Equality in Medicare and Medicaid Treatment Act of 2020

II 116TH CONGRESS 2D SESSION S. 4944 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 SENATE OF THE UNITED STATES DECEMBER 2, 2020 Mr. BOOKER introduced the following bill; which was read twice and referred to the Committee on Finance 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 2020’’. 5 VerDate Sep 11 2014 06:17 Dec 08, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S4944.IS S4944 pbinns on DSKJLVW7X2PROD with BILLS 2 •S 4944 IS 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), in the first sentence— 5 (A) by inserting ‘‘the Office of Minority 6 Health of the Centers for Medicare & Medicaid 7 Services, the Federal Office of Rural Health 8 Policy, the Office on Women’s Health, and 9 other’’ after ‘‘representatives of’’; and 10 (B) by inserting ‘‘, the causes of health 11 disparities and social determinants of health,’’ 12 after ‘‘medicine’’; 13 (2) in subsection (b)— 14 (A) in paragraph (2)— 15 (i) in subparagraph (A)— 16 (I) in the second sentence, by in- 17 serting ‘‘, as well as improving access 18 to care received by individuals receiv- 19 ing benefits under such title,’’ after 20 ‘‘applicable title’’; 21 (II) by inserting after the first 22 sentence, the following new sentence: 23 ‘‘Prior to model selection, the Sec- 24 retary shall consult with the Office of 25 Minority Health of the Centers for 26 VerDate Sep 11 2014 06:17 Dec 08, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S4944.IS S4944 pbinns on DSKJLVW7X2PROD with BILLS 3 •S 4944 IS Medicare & Medicaid Services, the 1 Federal Office of Rural Health Policy, 2 and the Office on Women’s Health to 3 ensure that models under consider- 4 ation address health disparities and 5 social determinants of health as ap- 6 propriate for populations to be cared 7 for under the model.’’; and 8 (III) by adding at the end the 9 following new sentence: ‘‘The models 10 selected under this subparagraph shall 11 include the social determinants of 12 health payment model described in 13 subparagraph (D), the testing of 14 which shall begin not later than De- 15 cember 31, 2021.’’; 16 (ii) in subparagraph (C), by adding at 17 the end the following new clauses: 18 ‘‘(ix) Whether the model will affect 19 access to care from providers and suppliers 20 caring for high risk patients or operating 21 in underserved areas. 22 ‘‘(x) Whether the model has the po- 23 tential to produce reductions in minority 24 and rural health disparities.’’; and 25 VerDate Sep 11 2014 06:17 Dec 08, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S4944.IS S4944 pbinns on DSKJLVW7X2PROD with BILLS 4 •S 4944 IS (iii) by adding at the end the fol- 1 lowing new subparagraph: 2 ‘‘(D) SOCIAL DETERMINANTS OF HEALTH 3 PAYMENT MODEL.— 4 ‘‘(i) IN GENERAL.—The social deter- 5 minants of health payment model described 6 in this subparagraph is a payment model 7 that tests each of the payment and service 8 delivery innovations described in clause (ii) 9 in a region determined appropriate by the 10 Secretary. 11 ‘‘(ii) PAYMENT AND SERVICE DELIV- 12 ERY INNOVATIONS DESCRIBED.—For pur- 13 poses of clause (i), the payment and serv- 14 ice delivery innovations described in this 15 clause are the following: 16 ‘‘(I) Payment and service delivery 17 innovations for behavioral health serv- 18 ices, focusing on gathering actionable 19 data to address the higher costs asso- 20 ciated with beneficiaries with diag- 21 nosed behavioral conditions. 22 ‘‘(II) Payment and service deliv- 23 ery innovations targeting conditions or 24 comorbidities of individuals entitled or 25 VerDate Sep 11 2014 06:17 Dec 08, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S4944.IS S4944 pbinns on DSKJLVW7X2PROD with BILLS 5 •S 4944 IS enrolled under the Medicare program 1 under title XVIII and enrolled under 2 a State plan under the Medicaid pro- 3 gram under title XIX to increase ca- 4 pacity in underserved areas. 