I 

116TH CONGRESS 

1ST SESSION H. R. 4925 

To require the Secretary of Health and Human Services to award grants 

to support community-based coverage entities to carry out a coverage 

program that provides to qualifying individuals health coverage and educational and occupational training, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 30, 2019 

Mr. HUIZENGA introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on 

Education and Labor, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

A BILL 

To require the Secretary of Health and Human Services 

to award grants to support community-based coverage 

entities to carry out a coverage program that provides 

to qualifying individuals health coverage and educational 

and occupational training, 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 ‘‘Community Multi5 share Coverage Program Act’’. 

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1 SEC. 2. GRANTS TO COMMUNITY-BASED COVERAGE ENTI2 TIES TO CARRY OUT A COVERAGE PROGRAM 

3 THAT PROVIDES HEALTH COVERAGE AND 

4 EDUCATIONAL AND OCCUPATIONAL TRAIN5 ING. 

6 (a) IN GENERAL.—Not later than 180 days after the 

7 date of the enactment of the Community Multi-share Cov8 erage Program Act, the Secretary shall award at least 3 

9 and not more than 5 grants to support community-based 

10 coverage entities to carry out qualifying coverage benefit 

11 pilot programs. Such programs shall— 

12 (1) reduce the number of uninsured individuals 

13 through hospital-community partnership initiatives 

14 that provide an affordable health coverage option for 

15 such individuals and provide a coverage transition 

16 for those limited to coverage through government17 sponsored programs; and 

18 (2) test the feasibility of moving individuals eli19 gible for medical assistance under a State plan 

20 under the Medicaid program under title XIX of the 

21 Social Security Act (42 U.S.C. 1396 et seq.) with 

22 full-time employment into such programs. 

23 (b) QUALIFYING COVERAGE BENEFIT PROGRAM RE24 QUIREMENTS.—For purposes of this section, the term 

25 ‘‘qualifying coverage benefit program’’ means a program 

26 that satisfies each of the following program requirements: 

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1 (1) HEALTH COVERAGE.—Under the program, 

2 a community-based coverage entity shall provide to 

3 qualifying individuals health coverage offered in con4 nection with a qualifying coverage benefit program 

5 that satisfies the following: 

6 (A) First-dollar coverage (where such cov7 erage is furnished by network providers and 

8 community resources) for— 

9 (i) diagnostic laboratory tests and x10 rays; 

11 (ii) emergency ambulance services 

12 that are provided by ground transpor13 tation; 

14 (iii) emergency services (as defined in 

15 section 2719A(b)(2)(B) of the Public 

16 Health Service Act (42 U.S.C. 300gg– 

17 19a(b)(2)(B))); 

18 (iv) inpatient and outpatient hospital 

19 services; 

20 (v) mental health services; 

21 (vi) physician services; 

22 (vii) population health improvement 

23 services; 

24 (viii) preventatives services; 

25 (ix) prescription drugs; and 

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1 (x) substance abuse services. 

2 (B) Coverage for— 

3 (i) community and individual assess4 ment tools to identify any negative influ5 ences of health and economic self-suffi6 ciency to assist physicians in under7 standing the social determinants of health 

8 impacting an individual; 

9 (ii) a planning process to resolve any 

10 negative influences identified pursuant to 

11 clause (i) and promote well-being through 

12 community partnerships between the com13 munity-based coverage entity and— 

14 (I) businesses; 

15 (II) educational institutions; 

16 (III) investors; 

17 (IV) local, State, and Federal 

18 governmental agencies; and 

19 (V) organizations described in 

20 section 501(c)(3) of the Internal Rev21 enue Code of 1986 that focuses on 

22 human service needs relating to be23 havioral health, poverty, education, 

24 and access and safety; 

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1 (iii) the monitoring of and support 

2 (including health coaching services and co3 ordination of services within a community 

4 to address the needs of an individual) with 

5 respect to financial, emotional, and phys6 ical health; and 

7 (iv) any other benefit the community8 based coverage entity determines appro9 priate. 

