I 
★
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) intro-
duced 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 deter-
mined 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘DIRECT Care for the 
Homeless Act of 2023’’ or the ‘‘Delivering Integral, Reha-
bilitating, Empathetic, Comprehensive and Targeted Care 
for the Homeless Act of 2023.’’ 
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SEC. 2. DEFINITIONS. 
(1) The terms ‘‘eligible city or county’’ and ‘‘eli-
gible cities and counties’’ refer to cities and counties, 
as applicable, in the United States that, according to 
the Department of Housing and Urban Develop-
ment, have a homeless population of 150 or more 
per 100,000 residents. 
(2) The terms ‘‘homeless’’ and ‘‘homeless indi-
vidual’’ have the meanings given to such terms in 
section 103 of the McKinney-Vento Homeless Assist-
ance Act (42 U.S.C. 11302). 
(3) The term ‘‘street medicine’’ refers to health 
professionals providing preventive, screening, diag-
nostic, and/or treatment services to unsheltered 
homeless individuals where said individuals live in a 
non-permanent location on the street or found envi-
ronment. 
(4) The term ‘‘unsheltered’’ means not residing 
in a permanent residence or shelter. 
SEC. 3. GAO REPORT. 
Not later than the end of fiscal year 2027, the Comp-
troller General of the United States shall submit to the 
Congress an interim report assessing the results achieved 
through this Act and the amendments made by this Act, 
including— 
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(1) the number of patients who moved into tem-
porary or permanent housing; 
(2) the number of patients who have established 
within their respective Continuum of Care awaiting 
housing placement; 
(3) patients diagnosed with a substance use dis-
order and number who received treatment; 
(4) the number of health care professionals pro-
viding care to unsheltered homeless individuals; 
(5) how efficient and sufficient reimbursements 
were for provided care, including any difficulties 
health care professionals experienced in being reim-
bursed; 
(6) the number of unique people receiving street 
medicine services; 
(7) the number of total patient visits provided 
by street medicine teams; 
(8) a report from street medicine providers de-
tailing barriers to accessing non-street medicine pri-
mary care healthcare services such as specialty care, 
medications, and diagnostic studies; and 
(9) an analysis of participating street medicine 
providers’ ability to sustain a sufficient amount of 
street medicine providers to provide adequate care to 
its unsheltered homeless population, 
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No later than 120 days after enactment of this Act, the 
Secretary of the Department of Health and Human Serv-
ices shall promulgate rules for data collection necessary 
to complete this report, without creating barriers which 
negatively impact the effective provision of health care. To 
ensure this, the Secretary shall also create and maintain 
an online platform through which health care professional 
participating in the Program may provide feedback on the 
Program as a whole, and such platform must be open for 
submissions 24/7. The online platform must be compliant 
with the Health Insurance Portability and Accountability 
Act of 1996. 
SEC. 4. SUNSET. 
The provisions of this Act and the amendments made 
by this Act shall cease to be effective at the end of fiscal 
year 2028. 
TITLE I—STREET MEDICINE 
SEC. 101. STREET MEDICINE PILOT PROGRAM. 
(a) IN GENERAL.—Beginning on the first day of the 
first fiscal year following the date of enactment of this 
Act, the Secretary of Health and Human Services (re-
ferred to in this section as the ‘‘Secretary’’) shall conduct 
a pilot program (referred to in this section as the ‘‘Pro-
gram’’) to provide payments to providers in eligible cities 
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and counties for furnishing medical services to covered in-
dividuals. 
(b) PROGRAM REQUIREMENTS.— 
(1) APPLICATION.—A street medicine provider 
seeking participation in the Program shall submit an 
application to the Secretary, at such time, in such 
manner, and containing such information, as the 
Secretary may require. 
(2) PROVIDER REQUIREMENTS.— 
(A) IN GENERAL.—In order to participate 
in the Program, a provider must— 
(i) be an eligible provider (as defined 
in subsection (e)(3)); 
(ii) be enrolled— 
(I) under section 1886(j) of the 
Social 
Security 
Act 
(42 
U.S.C. 
