicare 4 and Medicaid Treatment Act of 2019’’. 5 VerDate Sep 11 2014 02:51 Jul 31, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3910.IH H3910 lotter on DSKBCFDHB2PROD with BILLS 2 •HR 3910 IH SEC. 2. IMPROVING ACCESS TO CARE FOR MEDICARE AND 1 MEDICAID BENEFICIARIES. 2 Section 1115A of the Social Security Act (42 U.S.C. 3 1315a) is amended— 4 (1) in subsection (a)(3)— 5 (A) by inserting ‘‘, the causes of health 6 disparities and social determinants of health,’’ 7 after ‘‘medicine’’; and 8 (B) by inserting ‘‘, the Office of Minority 9 Health of the Centers for Medicare & Medicaid 10 Services, the Office of Rural Health Policy, and 11 the Office on Women’s Health’’; 12 (2) in subsection (b)— 13 (A) in paragraph (2)— 14 (i) in subparagraph (A)— 15 (I) by inserting after the first 16 sentence, the following new sentence: 17 ‘‘Prior to model selection, the Sec- 18 retary shall consult with the Office of 19 Minority Health of the Centers for 20 Medicare & Medicaid Services, the 21 Federal Office of Rural Health Policy, 22 and the Office on Women’s Health to 23 ensure that models under consider- 24 ation address health disparities and 25 social determinants of health as ap- 26 VerDate Sep 11 2014 02:51 Jul 31, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3910.IH H3910 lotter on DSKBCFDHB2PROD with BILLS 3 •HR 3910 IH propriate for populations to be cared 1 for under the model.’’; 2 (II) by inserting ‘‘, as well as im- 3 proving access to care received by in- 4 dividuals receiving benefits under such 5 title,’’ after ‘‘title’’; and 6 (III) by adding at the end the 7 following new sentence: ‘‘The models 8 selected under this subparagraph shall 9 include the social determinants of 10 health payment model described in 11 subparagraph (D), the testing of 12 which shall begin not later than De- 13 cember 31, 2020.’’; 14 (ii) in subparagraph (C), by adding at 15 the end the following new clauses: 16 ‘‘(ix) Whether the model will affect 17 access to care from providers and suppliers 18 caring for high risk patients or operating 19 in underserved areas. 20 ‘‘(x) Whether the model has the po- 21 tential to produce reductions in minority 22 and rural health disparities.’’; and 23 (iii) by adding at the end the fol- 24 lowing new subparagraph: 25 VerDate Sep 11 2014 02:51 Jul 31, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3910.IH H3910 lotter on DSKBCFDHB2PROD with BILLS 4 •HR 3910 IH ‘‘(D) SOCIAL DETERMINANTS OF HEALTH 1 PAYMENT MODEL.— 2 ‘‘(i) IN GENERAL.—The social deter- 3 minants of health payment model described 4 in this subparagraph is a payment model 5 that tests each of the payment and service 6 delivery innovations described in clause (ii) 7 in a region determined appropriate by the 8 Secretary. 9 ‘‘(ii) PAYMENT AND SERVICE DELIV- 10 ERY INNOVATIONS DESCRIBED.—For pur- 11 poses of clause (i), the payment and serv- 12 ice delivery innovations described in this 13 clause are the following: 14 ‘‘(I) Payment and service delivery 15 innovations for behavioral health serv- 16 ices, focusing on gathering actionable 17 data to address the higher costs asso- 18 ciated with beneficiaries with diag- 19 nosed behavioral conditions. 20 ‘‘(II) Payment and service deliv- 21 ery innovations targeting conditions or 22 comorbidities of individuals entitled or 23 enrolled under the Medicare program 24 under title XVIII and enrolled under 25 VerDate Sep 11 2014 02:51 Jul 31, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3910.IH H3910 lotter on DSKBCFDHB2PROD with BILLS 5 •HR 3910 IH a State plan under the Medicaid pro- 1 gram under title XIX to increase ca- 2 pacity in underserved areas. 