10 (2) EDUCATIONAL AND OCCUPATIONAL TRAIN11 ING.—Under the program, a community-based cov12 erage entity shall— 

13 (A) connect and foster ongoing relation14 ships between qualifying individuals and edu15 cational and occupational training (including 

16 classes, workshops, mentorships, and appren17 ticeships) designed to enhance preparation for 

18 work and support economic self-sufficiency in a 

19 manner that reflects the needs of such individ20 uals and opportunities in the community; 

21 (B) with respect to the comprehensive 

22 health improvement process described in sub23 section (e)(1)(C)(vi), identify and address bar24 riers to employment and increasing income for 

25 qualifying individuals; and 

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1 (C) measure and assess the effectiveness of 

2 the program in increasing employment and in3 creasing income for qualifying individuals. 

4 (3) BOARD OF DIRECTORS.—For the purpose of 

5 carrying out the program, the community-based cov6 erage entity shall form a board of directors, or uti7 lize an existing board of directors, in accordance 

8 with subsection (e). 

9 (c) COMMUNITY-BASED COVERAGE ENTITY.—For 

10 the purposes of this section, the term ‘‘community-based 

11 coverage entity’’ means an entity that maintains a phys12 ical presence within close geographic proximity to the indi13 viduals it is serving, with a focus on mitigating barriers 

14 to engagement by enabling face-to-face interactions be15 tween the entity staff, the individuals served, and commu16 nity organizations. 

17 (d) QUALIFYING INDIVIDUAL.—For the purposes of 

18 this section, the term ‘‘qualifying individual’’ means an in19 dividual who meets the following requirements: 

20 (1) Subject to any modification made by such 

21 program pursuant to subsection (e)(2)(C)(vii), an in22 come that exceeds 100 percent but does not exceed 

23 400 percent of the poverty line applicable to a family 

24 of the size involved. 

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1 (2) Not enrolled under a qualified health plan 

2 during the 180-day period preceding the date on 

3 which such qualifying individual seeks to enroll 

4 under the coverage program under this section. 

5 (3) Ineligibility for enrollment in a Federal 

6 health care program (including ineligibility to receive 

7 health services through the Indian Health Service). 

8 (4) Resides or works within the catchment area 

9 of a hospital described in subsection (g)(2)(C). 

10 (5) Works for a small employer that does not 

11 make enrollment in qualified health plans in the 

12 small group market such that the combined pre13 mium plus deductible cost to cover the employee’s 

14 household is less than seven percent of the employ15 ee’s household income available to its employees 

16 through— 

17 (A) in the case that a State elects to pro18 vide one exchange in the State for both quali19 fying individuals and qualified small employers 

20 pursuant to paragraph (2) of section 1311(b) of 

21 the Patient Protection and Affordable Care Act 

22 (42 U.S.C. 18031(b)), the American Health 

23 Benefit Exchange (as such term is used in 

24 paragraph (1) of such section) for the plan year 

25 in which such qualifying individual seeks health 

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1 insurance coverage described in subsection 

2 (b)(1) from a qualifying coverage benefit pro3 gram; and 

4 (B) in the case that a State retains sepa5 rate exchanges for qualifying individuals and 

6 qualified small employers, the Small Business 

7 Health Options Program (as such term is used 

8 in section 1311(b)(2) of the Patient Protection 

9 and Affordable Care Act (42 U.S.C. 

10 18031(b)(2))) for the plan year in which such 

11 qualifying individual seeks health insurance cov12 erage described in subsection (b)(1) from a 

13 qualifying coverage benefit program. 

14 (6) Any other requirement the Secretary deter15 mines appropriate. 

16 (e) BOARD OF DIRECTORS.— 

17 (1) COMPOSITION.—A board of directors 

18 formed pursuant to subsection (b)(3) shall be com19 posed of at least 9 members and not more than 15 

20 members with representation from— 

21 (A) local health care providers, of which 

22 not more than two individuals may be from the 

23 sponsoring health care organization; 

24 (B) qualifying individuals; 

25 (C) contributing employers; 

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1 (D) government representatives; 

2 (E) the local health authority; 

3 (F) local education systems; and 

4 (G) other representatives as necessary to 

5 reflect the community composition. 

6 (2) DUTIES.— 

7 (A) ENACTMENT OF BYLAWS.—A board of 

8 directors shall enact bylaws relating to— 

9 (i) public engagement with the board 

10 of directors; 

11 (ii) a shared goal of improving health 

12 access and increasing affordability; 

13 (iii) outcome-based goals for the pro14 gram that considers the needs of the com15 munity; 

16 (iv) program costs; and 

17 (v) an intent to receive comments re18 garding the health improvement goals for 

19 the community. 