1395cc(j)); or 
(II) as a participating provider 
under a State plan (or waiver of such 
plan) under title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.); 
(iii) be affiliated with a hospital, uni-
versity, non-profit organization, city gov-
ernment, county government, state govern-
ment, or private health care practice; 
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(iv) use a qualified electronic health 
record to document interactions with, and 
medical services furnished to, covered indi-
viduals under the Program; 
(v) maintain medical malpractice in-
surance in the State in which such pro-
vider is furnishing medical services under 
the Program; and 
(vi) in the case of a provider pre-
scribing opioid medication, meet the re-
quirement described in subparagraph (B). 
(B) 
REQUIREMENT
FOR
PRESCRIBING 
OPIOID MEDICATION.—In the case of a provider 
prescribing an opioid medication to a covered 
individual under the Program, such provider 
shall meet the standards of their respective 
State. 
(C) During each visit with a patient, there 
shall be a prescriber, as defined in (e)(3), 
present either in person, via telemedicine, or 
phone call. 
(3) DOCUMENTATION REQUIREMENTS.— 
(A) IN GENERAL.—A provider furnishing 
medical services under the Program shall docu-
ment in a qualified electronic health record each 
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interaction with a covered individual, such doc-
umentation shall include— 
(i) the name and date of birth of such 
individual; 
(ii) whether the covered individual 
has, or has history of, a substance use dis-
order; 
(iii) the length of time such individual 
has been homeless, and factors contrib-
uting to such individual’s lack of perma-
nent housing; 
(iv) whether an individual is under the 
care of a medical provider other than a 
street medicine team or provider; 
(v) the contact information, and bill-
ing information for such provider; 
(vi) the credentials of such provider; 
and 
(vii) any other information as deter-
mined by the Secretary. 
(B) RULES OF CONSTRUCTION REGARDING 
DOCUMENTATION.— 
(i) Nothing in this section shall be 
construed as requiring a covered individual 
to provide a permanent address in order to 
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receive medical services under the Pro-
gram. 
(ii) Nothing in this section shall be 
construed as requiring a provider to docu-
ment, with respect to a covered indi-
vidual— 
(I) the permanent address of 
such individual; 
(II) the address of the facility 
where medical services were furnished 
to such individual; or 
(III) the name of contact infor-
mation of a provider referring such 
individual to the program. 
(c) PAYMENT.— 
(1) IN GENERAL.—To receive payment for a 
medical service furnished to a covered individual 
under the Program, a provider shall submit to the 
Secretary, at such time and in such manner as de-
termined by the Secretary, a claim for such service. 
(A) No later than 120 days after enact-
ment of this Act, the Secretary shall promul-
gate rules to establish and maintain a clear 
process for reimbursements through the Pro-
gram. 
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(B) No later than 120 days after enact-
ment of this Act, the Secretary shall create and 
maintain an online platform through which 
health care professional participating in the 
Program may provide feedback on the reim-
bursement process, and such platform must be 
open for submissions 24/7. The online platform 
must be compliant with the Health Insurance 
Portability and Accountability Act of 1996. 
This platform may be the same as referred to 
in section 3 of this Act. 
(2) PAYMENT
AMOUNT.—The Secretary shall 
establish payment amounts for medical services fur-
nished to covered individuals under the Program. 
Such payment amounts shall be based upon payment 
amounts established with respect to medical assist-
ance furnished under title XIX of the Social Secu-
rity Act (42 U.S.C. 1396 et seq.). 
(3) PROHIBITION
AGAINST
SUPERVISED
CON-
SUMPTION.—No payment may be made under this 
Program with respect to medical services providing 
supervised drug consumption, as defined in (e)(9). 
This provision shall not be construed to prohibit 
States, counties, and cities which operate their own 
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supervised consumption programs from accessing the 
Program. 
(d) DIRECT ACCESS.— 
(1) Unsheltered homeless individuals may ob-
tain services from any qualified street medicine pro-
vider, as defined in this Act, for purposes of the 
Program. 
