II 

116TH CONGRESS 

2D SESSION S. 4944 

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 

DECEMBER 2, 2020 

Mr. BOOKER 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. 

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 ‘‘Equality in Medicare 

5 and Medicaid Treatment Act of 2020’’. 


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1 SEC. 2. IMPROVING ACCESS TO CARE FOR MEDICARE AND 

2 MEDICAID BENEFICIARIES. 

3 Section 1115A of the Social Security Act (42 U.S.C. 

4 1315a) is amended— 

5 (1) in subsection (a)(3), in the first sentence— 

6 (A) by inserting ‘‘the Office of Minority 

7 Health of the Centers for Medicare & Medicaid 

8 Services, the Federal Office of Rural Health 

9 Policy, the Office on Women’s Health, and 

10 other’’ after ‘‘representatives of’’; and 

11 (B) by inserting ‘‘, the causes of health 

12 disparities and social determinants of health,’’ 

13 after ‘‘medicine’’; 

14 (2) in subsection (b)— 

15 (A) in paragraph (2)— 

16 (i) in subparagraph (A)— 

17 (I) in the second sentence, by in18 serting ‘‘, as well as improving access 

19 to care received by individuals receiv20 ing benefits under such title,’’ after 

21 ‘‘applicable title’’; 

22 (II) by inserting after the first 

23 sentence, the following new sentence: 

24 ‘‘Prior to model selection, the Sec25 retary shall consult with the Office of 

26 Minority Health of the Centers for 


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1 Medicare & Medicaid Services, the 

2 Federal Office of Rural Health Policy, 

3 and the Office on Women’s Health to 

4 ensure that models under consider5 ation address health disparities and 

6 social determinants of health as ap7 propriate for populations to be cared 

8 for under the model.’’; and 

9 (III) by adding at the end the 

10 following new sentence: ‘‘The models 

11 selected under this subparagraph shall 

12 include the social determinants of 

13 health payment model described in 

14 subparagraph (D), the testing of 

15 which shall begin not later than De16 cember 31, 2021.’’; 

17 (ii) in subparagraph (C), by adding at 

18 the end the following new clauses: 

19 ‘‘(ix) Whether the model will affect 

20 access to care from providers and suppliers 

21 caring for high risk patients or operating 

22 in underserved areas. 

23 ‘‘(x) Whether the model has the po24 tential to produce reductions in minority 

25 and rural health disparities.’’; and 


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1 (iii) by adding at the end the fol2 lowing new subparagraph: 

3 ‘‘(D) SOCIAL DETERMINANTS OF HEALTH

4 PAYMENT MODEL.— 

5 ‘‘(i) IN GENERAL.—The social deter6 minants of health payment model described 

7 in this subparagraph is a payment model 

8 that tests each of the payment and service 

9 delivery innovations described in clause (ii) 

10 in a region determined appropriate by the 

11 Secretary. 

12 ‘‘(ii) PAYMENT AND SERVICE DELIV13 ERY INNOVATIONS DESCRIBED.—For pur14 poses of clause (i), the payment and serv15 ice delivery innovations described in this 

16 clause are the following: 

17 ‘‘(I) Payment and service delivery 

18 innovations for behavioral health serv19 ices, focusing on gathering actionable 

20 data to address the higher costs asso21 ciated with beneficiaries with diag22 nosed behavioral conditions. 

23 ‘‘(II) Payment and service deliv24 ery innovations targeting conditions or 

25 comorbidities of individuals entitled or 


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1 enrolled under the Medicare program 

2 under title XVIII and enrolled under 

3 a State plan under the Medicaid pro4 gram under title XIX to increase ca5 pacity in underserved areas. 

6 ‘‘(III) Payment and service deliv7 ery innovations targeted on Medicaid8 eligible pregnant and postpartum 

9 women, up to one year after deliv10 ery.’’; and 

11 (B) in paragraph (4)(A)— 

12 (i) in clause (i) at the end, by striking 

13 ‘‘and’’; 

14 (ii) in clause (ii), at the end, by strik15 ing the period and inserting ‘‘; and’’; and 

16 (iii) by adding at the end the fol17 lowing new clause: 

18 ‘‘(iii) the extent to which the model 

19 improves access to care or the extent to 

20 which the model improves care for high 

21 risk patients, patients from racial or ethnic 

22 minorities, or patients in underserved 

23 areas.’’; 

24 (3) in subsection (c)— 


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1 (A) in paragraph (2), by striking at the 

2 end ‘‘and’’; 

3 (B) by redesignating paragraph (3) as 

4 paragraph (4); 

5 (C) by inserting after paragraph (2) the 

6 following new paragraph: 

7 ‘‘(3) the Office of Minority Health of the Cen8 ters for Medicare & Medicaid Services certifies that 

9 such expansion will not reduce access to care for 

10 low-income, minority, or rural beneficiaries; and’’; 

11 (D) in paragraph (4), as redesignated by 

12 subparagraph (B), by inserting before the pe13 riod at the end the following: ‘‘nor increase 

14 health disparities experienced by low-income, 

15 minority, or rural beneficiaries’’; and 

16 (E) in the matter following paragraph (4), 

17 as redesignated by subparagraph (B), by insert18 ing ‘‘, improve access to care,’’ after ‘‘care’’; 

19 and 

20 (4) in subsection (g)— 

21 (A) by inserting ‘‘(or, beginning with 2022, 

22 once every year thereafter)’’ after ‘‘thereafter’’; 

23 and 

24 (B) by adding at the end the following new 

25 sentence: ‘‘For reports for 2022 and each subVerDate Sep 11 2014 06:17 Dec 08, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S4944.IS S4944

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1 sequent year, each such report shall include in2 formation on the following: 

3 ‘‘(1) The extent and severity of minority and 

4 rural health disparities in Medicare and Medicaid 

5 beneficiaries. 

6 ‘‘(2) The interventions that address social de7 terminants of health in payment models selected by 

8 the Center for Medicare and Medicaid Innovation for 

9 testing. 

10 ‘‘(3) The interventions that address social de11 terminants of health in payment models not selected 

12 by the Center for Medicare and Medicaid Innovation 

13 for testing. 

14 ‘‘(4) The effectiveness of interventions in miti15 gating negative health outcomes and higher costs as16 sociated with social determinants of health within 

17 models selected by the Center for Medicare and 

18 Medicaid Innovation for testing. 

19 ‘‘(5) Changes in disparities among minorities 

20 and Medicare and Medicaid beneficiaries in under21 served areas that are attributable to provider and 

22 supplier participation in a Phase II model. 

23 ‘‘(6) In consultation with the Comptroller Gen24 eral of the United States, estimated Federal savings 


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1 achieved through the reduction of rural and minority 

2 health disparities. 

3 ‘‘(7) Other areas determined appropriate by the 

4 Secretary.’’. 

Æ 


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