20 (B) MEETINGS.—A board of directors shall 

21 meet at least bimonthly. 

22 (C) QUALIFYING COVERAGE BENEFITS

23 PROGRAM.—A board of directors shall— 

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1 (i) carry out the qualifying coverage 

2 benefit program described in subsection 

3 (b); 

4 (ii) determine the share of payments 

5 for benefits under the health coverage de6 scribed in subsection (b)(1) that are attrib7 utable to— 

8 (I) the amount awarded to a 

9 community-based coverage entity; 

10 (II) a sponsoring health care or11 ganization; 

12 (III) a qualifying individual; and 

13 (IV) an employer of a qualifying 

14 individual or a skilled trade organiza15 tion of a qualifying individual; 

16 (iii) determine the premiums and limi17 tations on payments (including deductibles 

18 and coinsurance amounts) for the health 

19 coverage described in subsection (b)(1) for 

20 a qualifying individual enrolled under such 

21 coverage and the extent, if any, to which 

22 such premiums and limitations for a quali23 fying individual shall increase as the in24 come of such qualifying individual inVerDate Sep 11 2014 20:14 Nov 12, 2019 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H4925.IH H4925
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1 creases relative to the poverty line applica2 ble to a family of the size involved; 

3 (iv) establish a procedure to— 

4 (I) assist qualifying individuals in 

5 enrolling under the health coverage 

6 described in subsection (b)(1); 

7 (II) assist a qualifying individual 

8 that does not meet the requirements 

9 of a qualified individual specified 

10 under subsection (d), is eligible for 

11 medical assistance under a State plan 

12 under the Medicaid program under 

13 title XIX of the Social Security Act 

14 (42 U.S.C. 1396 et seq.), and resides 

15 in the catchment area of the hospital 

16 described in subsection (g)(2)(C) in 

17 enrolling under the appropriate State 

18 plan under such program; 

19 (III) bill and collect the share of 

20 payments for benefits described in 

21 clause (ii); 

22 (IV) bill and collect the pre23 miums and limitations on payment de24 scribed in clause (iii); 

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1 (V) for the purposes of inte2 grating community resources, form 

3 partnerships with community popu4 lation health initiatives; 

5 (VI) remove a qualifying indi6 vidual from the health insurance cov7 erage described in subsection (b)(1) in 

8 the case the qualifying individual— 

9 (aa) has been enrolled under 

10 the qualifying covered benefits 

11 program for a 4-year period; and 

12 (bb) fails to meet the mile13 stones identified pursuant to 

14 clause (vi); and 

15 (VII) determine a maximum en16 rollment period for individual partici17 pation, including required milestones 

18 for addressing social determinants of 

19 health while enrolled; 

20 (v) for the purpose of encouraging a 

21 qualifying individual to seek a primary 

22 care physician, establish incentives for a 

23 qualifying individual to initially seek such 

24 physician for care (including the reduction 

25 of benefits until a primary care physician 

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1 is engaged in the care of such qualifying 

2 individual); 

3 (vi) for the purpose of making 

4 progress toward health and economic self5 sufficiency, establish routine milestones 

6 and supportive services (to be known as 

7 the ‘‘comprehensive health improvement 

8 process’’) that a qualifying individual en9 rolled under health coverage described in 

10 subsection (b)(1) shall meet to maintain 

11 enrollment and such milestones shall in12 clude— 

13 (I) an assessment relating to so14 cial determinants of health, health 

15 risks, and any other assessment that 

16 is appropriate as determined by the 

17 circumstances of the qualifying indi18 vidual; 

19 (II) meetings with a health coach 

20 to address social influences of health 

21 and to support the physical, emo22 tional, and financial health of the 

23 qualifying individual; 

24 (III) connections with local com25 munity linkage partners to offer 

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1 health-related programs and services; 

2 and 

3 (IV) enrollment in group classes 

4 that address barriers to physical, emo5 tional, and financial health; 