(2) Individuals enrolled in a primary care case 
management system or Medicaid managed care or-
ganization (MCO) shall not be denied freedom of 
choice of qualified street medicine providers. 
(3) Prior authorization shall not be required for 
purposes of an individual receiving care from a 
street medicine provider. 
(4) If a patient is a Medicaid or Medicare bene-
ficiary, street medicine providers shall have the au-
thority to refer patients to medically necessary cov-
ered services within the proper Making Care Pri-
mary (MCP) network, to ensure beneficiaries have 
access to all medically necessary covered service. 
(A) The Secretary of the Department of 
Health and Human Services or Director of the 
Centers for Medicaid and Medicare Services 
shall develop rules to ensure street medicine 
providers have the appropriate referral and au-
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thorization mechanisms in place to facilitate ac-
cess to needed services in the network without 
requiring authorization by an assigned primary 
care; and 
(B) rules to guarantee a clear and acces-
sible process for making such referrals. 
(5) The Secretary of Health and Human Serv-
ices or Director of the Centers for Medicaid and 
Medicare Services shall develop rules to ensure pro-
viders operating within the Program shall have ap-
propriate referral and authorization mechanisms for 
patients who are not insured, or are not Medicaid or 
Medicare beneficiaries. 
(6) DELIVERY
NETWORK.—If a patient is a 
Medicaid or Medicare beneficiary, MCPs must en-
sure that, they meet the following requirements: 
(A) Maintains and monitors a network of 
appropriate providers that is supported by writ-
ten agreements and is sufficient to provide ade-
quate access to all services covered by the Pro-
gram or patients’ other health care benefits, 
such as Medicaid or Medicare, ensuring access 
to patients with limited English proficiency or 
physical or mental disabilities; 
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(B) provides female patients with direct 
access to women’s routine and preventive health 
care services; 
(C) arranges for patients to receive a sec-
ond opinion, should the patient elect, at no cost 
to the patient; and 
(D) if its network of street medicine pro-
viders are unable to provide necessary services, 
that the MCP is able to adequately and timely 
cover those services, without cost to the patient 
exceeding standards costs within the Program 
or the providers’ network. 
(e) FUNDING.—The Secretary has the authority to 
allocate existing funds for the Program. 
(f) DEFINITIONS.—In this Act: 
(1) COVERED INDIVIDUAL.—The term ‘‘covered 
individual’’ means an unsheltered homeless indi-
vidual over the age of zero who resides in an eligible 
city or county. 
(2) ELIGIBLE CITY OR COUNTY; ELIGIBLE CIT-
IES
AND
COUNTIES.—The terms ‘‘eligible city or 
county’’ and ‘‘eligible cities and counties’’ refer to 
cities and counties, as applicable, in the United 
States that, according to the Department of Hous-
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ing and Urban Development, have a homeless popu-
lation of 150 or more per 100,000. 
(3) 
PRESCRIBER.—The 
term 
‘‘prescriber’’ 
means a person permitted under State law, or agent 
of such person, to issue prescriptions for drugs in 
compliance with applicable requirements established 
by the Food and Drug Administration. 
(4) ELIGIBLE PROVIDER.—The term ‘‘eligible 
provider’’ includes— 
(A) a physician (as defined in section 
1861(r) of the Social Security Act (42 U.S.C. 
1395(aa)(5)(A)); 
(B) a physician assistant or nurse practi-
tioner (as such terms are defined in section 
1861(aa)(5)(A) of the Social Security Act (42 
U.S.C. 1395(aa)(5)(A)); 
(C) a behavioral health therapist; 
(D) a supplier (as defined in section 
1861(d) of the Social Security Act (42 U.S.C. 
1395(d)); 
(E) a psychologist (as defined in section 
799B(11) of the Public Health Service Act (42 
U.S.C. 295p(11)); 
(F) a physical therapist; 
(G) occupational therapist; 
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(H) an emergency medical technician re-
sponding to a call or case in which health care 
is administered to an unhoused homeless indi-
vidual; or 
(I) any provider as determined by the Sec-
retary. 