3 ‘‘(III) Payment and service deliv- 4 ery innovations targeted on Medicaid- 5 eligible pregnant and postpartum 6 women, up to one year after deliv- 7 ery.’’; and 8 (B) in paragraph (4)(A)— 9 (i) in clause (i) at the end, by striking 10 ‘‘and’’; 11 (ii) in clause (ii), at the end, by strik- 12 ing the period and inserting ‘‘; and’’; and 13 (iii) by adding at the end the fol- 14 lowing new clause: 15 ‘‘(iii) the extent to which the model 16 improves access to care or the extent to 17 which the model improves care for high 18 risk patients, patients from racial or ethnic 19 minorities, or patients in underserved 20 areas.’’; 21 (3) in subsection (c)— 22 (A) in paragraph (2), by striking at the 23 end ‘‘and’’; 24 VerDate Sep 11 2014 02:51 Jul 31, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3910.IH H3910 lotter on DSKBCFDHB2PROD with BILLS 6 •HR 3910 IH (B) by redesignating paragraph (3) as 1 paragraph (4); 2 (C) by inserting after paragraph (2) the 3 following new paragraph: 4 ‘‘(3) the Office of Minority Health of the Cen- 5 ters for Medicare & Medicaid Services certifies that 6 such expansion will not reduce access to care for 7 low-income, minority, or rural beneficiaries; and’’; 8 (D) in paragraph (4), as redesignated by 9 subparagraph (B), by inserting before the pe- 10 riod at the end the following: ‘‘nor increase 11 health disparities experienced by low-income, 12 minority, or rural beneficiaries’’; and 13 (E) in the matter following paragraph (4), 14 as redesignated by subparagraph (B), by insert- 15 ing ‘‘, improve access to care,’’ after ‘‘care’’; 16 and 17 (4) in subsection (g)— 18 (A) by inserting ‘‘(or, beginning with 2021, 19 once every year thereafter)’’ after ‘‘thereafter’’; 20 and 21 (B) by adding at the end the following new 22 sentence: ‘‘For reports for 2021 and each sub- 23 sequent year, each such report shall include in- 24 formation on the following: 25 VerDate Sep 11 2014 02:51 Jul 31, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3910.IH H3910 lotter on DSKBCFDHB2PROD with BILLS 7 •HR 3910 IH ‘‘(1) The extent and severity of minority and 1 rural health disparities in Medicare and Medicaid 2 beneficiaries. 3 ‘‘(2) The interventions that address social de- 4 terminants of health in payment models selected by 5 the Center for Medicare and Medicaid Innovation for 6 testing. 7 ‘‘(3) The interventions that address social de- 8 terminants of health in payment models not selected 9 by the Center for Medicare and Medicaid Innovation 10 for testing. 11 ‘‘(4) The effectiveness of interventions in miti- 12 gating negative health outcomes and higher costs as- 13 sociated with social determinants of health within 14 models selected by the Center for Medicare and 15 Medicaid Innovation for testing. 16 ‘‘(5) Changes in disparities among minorities 17 and Medicare and Medicaid beneficiaries in under- 18 served areas that are attributable to provider and 19 supplier participation in a Phase II model. 20 ‘‘(6) In consultation with the Comptroller Gen- 21 eral of the United States, estimated Federal savings 22 achieved through the reduction of rural and minority 23 health disparities. 24 VerDate Sep 11 2014 02:51 Jul 31, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3910.IH H3910 lotter on DSKBCFDHB2PROD with BILLS 8 •HR 3910 IH ‘‘(7) Other areas determined appropriate by the 1 Secretary.’’. 2 Æ VerDate Sep 11 2014 02:51 Jul 31, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6301 E:\BILLS\H3910.IH H3910 lotter on DSKBCFDHB2PROD with BILLS