6 (vii) for the purpose of tailoring a 

7 qualifying coverage benefits program to the 

8 needs and resources of the catchment area 

9 of the hospital described in subsection 

10 (g)(2)(C), determine the extent, if any, to 

11 narrow the income range specified in sub12 section (d)(1) with respect to first-time en13 rollees and continuing enrollees; 

14 (viii) incorporate population health 

15 improvement strategies into the benefits of 

16 health coverage described in subsection 

17 (b)(1), including strategies that align with 

18 the objectives of the program of the Sec19 retary regarding health-status goals for 

20 2020, commonly referred to as Healthy 

21 People 2020; 

22 (ix) select a plan administrator pursu23 ant to subsection (g)(2)(E) to carry out 

24 administrative and accounting responsibilVerDate Sep 11 2014 20:14 Nov 12, 2019 Jkt 099200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H4925.IH H4925
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1 ities of the health coverage described in 

2 subsection (b)(1); and 

3 (x) conduct a community asset assess4 ment to determine the services to be made 

5 available in the community to address so6 cial determinants of health and the eligi7 bility requirements for such services. 

8 (3) ADVISORY COMMITTEE.—A board of direc9 tors shall establish a finance advisory committee and 

10 a clinical and population health improvement advi11 sory committee. 

12 (f) GRANT TERMS.— 

13 (1) DURATION.—A grant awarded under this 

14 section shall be made for a period of 4 years. 

15 (2) AMOUNT.—The Secretary shall determine 

16 the maximum amount of each grant awarded under 

17 subsection (a). 

18 (3) NUMBER.—The Secretary may not award 

19 more than 4 grants under subsection (a). 

20 (g) APPLICATIONS.— 

21 (1) IN GENERAL.—To be eligible to be awarded 

22 a grant under subsection (a), a community-based 

23 coverage entity shall submit to the Secretary an ap24 plication at such time, in such manner, and con25 taining the certification described in paragraph (2) 

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1 and such other information as the Secretary may re2 quire. 

3 (2) CERTIFICATION.—An application described 

4 in paragraph (1) shall include a certification by the 

5 community-based coverage entity that the entity 

6 will— 

7 (A) not impose any preexisting condition 

8 exclusion (as such term is defined in section 

9 2704(b)(1)(A)) of the Public Health Service 

10 Act (42 U.S.C. 300gg–3(b)(1)(A)) with respect 

11 to the health coverage described in subsection 

12 (b)(1); 

13 (B) not later than 2 years after the date 

14 on which a grant is awarded under subsection 

15 (a), establish a plan to measure quality and ef16 ficiency of care provided under the coverage 

17 program; 

18 (C) partner with a hospital that will estab19 lish a network of health care providers suffi20 cient to provide services to qualifying individ21 uals enrolled under the health insurance cov22 erage described in subsection (b)(1); 

23 (D) seek to provide to 7 percent of individ24 uals whose household income is more than 300 

25 percent of the poverty line for a family of the 

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1 size involved and less than the basic cost of liv2 ing (as determined in a manner consistent the 

3 ‘‘Asset Limited, Income Constrained, Em4 ployed’’ or ‘‘ALICE’’ methodology that deter5 mines the cost of a basic household budget in 

6 the county of a State in which the catchment 

7 area of the hospital described in subparagraph 

8 (C) health coverage described in subsection 

9 (b)(1) is located) for the size of the family in10 volved living in such catchment area; and 

11 (E) select an entity to carry out adminis12 trative and accounting responsibilities (includ13 ing monthly billing, verification of eligibility of 

14 qualifying individuals, enrollment of qualifying 

15 individuals, maintenance of a list of active en16 rollees, and operation of a benefit utilization 

17 management program) necessary with respect 

18 to the health insurance coverage described in 

19 subsection (b)(1). 

20 (h) REPORTING.—Not later than 1 year after the 

21 date of the enactment of this section and annually for each 

22 of the 3 succeeding years, the board of directors formed 

23 pursuant to subsection (b)(3) shall submit to the Sec24 retary a report that— 

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1 (1) evaluates the progress of the qualifying cov2 erage benefits program; and 

3 (2) evaluates measurements relating to quality 

4 and efficiency of care described in subsection 

5 (g)(2)(B) collected by the community-based coverage 

6 entity. 

