I 

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118TH CONGRESS 

1ST SESSION H. R. 5387 

To improve the provision of health care to unsheltered homeless individuals, 

and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 12, 2023 

Mrs. CHAVEZ-DEREMER (for herself and Ms. LEE of Pennsylvania) introduced the following bill; which was referred to the Committee on Energy 

and Commerce, and in addition to the Committees on Education and the 

Workforce, and Financial Services, 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 improve the provision of health care to unsheltered 

homeless individuals, 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 ‘‘DIRECT Care for the 

5 Homeless Act of 2023’’ or the ‘‘Delivering Integral, Reha6 bilitating, Empathetic, Comprehensive and Targeted Care 

7 for the Homeless Act of 2023.’’ 


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1 SEC. 2. DEFINITIONS. 

2 (1) The terms ‘‘eligible city or county’’ and ‘‘eli3 gible cities and counties’’ refer to cities and counties, 

4 as applicable, in the United States that, according to 

5 the Department of Housing and Urban Develop6 ment, have a homeless population of 150 or more 

7 per 100,000 residents. 

8 (2) The terms ‘‘homeless’’ and ‘‘homeless indi9 vidual’’ have the meanings given to such terms in 

10 section 103 of the McKinney-Vento Homeless Assist11 ance Act (42 U.S.C. 11302). 

12 (3) The term ‘‘street medicine’’ refers to health 

13 professionals providing preventive, screening, diag14 nostic, and/or treatment services to unsheltered 

15 homeless individuals where said individuals live in a 

16 non-permanent location on the street or found envi17 ronment. 

18 (4) The term ‘‘unsheltered’’ means not residing 

19 in a permanent residence or shelter. 

20 SEC. 3. GAO REPORT. 

21 Not later than the end of fiscal year 2027, the Comp22 troller General of the United States shall submit to the 

23 Congress an interim report assessing the results achieved 

24 through this Act and the amendments made by this Act, 

25 including— 


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1 (1) the number of patients who moved into tem2 porary or permanent housing; 

3 (2) the number of patients who have established 

4 within their respective Continuum of Care awaiting 

5 housing placement; 

6 (3) patients diagnosed with a substance use dis7 order and number who received treatment; 

8 (4) the number of health care professionals pro9 viding care to unsheltered homeless individuals; 

10 (5) how efficient and sufficient reimbursements 

11 were for provided care, including any difficulties 

12 health care professionals experienced in being reim13 bursed; 

14 (6) the number of unique people receiving street 

15 medicine services; 

16 (7) the number of total patient visits provided 

17 by street medicine teams; 

18 (8) a report from street medicine providers de19 tailing barriers to accessing non-street medicine pri20 mary care healthcare services such as specialty care, 

21 medications, and diagnostic studies; and 

22 (9) an analysis of participating street medicine 

23 providers’ ability to sustain a sufficient amount of 

24 street medicine providers to provide adequate care to 

25 its unsheltered homeless population, 


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1 No later than 120 days after enactment of this Act, the 

2 Secretary of the Department of Health and Human Serv3 ices shall promulgate rules for data collection necessary 

4 to complete this report, without creating barriers which 

5 negatively impact the effective provision of health care. To 

6 ensure this, the Secretary shall also create and maintain 

7 an online platform through which health care professional 

8 participating in the Program may provide feedback on the 

9 Program as a whole, and such platform must be open for 

10 submissions 24/7. The online platform must be compliant 

11 with the Health Insurance Portability and Accountability 

12 Act of 1996. 

13 SEC. 4. SUNSET. 

14 The provisions of this Act and the amendments made 

15 by this Act shall cease to be effective at the end of fiscal 

16 year 2028. 

17 TITLE I—STREET MEDICINE 

18 SEC. 101. STREET MEDICINE PILOT PROGRAM. 

19 (a) IN GENERAL.—Beginning on the first day of the 

20 first fiscal year following the date of enactment of this 

21 Act, the Secretary of Health and Human Services (re22 ferred to in this section as the ‘‘Secretary’’) shall conduct 

23 a pilot program (referred to in this section as the ‘‘Pro24 gram’’) to provide payments to providers in eligible cities 


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1 and counties for furnishing medical services to covered in2 dividuals. 