(5) HOMELESS; HOMELESS INDIVIDUAL.—The 
term ‘‘homeless’’ and ‘‘homeless individual’’ have the 
meaning given such terms in section 103 of the 
McKinney-Vento Homeless Assistance Act (42 
U.S.C. 300jj(13)). 
(6) MEDICAL
SERVICES.—The term ‘‘medical 
services’’ mean the medical care and services de-
scribed in section 1905(a) of the Social Security Act 
(42 U.S.C. 1396d(a)). 
(7) 
QUALIFIED
ELECTRONIC
HEALTH 
RECORD.—The term ‘‘qualified electronic health 
record’’ has the meaning given such term in section 
3000(13) of the Public Health Service Act (42 
U.S.C. 300jj(13)). 
(8) STREET MEDICINE.—The term ‘‘street med-
icine’’ means the direct provision of medical services 
to unsheltered homeless individuals where such indi-
viduals live in a non-permanent location on the 
street or found environment. 
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(9) SUPERVISED
CONSUMPTION.—The con-
sumption of schedule I drugs, fentanyl, cocaine, and 
methamphetamine under the supervision of health 
care professionals. 
TITLE II—FEDERAL LOAN 
REPAYMENT PROGRAMS 
SEC. 201. PUBLIC HEALTH LOAN REPAYMENT PROGRAMS. 
(a) IN GENERAL.—In carrying out programs under 
the Public Health Service Act (42 U.S.C. 201 et seq.) for 
loan repayments for health care professionals, the Sec-
retary of Health and Human Services shall include awards 
to applicants seeking to practice street medicine in eligible 
cities and counties. 
(b) NATIONAL HEALTH SERVICE CORPS.—In assign-
ing members of the National Health Service Corps to 
health professional shortage areas pursuant to section 333 
of the Public Health Service Act (42 U.S.C. 254f) to fulfill 
a period of obligated service under the National Health 
Service Corps Loan Repayment Program, the Secretary 
of Health and Human Services shall assign an appropriate 
number of Corps members to practice street medicine in 
eligible cities and counties. 
(c) TREATMENT OF MOBILE CLINICS AS HPSAS.— 
The Secretary of Health and Human Services shall treat 
mobile clinics providing street medicine in an eligible city 
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or county as a health professional shortage area eligible 
for designation under section 332 of the Public Health 
Service Act (42 U.S.C. 254e). 
SEC. 202. COMMUNITY SERVICE OFFICERS. 
(a) IN GENERAL.—Public Service Loan Forgiveness 
(PSLF) Program eligibility shall include individuals who 
spend at least one year as a community service officer 
(CSO), including those working less than 30 hours per 
week, employed by a local law enforcement agency. 
(b) Section 455(m) of the Higher Education Act of 
1965 (20 U.S.C. 1087e(m)) is amended— 
(1) by striking the period at the end of 
(3)(B)(ii) and inserting ‘‘; or’’; 
(2) by adding at the end of (3)(B) the fol-
lowing: 
‘‘(iii) serving, for a calendar year, full- 
time or part-time as a community service 
officer’’; and 
(3) by inserting after subparagraph (B) the fol-
lowing: 
‘‘(C) Community service officers are pro-
fessionals or paraprofessional law enforcement 
who do not respond to emergencies, do not 
carry firearms, and do not have power of arrest; 
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this includes those persons training to be full- 
time law enforcement.’’. 
(c) THE DEPARTMENT OF EDUCATION.—The Sec-
retary of Education must treat local law enforcement 
agencies, including those of tribal governments, as quali-
fying employers as defined in 34 CFR 685.219. 
(1) No later than 120 days after enactment of 
this Act, the Secretary of Education must promul-
gate rules to provide a clear and accessible process 
for community service officers to apply for loan for-
giveness. These rules must ensure that community 
service officers employed by local law enforcement 
agencies receive Public Service Loan Forgiveness 
benefits no later than one year after applying for 
and being determined eligible for this program. 
