[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 3892 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
2d Session
S. 3892
To amend titles XVIII and XIX of the Social Security Act to increase
access to community health workers under the Medicare and Medicaid
programs.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 7, 2024
Mr. Casey introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend titles XVIII and XIX of the Social Security Act to increase
access to community health workers under the Medicare and Medicaid
programs.
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 ``Community Health Worker Access
Act''.
SEC. 2. COVERAGE OF COMMUNITY HEALTH SERVICES UNDER PART B OF THE
MEDICARE PROGRAM.
(a) Coverage of Services.--
(1) In general.--Section 1861(s)(2) of the Social Security
Act (42 U.S.C. 1395x(s)(2)) is amended--
(A) in subparagraph (II), by striking ``subsection
(lll)(3))'' and all that follows and inserting
``subsection (lll)(3));'';
(B) in subparagraph (JJ), by inserting ``and''
after the semicolon at the end; and
(C) by adding at the end the following new
subparagraph:
``(KK) community health services (as defined in subsection
(nnn)(1)) furnished on or after January 1, 2025;''.
(2) Definitions.--Section 1861 of the Social Security Act
(42 U.S.C. 1395x) is amended by adding at the end the following
new subsection:
``(nnn) Community Health Services; Community Health Agency.--
``(1) Community health services.--
``(A) In general.--The term `community health
services' means the services described in subparagraph
(B) that are furnished--
``(i) by a community health agency (as
defined in paragraph (2)); and
``(ii) in accordance with an individual
needs assessment that meets requirements
established by the Secretary and is conducted
under the supervision of an applicable
provider; and
``(B) Services described.--The services described
in this subparagraph are the following:
``(i) Preventive services.--Diagnostic,
screening, and preventive services to prevent
illness, disease, injury, or any other physical
or mental health condition, reduce physical or
mental disability, and restore an individual to
the best possible functional level, including
the following:
``(I) Services described in section
1905(a)(13).
``(II) Containment of infectious
disease outbreaks, including providing
in-language, culturally specific, and
trusted support services, such as
public health outreach.
``(III) Direct provision of
screenings and basic health services,
as recommended by an applicable
provider.
``(IV) Provision of coaching and
social support, such as support for
individuals to obtain health care,
support to reduce stress and social
isolation, support for self-management
of disease, and other support necessary
for the prevention and management of
health conditions.
``(V) Care coordination and
connection to preventive care services,
including for chronic conditions, such
as diabetes, asthma, chronic
obstructive pulmonary disease,
congestive heart disease, autoimmune
disease, or behavioral health
conditions.
``(VI) Facilitation of
transportation to needed services.
``(VII) Promotion of healthy
behaviors, such as physical activity
and smoking cessation.
``(VIII) Case management and
linkage to resources that connect
people with disabilities to assistive
technology, home modifications, and
other adaptations to increase their
ability to live independently in the
community.
``(IX) Provision of support for
health literacy and cross-cultural
communication.
``(X) Provision of culturally and
linguistically appropriate health
education.
``(XI) Other services, as the
Secretary determines appropriate to
preserve and improve individual and
public health.
``(ii) Services to address social
determinants of health.--Services to address
social determinants of health, including the
following:
``(I) Assessment of individual and
community needs and communicating
identified needs to public health,
health care, and social service
agencies.
``(II) Provision of outreach and
education regarding health insurance,
and other health and social service
systems.
``(III) Provision of education,
assessment of needs, and social support
through home visiting.
``(IV) Provision of case management
(as defined in section 1915(g)(2)) and
linkage to resources to alleviate
financial strain, including food,
housing, child services, technology,
educational services, employment
services, and other services.
``(V) Identification of underserved
populations and referring them to
appropriate health care agencies and
community-based programs and
organizations in order to increase
access to quality health and social
services and to streamline care,
including serving as a liaison between
individuals and communities and health
and social service organizations.
``(C) Applicable provider.--For purposes of
subparagraphs (A)(ii) and (B)(i)(III), the term
`applicable provider' means--
``(i) a physician (as defined in section
1861(r));
``(ii) a physician assistant, a nurse
practitioner; and a clinical nurse specialist
(as such terms are defined in section
1861(aa)(5)); and
``(iii) any other practitioner described in
section 1842(b)(18)(C) that the Secretary
determines appropriate.
``(2) Community health agency.--The term `community health
agency' means an entity, including a community-based
organization, a nonprofit organization, an urban Indian
organization, a community health worker network, a Federally
qualified health center, a rural health clinic, a local or
State public health department, an academic institution, a
health care provider, and any other organization deemed
appropriate by the Secretary, that meets requirements
established by the Secretary, which may include the following
requirements:
``(A) The entity provides for the employment of
health workers who share lived experiences with the
community served and minimize barriers to employment,
including formal educational requirements.
``(B) The entity provides for market wage
compensation and professional development and career
advancement opportunities for health workers, as well
as training on core competencies.
``(C) The entity has established work practices and
manageable caseloads that allow health workers to
provide tailored, holistic, person-centered support.
``(D) The entity ensures--
``(i) the safety of health workers, in
accordance with applicable fair labor laws;
``(ii) the supervision, coaching, and
evaluation of health workers, through the use
of evidence-informed process and outcome
indicators developed in consultation with
community health workers, promotoras, and
community health representatives (as such terms
are defined in section 1903(cc)(4)); and
``(iii) leadership and engagement of health
workers in organization- and program-level
decision making, including decision making
related to the improvement of processes and
outcomes.''.