3 (b) PROGRAM REQUIREMENTS.— 

4 (1) APPLICATION.—A street medicine provider 

5 seeking participation in the Program shall submit an 

6 application to the Secretary, at such time, in such 

7 manner, and containing such information, as the 

8 Secretary may require. 

9 (2) PROVIDER REQUIREMENTS.— 

10 (A) IN GENERAL.—In order to participate 

11 in the Program, a provider must— 

12 (i) be an eligible provider (as defined 

13 in subsection (e)(3)); 

14 (ii) be enrolled— 

15 (I) under section 1886(j) of the 

16 Social Security Act (42 U.S.C. 

17 1395cc(j)); or 

18 (II) as a participating provider 

19 under a State plan (or waiver of such 

20 plan) under title XIX of the Social 

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

22 (iii) be affiliated with a hospital, uni23 versity, non-profit organization, city gov24 ernment, county government, state govern25 ment, or private health care practice; 


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1 (iv) use a qualified electronic health 

2 record to document interactions with, and 

3 medical services furnished to, covered indi4 viduals under the Program; 

5 (v) maintain medical malpractice in6 surance in the State in which such pro7 vider is furnishing medical services under 

8 the Program; and 

9 (vi) in the case of a provider pre10 scribing opioid medication, meet the re11 quirement described in subparagraph (B). 

12 (B) REQUIREMENT FOR PRESCRIBING

13 OPIOID MEDICATION.—In the case of a provider 

14 prescribing an opioid medication to a covered 

15 individual under the Program, such provider 

16 shall meet the standards of their respective 

17 State. 

18 (C) During each visit with a patient, there 

19 shall be a prescriber, as defined in (e)(3), 

20 present either in person, via telemedicine, or 

21 phone call. 

22 (3) DOCUMENTATION REQUIREMENTS.— 

23 (A) IN GENERAL.—A provider furnishing 

24 medical services under the Program shall docu25 ment in a qualified electronic health record each 


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1 interaction with a covered individual, such doc2 umentation shall include— 

3 (i) the name and date of birth of such 

4 individual; 

5 (ii) whether the covered individual 

6 has, or has history of, a substance use dis7 order; 

8 (iii) the length of time such individual 

9 has been homeless, and factors contrib10 uting to such individual’s lack of perma11 nent housing; 

12 (iv) whether an individual is under the 

13 care of a medical provider other than a 

14 street medicine team or provider; 

15 (v) the contact information, and bill16 ing information for such provider; 

17 (vi) the credentials of such provider; 

18 and 

19 (vii) any other information as deter20 mined by the Secretary. 

21 (B) RULES OF CONSTRUCTION REGARDING

22 DOCUMENTATION.— 

23 (i) Nothing in this section shall be 

24 construed as requiring a covered individual 

25 to provide a permanent address in order to 


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1 receive medical services under the Pro2 gram. 

3 (ii) Nothing in this section shall be 

4 construed as requiring a provider to docu5 ment, with respect to a covered indi6 vidual— 

7 (I) the permanent address of 

8 such individual; 

9 (II) the address of the facility 

10 where medical services were furnished 

11 to such individual; or 

12 (III) the name of contact infor13 mation of a provider referring such 

14 individual to the program. 

15 (c) PAYMENT.— 

16 (1) IN GENERAL.—To receive payment for a 

17 medical service furnished to a covered individual 

18 under the Program, a provider shall submit to the 

19 Secretary, at such time and in such manner as de20 termined by the Secretary, a claim for such service. 

21 (A) No later than 120 days after enact22 ment of this Act, the Secretary shall promul23 gate rules to establish and maintain a clear 

24 process for reimbursements through the Pro25 gram. 


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1 (B) No later than 120 days after enact2 ment of this Act, the Secretary shall create and 

3 maintain an online platform through which 

4 health care professional participating in the 

5 Program may provide feedback on the reim6 bursement process, and such platform must be 

7 open for submissions 24/7. The online platform 

8 must be compliant with the Health Insurance 

9 Portability and Accountability Act of 1996. 

10 This platform may be the same as referred to 

11 in section 3 of this Act. 

12 (2) PAYMENT AMOUNT.—The Secretary shall 

13 establish payment amounts for medical services fur14 nished to covered individuals under the Program. 

15 Such payment amounts shall be based upon payment 

16 amounts established with respect to medical assist17 ance furnished under title XIX of the Social Secu18 rity Act (42 U.S.C. 1396 et seq.). 

19 (3) PROHIBITION AGAINST SUPERVISED CON20 SUMPTION.—No payment may be made under this 

21 Program with respect to medical services providing 

22 supervised drug consumption, as defined in (e)(9). 

