[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 1296 Introduced in Senate (IS)]
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118th CONGRESS
1st Session
S. 1296
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
April 26, 2023
Mr. Booker (for himself, Mr. Padilla, and Mr. Brown) 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 Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``John Lewis Equality in Medicare and
Medicaid Treatment Act of 2023''.
SEC. 2. IMPROVING ACCESS TO CARE FOR MEDICARE AND MEDICAID
BENEFICIARIES.
Section 1115A of the Social Security Act (42 U.S.C. 1315a) is
amended--
(1) in subsection (a)--
(A) in the last sentence of paragraph (1), by
inserting ``advance health equity and'' before
``improve the coordination''; and
(B) in the first sentence of paragraph (3)--
(i) by inserting ``(including the Office of
Minority Health of the Centers for Medicare &
Medicaid Services, the Office of Rural Health
Policy of the Health Resources and Services
Administration, and the Office on Women's
Health of the Department of Health and Human
Services)'' after ``relevant Federal
agencies''; and
(ii) by striking ``experts with expertise
in medicine'' and inserting ``experts with
expertise in medicine, the causes of health
disparities and the social determinants of
health, and'';
(2) in subsection (b)--
(A) in paragraph (2)--
(i) in subparagraph (A)--
(I) by inserting the following
after the first sentence: ``Prior to
selecting a model under this paragraph,
the Secretary shall consult with the
Office of Minority Health of the
Centers for Medicare & Medicaid
Services, the Office of Rural Health
Policy of the Health Resources and
Services Administration, and the Office
on Women's Health of the Department of
Health and Human Services to ensure
that models under consideration address
health disparities and social
determinants of health as appropriate
for populations to be cared for under
the model.'';
(II) by inserting ``and, for models
for which testing begins on or after
January 1, 2024, address health equity
as well as improving access to care
received by individuals receiving
benefits under such title'' after
``applicable title''; and
(III) by adding at the end the
following: ``The models selected under
this subparagraph shall include the
social determinants of health payment
model described in subsection (h), the
testing of which shall begin not later
than December 31, 2024.''; and
(ii) in subparagraph (C), by adding at the
end the following new clauses:
``(ix) Whether the model will affect access
to care from providers and suppliers caring for
high risk patients or operating in underserved
areas.
``(x) Whether the model has the potential
to reduce health disparities, including
minority and rural health disparities.'';
(B) in paragraph (3)(B)--
(i) in clause (i), by inserting ``or health
equity'' after ``quality of care'';
(ii) in clause (ii), by inserting ``or
increasing health inequities'' after ``quality
of care''; and
(iii) in clause (iii), by inserting ``or
health equity'' after ``quality of care''; and
(C) in paragraph (4)(A)--
(i) in clause (i), by striking ``; and''
and inserting a semicolon;
(ii) in clause (ii), by striking the period
and inserting ``; and''; and
(iii) by adding at the end the following
new clause:
``(iii) for models for which testing begins
on or after January 1, 2024, the extent to
which the model improves health equity.'';
(3) in subsection (c)--
(A) in paragraph (1)--
(i) in subparagraph (A), by inserting ``or,
beginning on or after January 1, 2024,
increasing health inequities'' before the
semicolon; and
(ii) in subparagraph (B), by inserting
``or, beginning on or after January 1, 2024,
health equity'' after ``patient care''; and
(B) in paragraph (3), by inserting ``or increase
health disparities experienced by beneficiaries,
including low-income, minority, or rural beneficiaries,
or that such expansion would improve health equity''
before the period;
(4) in subsection (g), by adding at the end the following:
``For reports submitted after the date of enactment of the John
Lewis Equality in Medicare and Medicaid Treatment Act of 2023,
each such report shall include information on the following:
``(1) The interventions that address social determinants of
health, health disparities, or health equity in payment models
selected by the CMI for testing under this section.
``(2) Estimated Federal savings achieved through reducing
disparities, including rural and minority health disparities,
improving health equity, or addressing social determinants of
health.
``(3) The effectiveness of interventions in mitigating
negative health outcomes and higher costs associated with
social determinants of health within models selected by the
Center for Medicare and Medicaid Innovation for testing.
``(4) Other areas determined appropriate by the
Secretary.''; and
(5) by adding at the end the following new subsection:
``(h) Social Determinants of Health Payment Model.--
``(1) In general.--The social determinants of health
payment model described in this subsection is a payment model
that tests each of the payment and service delivery innovations
described in paragraph (2) in a region determined appropriate
by the Secretary.
``(2) Payment and service delivery innovations described.--
For purposes of paragraph (1), the payment and service delivery
innovations described in this clause are the following:
``(A) Payment and service delivery innovations for
behavioral health services, focusing on gathering
actionable data to address the higher costs associated
with beneficiaries with diagnosed behavioral
conditions.
``(B) Payment and service delivery innovations
targeting conditions or comorbidities of individuals
entitled or enrolled under the Medicare program under
title XVIII and enrolled under a State plan under the
Medicaid program under title XIX to increase capacity
in underserved areas.
``(C) Payment and service delivery innovations
targeting conditions or comorbidities of applicable
individuals to increase capacity in underserved areas.
``(D) Payment and service delivery innovations
targeted on Medicaid eligible pregnant and postpartum
women, up to one year after delivery.''.
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