II 

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. 

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 ‘‘John Lewis Equality 

5 in Medicare and Medicaid Treatment Act of 2023’’. 


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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)— 

6 (A) in the last sentence of paragraph (1), 

7 by inserting ‘‘advance health equity and’’ before 

8 ‘‘improve the coordination’’; and 

9 (B) in the first sentence of paragraph 

10 (3)— 

11 (i) by inserting ‘‘(including the Office 

12 of Minority Health of the Centers for 

13 Medicare & Medicaid Services, the Office 

14 of Rural Health Policy of the Health Re15 sources and Services Administration, and 

16 the Office on Women’s Health of the De17 partment of Health and Human Services)’’ 

18 after ‘‘relevant Federal agencies’’; and 

19 (ii) by striking ‘‘experts with expertise 

20 in medicine’’ and inserting ‘‘experts with 

21 expertise in medicine, the causes of health 

22 disparities and the social determinants of 

23 health, and’’; 

24 (2) in subsection (b)— 

25 (A) in paragraph (2)— 

26 (i) in subparagraph (A)— 


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1 (I) by inserting the following 

2 after the first sentence: ‘‘Prior to se3 lecting a model under this paragraph, 

4 the Secretary shall consult with the 

5 Office of Minority Health of the Cen6 ters for Medicare & Medicaid Services, 

7 the Office of Rural Health Policy of 

8 the Health Resources and Services 

9 Administration, and the Office on 

10 Women’s Health of the Department of 

11 Health and Human Services to ensure 

12 that models under consideration ad13 dress health disparities and social de14 terminants of health as appropriate 

15 for populations to be cared for under 

16 the model.’’; 

17 (II) by inserting ‘‘and, for models 

18 for which testing begins on or after 

19 January 1, 2024, address health eq20 uity as well as improving access to 

21 care received by individuals receiving 

22 benefits under such title’’ after ‘‘appli23 cable title’’; and 

24 (III) by adding at the end the 

25 following: ‘‘The models selected under 


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1 this subparagraph shall include the 

2 social determinants of health payment 

3 model described in subsection (h), the 

4 testing of which shall begin not later 

5 than December 31, 2024.’’; and 

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

7 the end the following new clauses: 

8 ‘‘(ix) Whether the model will affect 

9 access to care from providers and suppliers 

10 caring for high risk patients or operating 

11 in underserved areas. 

12 ‘‘(x) Whether the model has the po13 tential to reduce health disparities, includ14 ing minority and rural health disparities.’’; 

15 (B) in paragraph (3)(B)— 

16 (i) in clause (i), by inserting ‘‘or 

17 health equity’’ after ‘‘quality of care’’; 

18 (ii) in clause (ii), by inserting ‘‘or in19 creasing health inequities’’ after ‘‘quality 

20 of care’’; and 

21 (iii) in clause (iii), by inserting ‘‘or 

22 health equity’’ after ‘‘quality of care’’; and 

23 (C) in paragraph (4)(A)— 

24 (i) in clause (i), by striking ‘‘; and’’ 

25 and inserting a semicolon; 


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1 (ii) in clause (ii), by striking the pe2 riod and inserting ‘‘; and’’; and 

3 (iii) by adding at the end the fol4 lowing new clause: 

5 ‘‘(iii) for models for which testing be6 gins on or after January 1, 2024, the ex7 tent to which the model improves health 

8 equity.’’; 

9 (3) in subsection (c)— 

10 (A) in paragraph (1)— 

11 (i) in subparagraph (A), by inserting 

12 ‘‘or, beginning on or after January 1, 

13 2024, increasing health inequities’’ before 

14 the semicolon; and 

15 (ii) in subparagraph (B), by inserting 

16 ‘‘or, beginning on or after January 1, 

17 2024, health equity’’ after ‘‘patient care’’; 

18 and 

19 (B) in paragraph (3), by inserting ‘‘or in20 crease health disparities experienced by bene21 ficiaries, including low-income, minority, or 

22 rural beneficiaries, or that such expansion 

23 would improve health equity’’ before the period; 

24 (4) in subsection (g), by adding at the end the 

25 following: ‘‘For reports submitted after the date of 


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1 enactment of the John Lewis Equality in Medicare 

2 and Medicaid Treatment Act of 2023, each such re3 port shall include information on the following: 

4 ‘‘(1) The interventions that address social de5 terminants of health, health disparities, or health eq6 uity in payment models selected by the CMI for test7 ing under this section. 

8 ‘‘(2) Estimated Federal savings achieved 

9 through reducing disparities, including rural and mi10 nority health disparities, improving health equity, or 

11 addressing social determinants of health. 

12 ‘‘(3) The effectiveness of interventions in miti13 gating negative health outcomes and higher costs as14 sociated with social determinants of health within 

15 models selected by the Center for Medicare and 

16 Medicaid Innovation for testing. 

17 ‘‘(4) Other areas determined appropriate by the 

18 Secretary.’’; and 

19 (5) by adding at the end the following new sub20 section: 

21 ‘‘(h) SOCIAL DETERMINANTS OF HEALTH PAYMENT

22 MODEL.— 

23 ‘‘(1) IN GENERAL.—The social determinants of 

24 health payment model described in this subsection is 

25 a payment model that tests each of the payment and 


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1 service delivery innovations described in paragraph 

2 (2) in a region determined appropriate by the Sec3 retary. 

4 ‘‘(2) PAYMENT AND SERVICE DELIVERY INNO5 VATIONS DESCRIBED.—For purposes of paragraph 

6 (1), the payment and service delivery innovations de7 scribed in this clause are the following: 

8 ‘‘(A) Payment and service delivery innova9 tions for behavioral health services, focusing on 

10 gathering actionable data to address the higher 

11 costs associated with beneficiaries with diag12 nosed behavioral conditions. 

13 ‘‘(B) Payment and service delivery innova14 tions targeting conditions or comorbidities of 

15 individuals entitled or enrolled under the Medi16 care program under title XVIII and enrolled 

17 under a State plan under the Medicaid program 

18 under title XIX to increase capacity in under19 served areas. 

20 ‘‘(C) Payment and service delivery innova21 tions targeting conditions or comorbidities of 

22 applicable individuals to increase capacity in 

23 underserved areas. 

24 ‘‘(D) Payment and service delivery innova25 tions targeted on Medicaid eligible pregnant 


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1 and postpartum women, up to one year after 

2 delivery.’’. 

Æ 


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