5 ‘‘(III) Payment and service deliv- 6 ery innovations targeted on Medicaid- 7 eligible pregnant and postpartum 8 women, up to one year after deliv- 9 ery.’’; and 10 (B) in paragraph (4)(A)— 11 (i) in clause (i) at the end, by striking 12 ‘‘and’’; 13 (ii) in clause (ii), at the end, by strik- 14 ing the period and inserting ‘‘; and’’; and 15 (iii) by adding at the end the fol- 16 lowing new clause: 17 ‘‘(iii) the extent to which the model 18 improves access to care or the extent to 19 which the model improves care for high 20 risk patients, patients from racial or ethnic 21 minorities, or patients in underserved 22 areas.’’; 23 (3) in subsection (c)— 24 VerDate Sep 11 2014 06:17 Dec 08, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S4944.IS S4944 pbinns on DSKJLVW7X2PROD with BILLS 6 •S 4944 IS (A) in paragraph (2), by striking at the 1 end ‘‘and’’; 2 (B) by redesignating paragraph (3) as 3 paragraph (4); 4 (C) by inserting after paragraph (2) the 5 following new paragraph: 6 ‘‘(3) the Office of Minority Health of the Cen- 7 ters for Medicare & Medicaid Services certifies that 8 such expansion will not reduce access to care for 9 low-income, minority, or rural beneficiaries; and’’; 10 (D) in paragraph (4), as redesignated by 11 subparagraph (B), by inserting before the pe- 12 riod at the end the following: ‘‘nor increase 13 health disparities experienced by low-income, 14 minority, or rural beneficiaries’’; and 15 (E) in the matter following paragraph (4), 16 as redesignated by subparagraph (B), by insert- 17 ing ‘‘, improve access to care,’’ after ‘‘care’’; 18 and 19 (4) in subsection (g)— 20 (A) by inserting ‘‘(or, beginning with 2022, 21 once every year thereafter)’’ after ‘‘thereafter’’; 22 and 23 (B) by adding at the end the following new 24 sentence: ‘‘For reports for 2022 and each sub- 25 VerDate Sep 11 2014 06:17 Dec 08, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S4944.IS S4944 pbinns on DSKJLVW7X2PROD with BILLS 7 •S 4944 IS sequent year, each such report shall include in- 1 formation on the following: 2 ‘‘(1) The extent and severity of minority and 3 rural health disparities in Medicare and Medicaid 4 beneficiaries. 5 ‘‘(2) The interventions that address social de- 6 terminants of health in payment models selected by 7 the Center for Medicare and Medicaid Innovation for 8 testing. 9 ‘‘(3) The interventions that address social de- 10 terminants of health in payment models not selected 11 by the Center for Medicare and Medicaid Innovation 12 for testing. 13 ‘‘(4) The effectiveness of interventions in miti- 14 gating negative health outcomes and higher costs as- 15 sociated with social determinants of health within 16 models selected by the Center for Medicare and 17 Medicaid Innovation for testing. 18 ‘‘(5) Changes in disparities among minorities 19 and Medicare and Medicaid beneficiaries in under- 20 served areas that are attributable to provider and 21 supplier participation in a Phase II model. 22 ‘‘(6) In consultation with the Comptroller Gen- 23 eral of the United States, estimated Federal savings 24 VerDate Sep 11 2014 06:17 Dec 08, 2020 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S4944.IS S4944 pbinns on DSKJLVW7X2PROD with BILLS 8 •S 4944 IS achieved through the reduction of rural and minority 1 health disparities. 2 ‘‘(7) Other areas determined appropriate by the 3 Secretary.’’. 4 Æ VerDate Sep 11 2014 06:17 Dec 08, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6301 E:\BILLS\S4944.IS S4944 pbinns on DSKJLVW7X2PROD with BILLS