Community Multi-share Coverage Program Act

I 116TH CONGRESS 1ST SESSION H. R. 4925 To require the Secretary of Health and Human Services to award grants to support community-based coverage entities to carry out a coverage program that provides to qualifying individuals health coverage and edu- cational and occupational training, and for other purposes. IN THE HOUSE OF REPRESENTATIVES OCTOBER 30, 2019 Mr. HUIZENGA introduced the following bill; which was referred to the Com- mittee on Energy and Commerce, and in addition to the Committee on Education and Labor, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To require the Secretary of Health and Human Services to award grants to support community-based coverage entities to carry out a coverage program that provides to qualifying individuals health coverage and educational and occupational training, 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 ‘‘Community Multi- 4 share Coverage Program Act’’. 5 VerDate Sep 11 2014 20:14 Nov 12, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4925.IH H4925 2 •HR 4925 IH SEC. 2. GRANTS TO COMMUNITY-BASED COVERAGE ENTI- 1 TIES TO CARRY OUT A COVERAGE PROGRAM 2 THAT PROVIDES HEALTH COVERAGE AND 3 EDUCATIONAL AND OCCUPATIONAL TRAIN- 4 ING. 5 (a) IN GENERAL.—Not later than 180 days after the 6 date of the enactment of the Community Multi-share Cov- 7 erage Program Act, the Secretary shall award at least 3 8 and not more than 5 grants to support community-based 9 coverage entities to carry out qualifying coverage benefit 10 pilot programs. Such programs shall— 11 (1) reduce the number of uninsured individuals 12 through hospital-community partnership initiatives 13 that provide an affordable health coverage option for 14 such individuals and provide a coverage transition 15 for those limited to coverage through government- 16 sponsored programs; and 17 (2) test the feasibility of moving individuals eli- 18 gible for medical assistance under a State plan 19 under the Medicaid program under title XIX of the 20 Social Security Act (42 U.S.C. 1396 et seq.) with 21 full-time employment into such programs. 22 (b) QUALIFYING COVERAGE BENEFIT PROGRAM RE- 23 QUIREMENTS.—For purposes of this section, the term 24 ‘‘qualifying coverage benefit program’’ means a program 25 that satisfies each of the following program requirements: 26 VerDate Sep 11 2014 20:14 Nov 12, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4925.IH H4925 3 •HR 4925 IH (1) HEALTH COVERAGE.—Under the program, 1 a community-based coverage entity shall provide to 2 qualifying individuals health coverage offered in con- 3 nection with a qualifying coverage benefit program 4 that satisfies the following: 5 (A) First-dollar coverage (where such cov- 6 erage is furnished by network providers and 7 community resources) for— 8 (i) diagnostic laboratory tests and x- 9 rays; 10 (ii) emergency ambulance services 11 that are provided by ground transpor- 12 tation; 13 (iii) emergency services (as defined in 14 section 2719A(b)(2)(B) of the Public 15 Health Service Act (42 U.S.C. 300gg– 16 19a(b)(2)(B))); 17 (iv) inpatient and outpatient hospital 18 services; 19 (v) mental health services; 20 (vi) physician services; 21 (vii) population health improvement 22 services; 23 (viii) preventatives services; 24 (ix) prescription drugs; and 25 VerDate Sep 11 2014 20:14 Nov 12, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4925.IH H4925 4 •HR 4925 IH (x) substance abuse services. 1 (B) Coverage for— 2 (i) community and individual assess- 3 ment tools to identify any negative influ- 4 ences of health and economic self-suffi- 5 ciency to assist physicians in under- 6 standing the social determinants of health 7 impacting an individual; 8 (ii) a planning process to resolve any 9 negative influences identified pursuant to 10 clause (i) and promote well-being through 11 community partnerships between the com- 12 munity-based coverage entity and— 13 (I) businesses; 14 (II) educational institutions; 15 (III) investors; 16 (IV) local, State, and Federal 17 governmental agencies; and 18 (V) organizations described in 19 section 501(c)(3) of the Internal Rev- 20 enue Code of 1986 that focuses on 21 human service needs relating to be- 22 havioral health, poverty, education, 23 and access and safety; 24 VerDate Sep 11 2014 20:14 Nov 12, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4925.IH H4925 5 •HR 4925 IH (iii) the monitoring of and support 1 (including health coaching services and co- 2 ordination of services within a community 3 to address the needs of an individual) with 4 respect to financial, emotional, and phys- 5 ical health; and 6 (iv) any other benefit the community- 7 based coverage entity determines appro- 8 priate. 9 (2) EDUCATIONAL AND OCCUPATIONAL TRAIN- 10 ING.