Patient Navigation Assistance Act

I 116TH CONGRESS 1ST SESSION H. R. 4830 To provide payment for patient navigator services under title XIX of the Social Security Act, and for other purposes. IN THE HOUSE OF REPRESENTATIVES OCTOBER 23, 2019 Mr. DESAULNIER (for himself and Mr. CARTER of Georgia) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To provide payment for patient navigator services under title XIX of the Social Security Act, 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 ‘‘Patient Navigation As- 4 sistance Act’’. 5 SEC. 2. MEDICAID COVERAGE FOR PATIENT NAVIGATOR 6 SERVICES. 7 (a) IN GENERAL.—Section 1902(a) of the Social Se- 8 curity Act (42 U.S.C. 1396a(a)) is amended— 9 VerDate Sep 11 2014 04:04 Oct 29, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4830.IH H4830 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 4830 IH (1) in paragraph (82), by striking ‘‘and’’ at the 1 end; 2 (2) in paragraph (83), by striking at the end 3 the period and inserting ‘‘; and’’; and 4 (3) by inserting after paragraph (83) the fol- 5 lowing new paragraph: 6 ‘‘(84) provide that the State shall reimburse an 7 eligible entity (as defined in subsection (nn)(1)) for 8 any patient navigator service (as defined in sub- 9 section (nn)(3)) that is provided— 10 ‘‘(A) to an individual who is eligible for 11 medical assistance under the State plan; and 12 ‘‘(B) by a patient navigator (as defined in 13 subsection (nn)(2)) through the eligible entity.’’; 14 and 15 (4) by adding at the end the following new sub- 16 section: 17 ‘‘(nn) PATIENT NAVIGATOR SERVICES DEFINI- 18 TIONS.—For purposes of this section: 19 ‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en- 20 tity’ means an entity that— 21 ‘‘(A) is an eligible entity (as defined in 22 subsection (l)(1) of section 340A of the Public 23 Health Service Act); and 24 VerDate Sep 11 2014 04:04 Oct 29, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4830.IH H4830 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 4830 IH ‘‘(B) complies with the following require- 1 ments of such section (insofar as they apply to 2 a grant recipient under such section): 3 ‘‘(i) Subsection (b) (relating to patient 4 navigator duties and community knowl- 5 edge). 6 ‘‘(ii) Subsection (c) (relating to prohi- 7 bitions). 8 ‘‘(iii) Subsection (e) (relating to appli- 9 cations). 10 ‘‘(iv) Subsection (j)(3) (relating to re- 11 ports). 12 ‘‘(2) PATIENT NAVIGATOR.— 13 ‘‘(A) IN GENERAL.—The term ‘patient 14 navigator’ has the meaning given such term in 15 section 340A(l)(3) of the Public Health Service 16 Act. 17 ‘‘(B) CONSULTATION WITH ADVISORY COM- 18 MITTEE.— 19 ‘‘(i) IN GENERAL.—The Secretary 20 shall consult with the patient navigation 21 advisory committee to the extent necessary 22 to further clarify the definition of the term 23 ‘patient navigator’ for purposes of this sec- 24 tion, including establishing requirements to 25 VerDate Sep 11 2014 04:04 Oct 29, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4830.IH H4830 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 4830 IH ensure adequate training for such naviga- 1 tors, such as developing a training cur- 2 riculum and determining required quali- 3 fications and maintenance of qualifications. 4 ‘‘(ii) MEMBERSHIP.—The Secretary 5 shall convene a patient navigation advisory 6 committee. The members of such com- 7 mittee shall include— 8 ‘‘(I) representatives from relevant 9 Federal departments and agencies, in- 10 cluding the National Institutes of 11 Health, the Centers for Disease Con- 12 trol and Prevention, the Health Re- 13 sources and Services Administration, 14 the Centers for Medicare & Medicaid 15 Services, the Indian Health Service, 16 and the Office of Rural Health Policy 17 of the Department of Health and 18 Human Services; and 19 ‘‘(II) physicians, nurses, stake- 20 holder groups, and other individuals 21 and representatives of public and pri- 22 vate organizations with expertise in 23 patient navigation. 24 VerDate Sep 11 2014 04:04 Oct 29, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4830.IH H4830 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 4830 IH ‘‘(3) PATIENT NAVIGATOR SERVICES.—The 1 term ‘patient navigator service’ means a service that 2 is a duty specified under paragraphs (1) through (6) 3 of subsection (b) of section 340A of the Public 4 Health Service Act and that is provided by a patient 5 navigator through an eligible entity.’’. 6 (b) TREATMENT AS MEDICAL ASSISTANCE FOR PUR- 7 POSES OF FMAP.—Section 1905(a) of the Social Security 8 Act (42 U.S.C. 1396d(a)) is amended— 9 (1) in paragraph (28), by striking ‘‘and’’ at the 10 end; 11 (2) by redesignating paragraph (29) as para- 12 graph (30); and 13 (3) by inserting after paragraph (28) the fol- 14 lowing new paragraph: 15 ‘‘(29) patient navigator services (as defined in 16 section 1902(nn)(3)) that are provided in a manner 17 that meets the requirements of section 1902(a)(84); 18 and’’. 19 (c) EFFECTIVE DATE.— 20 (1) IN GENERAL.—Subject to paragraph (2), 21 the amendments made by this section shall apply to 22 patient navigator services provided after the first 23 day of the first calendar year that begins after the 24 date of enactment of this Act. 25 VerDate Sep 11 2014 04:04 Oct 29, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4830.IH H4830 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 4830 IH (2) EXCEPTION FOR STATE LEGISLATION.—In 1 the case of a State plan under title XIX of the So- 2 cial Security Act, which the Secretary of Health and 3 Human Services determines requires State legisla- 4 tion in order for the respective plan to meet any re- 5 quirement imposed by amendments made by this 6 Act, the respective plan shall not be regarded as fail- 7 ing to comply with the requirements of such title 8 solely on the basis of its failure to meet such an ad- 9 ditional requirement before the first day of the first 10 calendar quarter beginning after the close of the 11 first regular session of the State legislature that be- 12 gins after the date of enactment of this Act. For 13 purposes of the previous sentence, in the case of a 14 State that has a 2-year legislative session, each year 15 of the session shall be considered to be a separate 16 regular session of the State legislature. 17 Æ VerDate Sep 11 2014 04:04 Oct 29, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6301 E:\BILLS\H4830.IH H4830 pamtmann on DSKBC07HB2PROD with BILLS