23 This provision shall not be construed to prohibit 

24 States, counties, and cities which operate their own 


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1 supervised consumption programs from accessing the 

2 Program. 

3 (d) DIRECT ACCESS.— 

4 (1) Unsheltered homeless individuals may ob5 tain services from any qualified street medicine pro6 vider, as defined in this Act, for purposes of the 

7 Program. 

8 (2) Individuals enrolled in a primary care case 

9 management system or Medicaid managed care or10 ganization (MCO) shall not be denied freedom of 

11 choice of qualified street medicine providers. 

12 (3) Prior authorization shall not be required for 

13 purposes of an individual receiving care from a 

14 street medicine provider. 

15 (4) If a patient is a Medicaid or Medicare bene16 ficiary, street medicine providers shall have the au17 thority to refer patients to medically necessary cov18 ered services within the proper Making Care Pri19 mary (MCP) network, to ensure beneficiaries have 

20 access to all medically necessary covered service. 

21 (A) The Secretary of the Department of 

22 Health and Human Services or Director of the 

23 Centers for Medicaid and Medicare Services 

24 shall develop rules to ensure street medicine 

25 providers have the appropriate referral and auVerDate Sep 11 2014 01:34 Nov 08, 2023 Jkt 049200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H5387.IH H5387

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1 thorization mechanisms in place to facilitate ac2 cess to needed services in the network without 

3 requiring authorization by an assigned primary 

4 care; and 

5 (B) rules to guarantee a clear and acces6 sible process for making such referrals. 

7 (5) The Secretary of Health and Human Serv8 ices or Director of the Centers for Medicaid and 

9 Medicare Services shall develop rules to ensure pro10 viders operating within the Program shall have ap11 propriate referral and authorization mechanisms for 

12 patients who are not insured, or are not Medicaid or 

13 Medicare beneficiaries. 

14 (6) DELIVERY NETWORK.—If a patient is a 

15 Medicaid or Medicare beneficiary, MCPs must en16 sure that, they meet the following requirements: 

17 (A) Maintains and monitors a network of 

18 appropriate providers that is supported by writ19 ten agreements and is sufficient to provide ade20 quate access to all services covered by the Pro21 gram or patients’ other health care benefits, 

22 such as Medicaid or Medicare, ensuring access 

23 to patients with limited English proficiency or 

24 physical or mental disabilities; 


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1 (B) provides female patients with direct 

2 access to women’s routine and preventive health 

3 care services; 

4 (C) arranges for patients to receive a sec5 ond opinion, should the patient elect, at no cost 

6 to the patient; and 

7 (D) if its network of street medicine pro8 viders are unable to provide necessary services, 

9 that the MCP is able to adequately and timely 

10 cover those services, without cost to the patient 

11 exceeding standards costs within the Program 

12 or the providers’ network. 

13 (e) FUNDING.—The Secretary has the authority to 

14 allocate existing funds for the Program. 

15 (f) DEFINITIONS.—In this Act: 

16 (1) COVERED INDIVIDUAL.—The term ‘‘covered 

17 individual’’ means an unsheltered homeless indi18 vidual over the age of zero who resides in an eligible 

19 city or county. 

20 (2) ELIGIBLE CITY OR COUNTY; ELIGIBLE CIT21 IES AND COUNTIES.—The terms ‘‘eligible city or 

22 county’’ and ‘‘eligible cities and counties’’ refer to 

23 cities and counties, as applicable, in the United 

24 States that, according to the Department of HousVerDate Sep 11 2014 01:34 Nov 08, 2023 Jkt 049200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H5387.IH H5387

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1 ing and Urban Development, have a homeless popu2 lation of 150 or more per 100,000. 

3 (3) PRESCRIBER.—The term ‘‘prescriber’’ 

4 means a person permitted under State law, or agent 

5 of such person, to issue prescriptions for drugs in 

6 compliance with applicable requirements established 

7 by the Food and Drug Administration. 

8 (4) ELIGIBLE PROVIDER.—The term ‘‘eligible 

9 provider’’ includes— 

10 (A) a physician (as defined in section 

11 1861(r) of the Social Security Act (42 U.S.C. 

12 1395(aa)(5)(A)); 

13 (B) a physician assistant or nurse practi14 tioner (as such terms are defined in section 

15 1861(aa)(5)(A) of the Social Security Act (42 

16 U.S.C. 1395(aa)(5)(A)); 

17 (C) a behavioral health therapist; 

18 (D) a supplier (as defined in section 

19 1861(d) of the Social Security Act (42 U.S.C. 

