[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9285 Introduced in House (IH)]
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117th CONGRESS
2d Session
H. R. 9285
To provide payment for patient navigator services under title XIX of
the Social Security Act, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
November 10, 2022
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 Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Patient Navigation Assistance Act''.
SEC. 2. MEDICAID COVERAGE FOR PATIENT NAVIGATOR SERVICES.
(a) In General.--Section 1902(a) of the Social Security Act (42
U.S.C. 1396a(a)) is amended--
(1) in paragraph (86), by striking ``and'' at the end;
(2) in paragraph (87), by striking at the end the period
and inserting ``; and'';
(3) by inserting after paragraph (87) the following new
paragraph:
``(88) provide that the State shall reimburse an eligible
entity (as defined in subsection (tt)(1)) for any patient
navigator service (as defined in subsection (tt)(3)) that is
provided--
``(A) to an individual who is eligible for medical
assistance under the State plan; and
``(B) by a patient navigator (as defined in
subsection (tt)(2)) through the eligible entity.''; and
(4) by adding at the end the following new subsection:
``(tt) Patient Navigator Services Definitions.--For purposes of
this section:
``(1) Eligible entity.--The term `eligible entity' means an
entity that--
``(A) is an eligible entity (as defined in
subsection (l)(1) of section 340A of the Public Health
Service Act); and
``(B) complies with the following requirements of
such section (insofar as they apply to a grant
recipient under such section):
``(i) Subsection (b) (relating to patient
navigator duties and community knowledge).
``(ii) Subsection (c) (relating to
prohibitions).
``(iii) Subsection (e) (relating to
applications).
``(iv) Subsection (j)(3) (relating to
reports).
``(2) Patient navigator.--
``(A) In general.--The term `patient navigator'
means an individual who--
``(i) is employed by a health care or
community-based organization and provides
individualized education and resources to
facilitate informed decision-making and timely
access to quality health and psychosocial care;
and
``(ii) has obtained and complies with
education, licensure, or certification,
including at least--
``(I) a bachelor's degree in
nursing from an accredited university,
master's degree in social work from an
accredited university, or bachelor's
degree in a health-related field from
an accredited university;
``(II) licensing and certification
requirements for a registered nurse,
social work, or clinical practitioner,
as applicable, and scope of practice
requirements, as defined by the State
or jurisdiction in which the individual
is licensed or certified;
``(III) completion of competency-
based navigation training sessions or
courses for clinical or non-clinical
professionals, as applicable; or
``(IV) subject to subparagraph (B),
completion of a training program
approved by the Secretary for purposes
of section 340A(l)(3) of the Public
Health Service Act.
``(B) Transitional limitation.--The training
described in subclause (IV) of subparagraph (A)(ii)
shall not satisfy the requirement of subparagraph
(A)(ii) after the date that is 3 years after the date
on which the provisions of this subsection apply to
patient navigator services pursuant to section 2(c) of
the Patient Navigator Assistance Act.
``(3) Patient navigator services.--The term `patient
navigator service' means a service provided by a patient
navigator to an individual, including--
``(A) referrals and related activities to help the
individual obtain needed services, including activities
that help link the individual with medical, social,
logistical, financial, or other programs or services to
address identified or specified needs of the
individual;
``(B) services specified under paragraphs (1)
through (6) of subsection (b) of section 340A of the
Public Health Service Act; and
``(C) other services specified by the Secretary.''.
(b) Treatment as Medical Assistance for Purposes of FMAP.--Section
1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended--
(1) in paragraph (30), by striking ``and'' at the end;
(2) by redesignating paragraph (31) as paragraph (32); and
(3) by inserting after paragraph (30) the following new
paragraph:
``(31) patient navigator services (as defined in section
1902(tt)(3)) that are provided in a manner that meets the
requirements of section 1902(a)(88); and''.
(c) Effective Date.--
(1) In general.--Subject to paragraph (2), the amendments
made by this section shall apply to patient navigator services
provided after the first day of the first calendar year that
begins after the date of enactment of this Act.
(2) Exception for state legislation.--In the case of a
State plan under title XIX of the Social Security Act, which
the Secretary of Health and Human Services determines requires
State legislation in order for the respective plan to meet any
requirement imposed by amendments made by this Act, the
respective plan shall not be regarded as failing to comply with
the requirements of such title solely on the basis of its
failure to meet such an additional requirement before the first
day of the first calendar quarter beginning after the close of
the first regular session of the State legislature that begins
after the date of enactment of this Act. For purposes of the
previous sentence, in the case of a State that has a 2-year
legislative session, each year of the session shall be
considered to be a separate regular session of the State
legislature.
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