—Under the program, a community-based cov- 11 erage entity shall— 12 (A) connect and foster ongoing relation- 13 ships between qualifying individuals and edu- 14 cational and occupational training (including 15 classes, workshops, mentorships, and appren- 16 ticeships) designed to enhance preparation for 17 work and support economic self-sufficiency in a 18 manner that reflects the needs of such individ- 19 uals and opportunities in the community; 20 (B) with respect to the comprehensive 21 health improvement process described in sub- 22 section (e)(1)(C)(vi), identify and address bar- 23 riers to employment and increasing income for 24 qualifying individuals; and 25 VerDate Sep 11 2014 20:14 Nov 12, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4925.IH H4925 6 •HR 4925 IH (C) measure and assess the effectiveness of 1 the program in increasing employment and in- 2 creasing income for qualifying individuals. 3 (3) BOARD OF DIRECTORS.—For the purpose of 4 carrying out the program, the community-based cov- 5 erage entity shall form a board of directors, or uti- 6 lize an existing board of directors, in accordance 7 with subsection (e). 8 (c) COMMUNITY-BASED COVERAGE ENTITY.—For 9 the purposes of this section, the term ‘‘community-based 10 coverage entity’’ means an entity that maintains a phys- 11 ical presence within close geographic proximity to the indi- 12 viduals it is serving, with a focus on mitigating barriers 13 to engagement by enabling face-to-face interactions be- 14 tween the entity staff, the individuals served, and commu- 15 nity organizations. 16 (d) QUALIFYING INDIVIDUAL.—For the purposes of 17 this section, the term ‘‘qualifying individual’’ means an in- 18 dividual who meets the following requirements: 19 (1) Subject to any modification made by such 20 program pursuant to subsection (e)(2)(C)(vii), an in- 21 come that exceeds 100 percent but does not exceed 22 400 percent of the poverty line applicable to a family 23 of the size involved. 24 VerDate Sep 11 2014 20:14 Nov 12, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4925.IH H4925 7 •HR 4925 IH (2) Not enrolled under a qualified health plan 1 during the 180-day period preceding the date on 2 which such qualifying individual seeks to enroll 3 under the coverage program under this section. 4 (3) Ineligibility for enrollment in a Federal 5 health care program (including ineligibility to receive 6 health services through the Indian Health Service). 7 (4) Resides or works within the catchment area 8 of a hospital described in subsection (g)(2)(C). 9 (5) Works for a small employer that does not 10 make enrollment in qualified health plans in the 11 small group market such that the combined pre- 12 mium plus deductible cost to cover the employee’s 13 household is less than seven percent of the employ- 14 ee’s household income available to its employees 15 through— 16 (A) in the case that a State elects to pro- 17 vide one exchange in the State for both quali- 18 fying individuals and qualified small employers 19 pursuant to paragraph (2) of section 1311(b) of 20 the Patient Protection and Affordable Care Act 21 (42 U.S.C. 18031(b)), the American Health 22 Benefit Exchange (as such term is used in 23 paragraph (1) of such section) for the plan year 24 in which such qualifying individual seeks health 25 VerDate Sep 11 2014 20:14 Nov 12, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4925.IH H4925 8 •HR 4925 IH insurance coverage described in subsection 1 (b)(1) from a qualifying coverage benefit pro- 2 gram; and 3 (B) in the case that a State retains sepa- 4 rate exchanges for qualifying individuals and 5 qualified small employers, the Small Business 6 Health Options Program (as such term is used 7 in section 1311(b)(2) of the Patient Protection 8 and Affordable Care Act (42 U.S.C. 9 18031(b)(2))) for the plan year in which such 10 qualifying individual seeks health insurance cov- 11 erage described in subsection (b)(1) from a 12 qualifying coverage benefit program. 13 (6) Any other requirement the Secretary deter- 14 mines appropriate. 15 (e) BOARD OF DIRECTORS.— 16 (1) COMPOSITION.—A board of directors 17 formed pursuant to subsection (b)(3) shall be com- 18 posed of at least 9 members and not more than 15 19 members with representation from— 20 (A) local health care providers, of which 21 not more than two individuals may be from the 22 sponsoring health care organization; 23 (B) qualifying individuals; 24 (C) contributing employers; 25 VerDate Sep 11 2014 20:14 Nov 12, 2019 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H4925.IH H4925 9 •HR 4925 IH (D) government representatives; 1 (E) the local health authority; 2 (F) local education systems; and 3 (G) other representatives as necessary to 4 reflect the community composition. 5 (2) DUTIES.— 6 (A) ENACTMENT OF BYLAWS.