7 (i) DEFINITIONS.—In this section: 

8 (1) AGENCY.—The term ‘‘agency’’ means a 

9 local, State, or Federal agency. 

10 (2) FEDERAL HEALTH CARE PROGRAM.—The 

11 term ‘‘Federal health care program’’ has the mean12 ing given such term in section 1128B(f) of the So13 cial Security Act (42 U.S.C. 1320a–7b(f)). 

14 (3) FIRST DOLLAR COVERAGE.—The term 

15 ‘‘first dollar coverage’’ means coverage of a benefit 

16 by health coverage described in subsection (b)(1) 

17 without requiring any payment by the qualifying in18 dividual. 

19 (4) HEALTH COACH.—The term ‘‘health coach’’ 

20 means an individual who is a member of the staff 

21 of the community-based coverage entity that has re22 ceived training to provide health coaching services 

23 (including health improvement program services). 

24 (5) HOSPITAL.—The term ‘‘hospital’’ means an 

25 institution that— 

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1 (A) meets the requirements of section 

2 1861(e) of the Social Security Act (42 U.S.C. 

3 1395x(e)); and 

4 (B) is an organization described in para5 graphs (c)(3) and (r)(3) of section 501 of the 

6 Internal Revenue Code of 1986 and is exempt 

7 from taxation under section 501(a) of such 

8 Code. 

9 (6) POPULATION HEALTH IMPROVEMENT SERV10 ICE.— 

11 (A) IN GENERAL.—The term ‘‘population 

12 health improvement service’’ means a service 

13 that supports the physical, emotional, and fi14 nancial health of a qualifying individual 

15 through— 

16 (i) health coaching that— 

17 (I) identifies any social deter18 minant of health that prevents a 

19 qualifying individual from obtaining 

20 physical, emotional, and financial 

21 health; 

22 (II) develops a personalized plan 

23 to improve the physical, emotional, 

24 and financial health of a qualifying in25 dividual based on the circumstances 

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1 and health domain score of such 

2 qualifying individual; and 

3 (III) measures and evaluates the 

4 health domain score of an individual; 

5 (ii) health education courses; and 

6 (iii) integrated community linkage 

7 partnerships with organizations serving the 

8 catchment area of a hospital described in 

9 subsection (g)(2)(C) that provide health 

10 programs and services to qualifying indi11 viduals that— 

12 (I) support a qualifying indi13 vidual with respect to any appropriate 

14 social determinant of health; and 

15 (II) support a qualifying indi16 vidual in job retention, including jobs 

17 in childcare and transportation. 

18 (B) HEALTH DOMAIN SCORE DEFINED.— 

19 In this paragraph, the term ‘‘health domain 

20 score’’ means a measurement of specific influ21 ences of physical, emotional, and financial 

22 health with respect to a qualifying individual. 

23 (7) QUALIFIED HEALTH PLAN.—The term 

24 ‘‘qualified health plan’’ has the meaning given such 

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1 term in section 1301(a) of the Patient Protection 

2 and Affordable Care Act (42 U.S.C. 18021(a)). 

3 (8) SECRETARY.—The term ‘‘Secretary’’ means 

4 the Secretary of Health and Human Services. 

5 (9) SMALL BUSINESS HEALTH OPTIONS PRO6 GRAM.—The term ‘‘Small Business Health Options 

7 Program’’ has the meaning given such term in sec8 tion 1311(b)(2) of the Patient Protection and Af9 fordable Care Act (42 U.S.C. 18031(b)(2)). 

10 (10) SMALL EMPLOYER.—The term ‘‘small em11 ployer’’ has the meaning given such term in section 

12 1304(b)(2) of the Patient Protection and Affordable 

13 Care Act (42 U.S.C. 18024(b)(2)). 

14 (11) SOCIAL DETERMINANTS OF HEALTH.—The 

15 term ‘‘social determinants of health’’ has the mean16 ing given such term by the Director of the Centers 

17 for Disease Control and Prevention. 

18 (j) AUTHORIZATION OF APPROPRIATIONS.—There is 

19 authorized to be appropriated to carry out this section— 

20 (1) $4,800,000 for fiscal year 2020; 

21 (2) $7,200,000 for fiscal year 2021; and 

22 (3) $12,000,000 for each of fiscal years 2022 

23 and 2023. 

Æ