(2) No later than 120 days after enactment of 
this Act, the Secretary of Education must create 
and maintain a clear and accessible appeals process 
for all borrowers who are denied participation in the 
PSLF Program. The appeals process must meet, but 
is not limited to, the following requirements: 
(A) petition for appeal must be submitted 
through an online program which is clearly dis-
played on the department website and is acces-
sible to non-English speakers; 
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(B) the Department must provide notice of 
the appeals process when a borrower initially 
applies for the PSLF Program; 
(C) the Department must provide for ac-
cessible communication with borowers; 
(D) the Department must provide the bor-
rower detailed information about which loans 
did not qualify, which payments did not qualify, 
and what information is necessary for a suc-
cessful appeal; 
(E) borrowers who were denied loan for-
giveness prior to enactment of this Act have 
180 days to request reconsideration; and 
(F) for any months in which a borrower 
postponed monthly payments under a deferment 
or forbearance and was employed full-time or 
part-time at a qualifying employer as defined in 
34 CFR 685.219 but was in a deferment or for-
bearance status, the borrower may obtain credit 
towards forgiveness for those months. 
TITLE III—LOAN AND INTEREST 
PAUSE 
SEC. 301. STUDENT LOAN AND INTEREST PAUSE. 
(a) Section 455(f) of the Higher Education Act of 
1965 (20 U.S.C. 1087e(f)) is amended— 
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(1) in paragraph (1), in the matter preceding 
subparagraph (A), by striking ‘‘A borrower’’ and in-
serting ‘‘Except as provided in paragraph (6), a bor-
rower’’; 
(2) in paragraph (2)(A)— 
(A) in clause (i), by striking ‘‘or’’ after the 
semicolon; 
(B) by striking the matter following clause 
(ii); 
(C) in clause (ii), by striking the comma at 
the end and inserting ‘‘; or’’; and 
(D) by adding at the end the following: 
‘‘(iii) is serving in a medical or resi-
dency program which, in part, focuses on 
the provision of street medicine;’’; and 
(3) by adding at the end the following: 
‘‘(6) SPECIAL RULE FOR CERTAIN IN SCHOOL 
DEFERMENT.—Notwithstanding any other provision 
of this Act, a borrower described in paragraph 
(2)(A)(ii) shall be eligible for a deferment, during 
which periodic installments of principal need not be 
paid and interest shall not accrue on any loan made 
to the borrower under this part.’’. 
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TITLE IV—IMPROVED 
STANDARDS FOR SHELTERS 
SEC. 401. SAFE SHELTERS. 
Whereas homeless shelters should always be safe for 
residents; 
Whereas a significant number of homeless women re-
port feeling safer spending the night in a car as opposed 
to a shelter; 
Whereas approximately thirty-two percent of home-
less women report being sexually or physically assaulted 
each year; 
Whereas homeless individuals accrue citations for 
sleeping in their car or parking their car in a certain spot 
for too long, resulting in criminal records which might pre-
vent an employer from providing them employment; 
Whereas a significant number of homeless women are 
unable to afford menstrual products; and 
Whereas transgender men frequently experience dis-
crimination by being denied necessary menstrual products. 
SEC. 402. IMPROVED STANDARDS. 
(a) Section 415 of the McKinney-Vento Homeless As-
sistance Act (42 U.S.C. 1137) is amended by adding at 
the end the following: 
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‘‘(c) EMERGENCY SHELTER REQUIREMENTS.—No 
amount provided under this subtitle may be allocated to 
an emergency shelter unless such emergency shelter— 
‘‘(1) provides menstrual products for each men-
struating resident; and 
‘‘(2) maintains a security camera system with 
no less than two functional security cameras and 
consideration for residents’ personal privacy.’’. 
(b) There shall be no restrictions on the kind of secu-
rity cameras a shelter may install and maintain to be in 
compliance with this Act. 
Æ 
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