—A board of 7 directors shall enact bylaws relating to— 8 (i) public engagement with the board 9 of directors; 10 (ii) a shared goal of improving health 11 access and increasing affordability; 12 (iii) outcome-based goals for the pro- 13 gram that considers the needs of the com- 14 munity; 15 (iv) program costs; and 16 (v) an intent to receive comments re- 17 garding the health improvement goals for 18 the community. 19 (B) MEETINGS.—A board of directors shall 20 meet at least bimonthly. 21 (C) QUALIFYING COVERAGE BENEFITS 22 PROGRAM.—A board of directors shall— 23 VerDate Sep 11 2014 20:14 Nov 12, 2019 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H4925.IH H4925 10 •HR 4925 IH (i) carry out the qualifying coverage 1 benefit program described in subsection 2 (b); 3 (ii) determine the share of payments 4 for benefits under the health coverage de- 5 scribed in subsection (b)(1) that are attrib- 6 utable to— 7 (I) the amount awarded to a 8 community-based coverage entity; 9 (II) a sponsoring health care or- 10 ganization; 11 (III) a qualifying individual; and 12 (IV) an employer of a qualifying 13 individual or a skilled trade organiza- 14 tion of a qualifying individual; 15 (iii) determine the premiums and limi- 16 tations on payments (including deductibles 17 and coinsurance amounts) for the health 18 coverage described in subsection (b)(1) for 19 a qualifying individual enrolled under such 20 coverage and the extent, if any, to which 21 such premiums and limitations for a quali- 22 fying individual shall increase as the in- 23 come of such qualifying individual in- 24 VerDate Sep 11 2014 20:14 Nov 12, 2019 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H4925.IH H4925 11 •HR 4925 IH creases relative to the poverty line applica- 1 ble to a family of the size involved; 2 (iv) establish a procedure to— 3 (I) assist qualifying individuals in 4 enrolling under the health coverage 5 described in subsection (b)(1); 6 (II) assist a qualifying individual 7 that does not meet the requirements 8 of a qualified individual specified 9 under subsection (d), is eligible for 10 medical assistance under a State plan 11 under the Medicaid program under 12 title XIX of the Social Security Act 13 (42 U.S.C. 1396 et seq.), and resides 14 in the catchment area of the hospital 15 described in subsection (g)(2)(C) in 16 enrolling under the appropriate State 17 plan under such program; 18 (III) bill and collect the share of 19 payments for benefits described in 20 clause (ii); 21 (IV) bill and collect the pre- 22 miums and limitations on payment de- 23 scribed in clause (iii); 24 VerDate Sep 11 2014 20:14 Nov 12, 2019 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H4925.IH H4925 12 •HR 4925 IH (V) for the purposes of inte- 1 grating community resources, form 2 partnerships with community popu- 3 lation health initiatives; 4 (VI) remove a qualifying indi- 5 vidual from the health insurance cov- 6 erage described in subsection (b)(1) in 7 the case the qualifying individual— 8 (aa) has been enrolled under 9 the qualifying covered benefits 10 program for a 4-year period; and 11 (bb) fails to meet the mile- 12 stones identified pursuant to 13 clause (vi); and 14 (VII) determine a maximum en- 15 rollment period for individual partici- 16 pation, including required milestones 17 for addressing social determinants of 18 health while enrolled; 19 (v) for the purpose of encouraging a 20 qualifying individual to seek a primary 21 care physician, establish incentives for a 22 qualifying individual to initially seek such 23 physician for care (including the reduction 24 of benefits until a primary care physician 25 VerDate Sep 11 2014 20:14 Nov 12, 2019 Jkt 099200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H4925.IH H4925 13 •HR 4925 IH is engaged in the care of such qualifying 1 individual); 2 (vi) for the purpose of making 3 progress toward health and economic self- 4 sufficiency, establish routine milestones 5 and supportive services (to be known as 6 the ‘‘comprehensive health improvement 7 process’’) that a qualifying individual en- 8 rolled under health coverage described in 9 subsection (b)(1) shall meet to maintain 10 enrollment and such milestones shall in- 11 clude— 12 (I) an assessment relating to so- 13 cial determinants of health, health 14 risks, and any other assessment that 15 is appropriate as determined by the 16 circumstances of the qualifying indi- 17 vidual; 18 (II) meetings with a health coach 19 to address social influences of health 20 and to support the physical, emo- 21 tional, and financial health of the 22 qualifying individual; 23 (III) connections with local com- 24 munity linkage partners to offer 25 VerDate Sep 11 2014 20:14 Nov 12, 2019 Jkt 09 [Text truncated for display. 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