(3) Amount of payment.--Section 1833(a)(1) of the Social
Security Act (42 U.S.C. 1395l(a)(1)) is amended--
(A) by striking ``and'' before ``(HH)''; and
(B) by inserting before the semicolon: ``, and (II)
with respect to community health services under section
1861(s)(2)(KK), the amounts paid shall be 100 percent
of the lesser of the actual charge for the services or
the amount determined under a fee schedule established
by the Secretary for such services''.
(4) Waiver of application of deductible.--The first
sentence of section 1833(b) of the Social Security Act (42
U.S.C. 1395l(b)) is amended--
(A) by striking ``, and (13)'' and inserting
``(13)''; and
(B) by striking ``1861(n)..'' and inserting
``1861(n), and (14) such deductible shall not apply
with respect to community health services (as defined
in section 1861(nnn)(1)).''.
SEC. 3. STATE MEDICAID OPTION TO SUPPORT COMMUNITY HEALTH WORKFORCE FOR
SUSTAINABLE COMMUNITY HEALTH.
Section 1903 of the Social Security Act (42 U.S.C. 1396b) is
amended by adding at the end the following new subsection:
``(cc) Community Health Workforce Support.--
``(1) In general.--Notwithstanding section 1902(a)(1)
(relating to statewideness), section 1902(a)(10)(B) (relating
to comparability), and any other provision of this title that
the Secretary determines is necessary to waive in order to
implement this subsection, beginning January 1, 2025, a State,
at its option as a State plan amendment, may provide for
medical assistance for preventive services and services to
address the social determinants of health furnished by a
community health worker, promotora, or community health
representative.
``(2) Guidance.--The Secretary shall issue guidance on the
components that are necessary for a State plan amendment to
receive approval under this subsection, including:
``(A) Plans to recruit community health agencies
for the provision of preventive services and services
to address the social determinants of health that are
furnished by a community health worker, promotora, or
community health representative.
``(B) Plans to make medical assistance available
for each category of preventive services and services
to address the social determinants of health.
``(C) Plans to ensure that the preventive services
furnished by community health workers, promotoras, or
community health representatives under the amendment
will respond to public health emergencies.
``(D) Plans to minimize barriers to community
health worker, promotora, or community health
representative program participation in the State plan,
such as by providing guidance and technical assistance
on requirements for participation.
``(E) Plans to coordinate with and build the
capacity of community health worker networks within the
state or region.
``(F) Plans to address barriers to participation
experienced by community health agencies that do not
bill insurance for other services, such as community-
based and nonprofit organizations, academic
institutions, faith-based organizations, tribal
organizations, or other organizations that employ
community health workers, promotoras, or community
health representatives, including by implementing a
mechanism to reimburse such community health agencies
for preventive services and services to address the
social determinants of health.
``(3) Increased fmap.--
``(A) In general.--Notwithstanding section 1905(b),
for calendar quarters beginning on or after January 1,
2025, the Federal medical assistance percentage
determined under such section for a State shall be
increased by 6 percentage points with respect to
amounts expended by the State for medical assistance
for preventive services and services to address the
social determinants of health furnished by a community
health worker, promotora, or community health
representative that is provided in accordance with a
State plan amendment approved under this subsection or
otherwise provided in accordance with the guidance
issued under paragraph (2).
``(B) Exclusion of amounts attributable to
increased fmap from territorial caps.--With respect to
payments made to a territory for expenditures for
medical assistance described in subparagraph (A), the
portion of such payment that exceeds the amount that
would have been paid without regard to the increase in
the Federal medical assistance percentage under such
subparagraph shall not be taken into account for
purposes of applying payment limits under subsections
(f) and (g) of section 1108.
``(4) Definitions.-- In this subsection:
``(A) Community health agency.--The term `community
health agency' has the meaning given that term in
section 1861(nnn).
``(B) Community health representative.--The term
`community health representative' means a frontline
health worker who is a trusted member of a tribal
community with a close understanding of the community,
language, and traditions that enables the worker to
serve as a liaison between health and social services
and the community, facilitate access to services, and
improve the quality and cultural competence of service
delivery.
``(C) Community health worker.--The term `community
health worker' means a frontline health worker who is a
trusted member of the community in which the worker
serves or who has an unusually close understanding of
the community served that enables the worker to build
trusted relationships, serve as a liaison between
health and social services and the community,
facilitate access to services, and improve the quality
and cultural competence of service delivery.
``(D) Community health worker network.--The term
`community health worker network' means a statewide,
regional, or local association or coalition with
leadership and membership that is composed of at least
50 percent community health workers, promotoras, or
community health representatives and whose activities
include training, workforce development, mentoring, and
other initiatives to support community health worker,
promotora, and community health representative
programs.
``(E) Preventive services.--The term `preventive
services' means services described in clause (i) of
section 1861(nnn)(1)(B).
``(F) Promotora.--The term `promotora' means a
trusted frontline worker who primarily works in
Spanish-speaking communities and who shares lived
experiences, language, and culture with the populations
served that enables the worker to improve individual,
family and community health outcomes by serving as a
liaison between health and social services and the
community, facilitating access to services, and
improving the quality and cultural competence of
service delivery.
``(G) Services to address the social determinants
of health.--The term `services to address the social
determinants of health' means services described in
clause (ii) of section 1861(nnn)(1)(B).''.
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