20 1395(d)); 

21 (E) a psychologist (as defined in section 

22 799B(11) of the Public Health Service Act (42 

23 U.S.C. 295p(11)); 

24 (F) a physical therapist; 

25 (G) occupational therapist; 


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1 (H) an emergency medical technician re2 sponding to a call or case in which health care 

3 is administered to an unhoused homeless indi4 vidual; or 

5 (I) any provider as determined by the Sec6 retary. 

7 (5) HOMELESS; HOMELESS INDIVIDUAL.—The 

8 term ‘‘homeless’’ and ‘‘homeless individual’’ have the 

9 meaning given such terms in section 103 of the 

10 McKinney-Vento Homeless Assistance Act (42 

11 U.S.C. 300jj(13)). 

12 (6) MEDICAL SERVICES.—The term ‘‘medical 

13 services’’ mean the medical care and services de14 scribed in section 1905(a) of the Social Security Act 

15 (42 U.S.C. 1396d(a)). 

16 (7) QUALIFIED ELECTRONIC HEALTH

17 RECORD.—The term ‘‘qualified electronic health 

18 record’’ has the meaning given such term in section 

19 3000(13) of the Public Health Service Act (42 

20 U.S.C. 300jj(13)). 

21 (8) STREET MEDICINE.—The term ‘‘street med22 icine’’ means the direct provision of medical services 

23 to unsheltered homeless individuals where such indi24 viduals live in a non-permanent location on the 

25 street or found environment. 


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1 (9) SUPERVISED CONSUMPTION.—The con2 sumption of schedule I drugs, fentanyl, cocaine, and 

3 methamphetamine under the supervision of health 

4 care professionals. 

5 TITLE II—FEDERAL LOAN 

6 REPAYMENT PROGRAMS 

7 SEC. 201. PUBLIC HEALTH LOAN REPAYMENT PROGRAMS. 

8 (a) IN GENERAL.—In carrying out programs under 

9 the Public Health Service Act (42 U.S.C. 201 et seq.) for 

10 loan repayments for health care professionals, the Sec11 retary of Health and Human Services shall include awards 

12 to applicants seeking to practice street medicine in eligible 

13 cities and counties. 

14 (b) NATIONAL HEALTH SERVICE CORPS.—In assign15 ing members of the National Health Service Corps to 

16 health professional shortage areas pursuant to section 333 

17 of the Public Health Service Act (42 U.S.C. 254f) to fulfill 

18 a period of obligated service under the National Health 

19 Service Corps Loan Repayment Program, the Secretary 

20 of Health and Human Services shall assign an appropriate 

21 number of Corps members to practice street medicine in 

22 eligible cities and counties. 

23 (c) TREATMENT OF MOBILE CLINICS AS HPSAS.— 

24 The Secretary of Health and Human Services shall treat 

25 mobile clinics providing street medicine in an eligible city 


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1 or county as a health professional shortage area eligible 

2 for designation under section 332 of the Public Health 

3 Service Act (42 U.S.C. 254e). 

4 SEC. 202. COMMUNITY SERVICE OFFICERS. 

5 (a) IN GENERAL.—Public Service Loan Forgiveness 

6 (PSLF) Program eligibility shall include individuals who 

7 spend at least one year as a community service officer 

8 (CSO), including those working less than 30 hours per 

9 week, employed by a local law enforcement agency. 

10 (b) Section 455(m) of the Higher Education Act of 

11 1965 (20 U.S.C. 1087e(m)) is amended— 

12 (1) by striking the period at the end of 

13 (3)(B)(ii) and inserting ‘‘; or’’; 

14 (2) by adding at the end of (3)(B) the fol15 lowing: 

16 ‘‘(iii) serving, for a calendar year, full17 time or part-time as a community service 

18 officer’’; and 

19 (3) by inserting after subparagraph (B) the fol20 lowing: 

21 ‘‘(C) Community service officers are pro22 fessionals or paraprofessional law enforcement 

23 who do not respond to emergencies, do not 

24 carry firearms, and do not have power of arrest; 


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1 this includes those persons training to be full2 time law enforcement.’’. 

3 (c) THE DEPARTMENT OF EDUCATION.—The Sec4 retary of Education must treat local law enforcement 

5 agencies, including those of tribal governments, as quali6 fying employers as defined in 34 CFR 685.219. 

