I 

113TH CONGRESS 

2D SESSION H. R. 4168 

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

Social Security Act, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 6, 2014 

Mr. ISRAEL 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 of 2014’’. 

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) by inserting after paragraph (77) the fol2 lowing new paragraph: 

3 ‘‘(78) provide that the State shall reimburse an 

4 eligible entity (as defined in subsection (ll)(1)) for 

5 any patient navigator service (as defined in sub6 section (ll)(3)) that is provided— 

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

8 medical assistance under the State plan; and 

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

10 subsection (ll)(2)) through the eligible entity.’’; 

11 and 

12 (2) by adding at the end the following new sub13 section: 

14 ‘‘(ll) PATIENT NAVIGATOR SERVICES DEFINI15 TIONS.—For purposes of this section: 

16 ‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en17 tity’ means an entity that— 

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

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

20 Health Service Act); and 

21 ‘‘(B) complies with the following require22 ments of such section (insofar as they apply to 

23 a grant recipient under such section): 


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

2 navigator duties and community knowl3 edge). 

4 ‘‘(ii) Subsection (c) (relating to prohi5 bitions). 

6 ‘‘(iii) Subsection (e) (relating to appli7 cations). 

8 ‘‘(iv) Subsection (j)(3) (relating to re9 ports). 

10 ‘‘(2) PATIENT NAVIGATOR.— 

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

12 navigator’ has the meaning given such term in 

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

14 Act. 

15 ‘‘(B) CONSULTATION WITH ADVISORY COM16 MITTEE.— 

17 ‘‘(i) IN GENERAL.—The Secretary 

18 shall consult with the patient navigation 

19 advisory committee to the extent necessary 

20 to further clarify the definition of the term 

21 ‘patient navigator’ for purposes of this sec22 tion, including establishing requirements to 

23 ensure adequate training for such naviga24 tors, such as developing a training cur25 riculum. 


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1 ‘‘(ii) MEMBERSHIP.—The Secretary 

2 shall convene a patient navigation advisory 

3 committee. The members of such com4 mittee shall include— 

5 ‘‘(I) representatives from relevant 

6 Federal departments and agencies, in7 cluding the National Institutes of 

8 Health, the Centers for Disease Con9 trol and Prevention, the Health Re10 sources and Services Administration, 

11 and the Centers for Medicare & Med12 icaid Services; and 

13 ‘‘(II) individuals and representa14 tives of public and private organiza15 tions with expertise in patient naviga16 tion. 

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

18 term ‘patient navigator service’ means a service that 

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

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

21 Health Service Act and that is provided by a patient 

22 navigator through an eligible entity.’’. 

23 (b) TREATMENT AS MEDICAL ASSISTANCE FOR PUR24 POSES OF FMAP.—Section 1905(a) of the Social Security 

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


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

2 end; 

3 (2) by redesignating paragraph (29) as para4 graph (30); and 

5 (3) by inserting after paragraph (28) the fol6 lowing new paragraph: 

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

8 section 1902(ll)(3)) that are provided in a manner 

9 that meets the requirements of section 1902(a)(78); 

10 and’’. 

11 (c) EFFECTIVE DATE.— 

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

13 the amendments made by this section shall apply to 

14 patient navigator services provided after the first 

15 day of the first calendar year that begins after the 

16 date of enactment of this Act. 

17 (2) EXCEPTION FOR STATE LEGISLATION.—In 

18 the case of a State plan under title XIX of the So19 cial Security Act, which the Secretary of Health and 

20 Human Services determines requires State legisla21 tion in order for the respective plan to meet any re22 quirement imposed by amendments made by this 

23 Act, the respective plan shall not be regarded as fail24 ing to comply with the requirements of such title 

25 solely on the basis of its failure to meet such an adVerDate Mar 15 2010 00:17 Mar 14, 2014 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4168.IH H4168

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1 ditional requirement before the first day of the first 

2 calendar quarter beginning after the close of the 

3 first regular session of the State legislature that be4 gins after the date of enactment of this Act. For 

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

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

7 of the session shall be considered to be a separate 

8 regular session of the State legislature. 

Æ 


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