I 

116TH CONGRESS 

1ST SESSION H. R. 4830 

To provide payment for patient navigator services under title XIX of the 

Social Security Act, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 23, 2019 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Patient Navigation As5 sistance Act’’. 

6 SEC. 2. MEDICAID COVERAGE FOR PATIENT NAVIGATOR 

7 SERVICES. 

8 (a) IN GENERAL.—Section 1902(a) of the Social Se9 curity Act (42 U.S.C. 1396a(a)) is amended— 


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1 (1) in paragraph (82), by striking ‘‘and’’ at the 

2 end; 

3 (2) in paragraph (83), by striking at the end 

4 the period and inserting ‘‘; and’’; and 

5 (3) by inserting after paragraph (83) the fol6 lowing new paragraph: 

7 ‘‘(84) provide that the State shall reimburse an 

8 eligible entity (as defined in subsection (nn)(1)) for 

9 any patient navigator service (as defined in sub10 section (nn)(3)) that is provided— 

11 ‘‘(A) to an individual who is eligible for 

12 medical assistance under the State plan; and 

13 ‘‘(B) by a patient navigator (as defined in 

14 subsection (nn)(2)) through the eligible entity.’’; 

15 and 

16 (4) by adding at the end the following new sub17 section: 

18 ‘‘(nn) PATIENT NAVIGATOR SERVICES DEFINI19 TIONS.—For purposes of this section: 

20 ‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en21 tity’ means an entity that— 

22 ‘‘(A) is an eligible entity (as defined in 

23 subsection (l)(1) of section 340A of the Public 

24 Health Service Act); and 


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1 ‘‘(B) complies with the following require2 ments of such section (insofar as they apply to 

3 a grant recipient under such section): 

4 ‘‘(i) Subsection (b) (relating to patient 

5 navigator duties and community knowl6 edge). 

7 ‘‘(ii) Subsection (c) (relating to prohi8 bitions). 

9 ‘‘(iii) Subsection (e) (relating to appli10 cations). 

11 ‘‘(iv) Subsection (j)(3) (relating to re12 ports). 

13 ‘‘(2) PATIENT NAVIGATOR.— 

14 ‘‘(A) IN GENERAL.—The term ‘patient 

15 navigator’ has the meaning given such term in 

16 section 340A(l)(3) of the Public Health Service 

17 Act. 

18 ‘‘(B) CONSULTATION WITH ADVISORY COM19 MITTEE.— 

20 ‘‘(i) IN GENERAL.—The Secretary 

21 shall consult with the patient navigation 

22 advisory committee to the extent necessary 

23 to further clarify the definition of the term 

24 ‘patient navigator’ for purposes of this sec25 tion, including establishing requirements to 


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1 ensure adequate training for such naviga2 tors, such as developing a training cur3 riculum and determining required quali4 fications and maintenance of qualifications. 

5 ‘‘(ii) MEMBERSHIP.—The Secretary 

6 shall convene a patient navigation advisory 

7 committee. The members of such com8 mittee shall include— 

9 ‘‘(I) representatives from relevant 

10 Federal departments and agencies, in11 cluding the National Institutes of 

12 Health, the Centers for Disease Con13 trol and Prevention, the Health Re14 sources and Services Administration, 

15 the Centers for Medicare & Medicaid 

16 Services, the Indian Health Service, 

17 and the Office of Rural Health Policy 

18 of the Department of Health and 

19 Human Services; and 

20 ‘‘(II) physicians, nurses, stake21 holder groups, and other individuals 

22 and representatives of public and pri23 vate organizations with expertise in 

24 patient navigation. 


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1 ‘‘(3) PATIENT NAVIGATOR SERVICES.—The 

2 term ‘patient navigator service’ means a service that 

3 is a duty specified under paragraphs (1) through (6) 

4 of subsection (b) of section 340A of the Public 

5 Health Service Act and that is provided by a patient 

6 navigator through an eligible entity.’’. 

7 (b) TREATMENT AS MEDICAL ASSISTANCE FOR PUR8 POSES OF FMAP.—Section 1905(a) of the Social Security 

9 Act (42 U.S.C. 1396d(a)) is amended— 

10 (1) in paragraph (28), by striking ‘‘and’’ at the 

11 end; 

12 (2) by redesignating paragraph (29) as para13 graph (30); and 

14 (3) by inserting after paragraph (28) the fol15 lowing new paragraph: 

16 ‘‘(29) patient navigator services (as defined in 

17 section 1902(nn)(3)) that are provided in a manner 

18 that meets the requirements of section 1902(a)(84); 

19 and’’. 

20 (c) EFFECTIVE DATE.— 

21 (1) IN GENERAL.—Subject to paragraph (2), 

22 the amendments made by this section shall apply to 

23 patient navigator services provided after the first 

24 day of the first calendar year that begins after the 

25 date of enactment of this Act. 


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1 (2) EXCEPTION FOR STATE LEGISLATION.—In 

2 the case of a State plan under title XIX of the So3 cial Security Act, which the Secretary of Health and 

4 Human Services determines requires State legisla5 tion in order for the respective plan to meet any re6 quirement imposed by amendments made by this 

7 Act, the respective plan shall not be regarded as fail8 ing to comply with the requirements of such title 

9 solely on the basis of its failure to meet such an ad10 ditional requirement before the first day of the first 

11 calendar quarter beginning after the close of the 

12 first regular session of the State legislature that be13 gins after the date of enactment of this Act. For 

14 purposes of the previous sentence, in the case of a 

15 State that has a 2-year legislative session, each year 

16 of the session shall be considered to be a separate 

17 regular session of the State legislature. 

Æ 


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