7 (1) No later than 120 days after enactment of 

8 this Act, the Secretary of Education must promul9 gate rules to provide a clear and accessible process 

10 for community service officers to apply for loan for11 giveness. These rules must ensure that community 

12 service officers employed by local law enforcement 

13 agencies receive Public Service Loan Forgiveness 

14 benefits no later than one year after applying for 

15 and being determined eligible for this program. 

16 (2) No later than 120 days after enactment of 

17 this Act, the Secretary of Education must create 

18 and maintain a clear and accessible appeals process 

19 for all borrowers who are denied participation in the 

20 PSLF Program. The appeals process must meet, but 

21 is not limited to, the following requirements: 

22 (A) petition for appeal must be submitted 

23 through an online program which is clearly dis24 played on the department website and is acces25 sible to non-English speakers; 


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1 (B) the Department must provide notice of 

2 the appeals process when a borrower initially 

3 applies for the PSLF Program; 

4 (C) the Department must provide for ac5 cessible communication with borowers; 

6 (D) the Department must provide the bor7 rower detailed information about which loans 

8 did not qualify, which payments did not qualify, 

9 and what information is necessary for a suc10 cessful appeal; 

11 (E) borrowers who were denied loan for12 giveness prior to enactment of this Act have 

13 180 days to request reconsideration; and 

14 (F) for any months in which a borrower 

15 postponed monthly payments under a deferment 

16 or forbearance and was employed full-time or 

17 part-time at a qualifying employer as defined in 

18 34 CFR 685.219 but was in a deferment or for19 bearance status, the borrower may obtain credit 

20 towards forgiveness for those months. 

21 TITLE III—LOAN AND INTEREST 

22 PAUSE 

23 SEC. 301. STUDENT LOAN AND INTEREST PAUSE. 

24 (a) Section 455(f) of the Higher Education Act of 

25 1965 (20 U.S.C. 1087e(f)) is amended— 


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1 (1) in paragraph (1), in the matter preceding 

2 subparagraph (A), by striking ‘‘A borrower’’ and in3 serting ‘‘Except as provided in paragraph (6), a bor4 rower’’; 

5 (2) in paragraph (2)(A)— 

6 (A) in clause (i), by striking ‘‘or’’ after the 

7 semicolon; 

8 (B) by striking the matter following clause 

9 (ii); 

10 (C) in clause (ii), by striking the comma at 

11 the end and inserting ‘‘; or’’; and 

12 (D) by adding at the end the following: 

13 ‘‘(iii) is serving in a medical or resi14 dency program which, in part, focuses on 

15 the provision of street medicine;’’; and 

16 (3) by adding at the end the following: 

17 ‘‘(6) SPECIAL RULE FOR CERTAIN IN SCHOOL

18 DEFERMENT.—Notwithstanding any other provision 

19 of this Act, a borrower described in paragraph 

20 (2)(A)(ii) shall be eligible for a deferment, during 

21 which periodic installments of principal need not be 

22 paid and interest shall not accrue on any loan made 

23 to the borrower under this part.’’. 


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1 TITLE IV—IMPROVED 

2 STANDARDS FOR SHELTERS 

3 SEC. 401. SAFE SHELTERS. 

4 Whereas homeless shelters should always be safe for 

5 residents; 

6 Whereas a significant number of homeless women re7 port feeling safer spending the night in a car as opposed 

8 to a shelter; 

9 Whereas approximately thirty-two percent of home10 less women report being sexually or physically assaulted 

11 each year; 

12 Whereas homeless individuals accrue citations for 

13 sleeping in their car or parking their car in a certain spot 

14 for too long, resulting in criminal records which might pre15 vent an employer from providing them employment; 

16 Whereas a significant number of homeless women are 

17 unable to afford menstrual products; and 

18 Whereas transgender men frequently experience dis19 crimination by being denied necessary menstrual products. 

20 SEC. 402. IMPROVED STANDARDS. 

21 (a) Section 415 of the McKinney-Vento Homeless As22 sistance Act (42 U.S.C. 1137) is amended by adding at 

23 the end the following: 


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1 ‘‘(c) EMERGENCY SHELTER REQUIREMENTS.—No 

2 amount provided under this subtitle may be allocated to 

3 an emergency shelter unless such emergency shelter— 

4 ‘‘(1) provides menstrual products for each men5 struating resident; and 

6 ‘‘(2) maintains a security camera system with 

7 no less than two functional security cameras and 

8 consideration for residents’ personal privacy.’’. 

9 (b) There shall be no restrictions on the kind of secu10 rity cameras a shelter may install and maintain to be in 

11 compliance with this Act. 

Æ 


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