I 
117TH CONGRESS 
2D SESSION 
H. R. 9285 
To provide payment for patient navigator services under title XIX of the 
Social Security Act, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 10, 2022 
Mr. DESAULNIER (for himself and Mr. CARTER of Georgia) 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. 
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 ‘‘Patient Navigation As-
sistance Act’’. 
SEC. 2. MEDICAID COVERAGE FOR PATIENT NAVIGATOR 
SERVICES. 
(a) IN GENERAL.—Section 1902(a) of the Social Se-
curity Act (42 U.S.C. 1396a(a)) is amended— 
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(1) in paragraph (86), by striking ‘‘and’’ at the 
end; 
(2) in paragraph (87), by striking at the end 
the period and inserting ‘‘; and’’; 
(3) by inserting after paragraph (87) the fol-
lowing new paragraph: 
‘‘(88) provide that the State shall reimburse an 
eligible entity (as defined in subsection (tt)(1)) for 
any patient navigator service (as defined in sub-
section (tt)(3)) that is provided— 
‘‘(A) to an individual who is eligible for 
medical assistance under the State plan; and 
‘‘(B) by a patient navigator (as defined in 
subsection (tt)(2)) through the eligible entity.’’; 
and 
(4) by adding at the end the following new sub-
section: 
‘‘(tt) PATIENT
NAVIGATOR
SERVICES
DEFINI-
TIONS.—For purposes of this section: 
‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en-
tity’ means an entity that— 
‘‘(A) is an eligible entity (as defined in 
subsection (l)(1) of section 340A of the Public 
Health Service Act); and 
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‘‘(B) complies with the following require-
ments of such section (insofar as they apply to 
a grant recipient under such section): 
‘‘(i) Subsection (b) (relating to patient 
navigator duties and community knowl-
edge). 
‘‘(ii) Subsection (c) (relating to prohi-
bitions). 
‘‘(iii) Subsection (e) (relating to appli-
cations). 
‘‘(iv) Subsection (j)(3) (relating to re-
ports). 
‘‘(2) PATIENT NAVIGATOR.— 
‘‘(A) IN
GENERAL.—The term ‘patient 
navigator’ means an individual who— 
‘‘(i) is employed by a health care or 
community-based organization and pro-
vides individualized education and re-
sources to facilitate informed decision-mak-
ing and timely access to quality health and 
psychosocial care; and 
‘‘(ii) has obtained and complies with 
education, licensure, or certification, in-
cluding at least— 
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‘‘(I) a bachelor’s degree in nurs-
ing from an accredited university, 
master’s degree in social work from 
an accredited university, or bachelor’s 
degree in a health-related field from 
an accredited university; 
‘‘(II) licensing and certification 
requirements for a registered nurse, 
social work, or clinical practitioner, as 
applicable, and scope of practice re-
quirements, as defined by the State or 
jurisdiction in which the individual is 
licensed or certified; 
‘‘(III) completion of competency- 
based navigation training sessions or 
courses for clinical or non-clinical pro-
fessionals, as applicable; or 
‘‘(IV) subject to subparagraph 
(B), completion of a training program 
approved by the Secretary for pur-
poses of section 340A(l)(3) of the 
Public Health Service Act. 
‘‘(B) 
TRANSITIONAL
LIMITATION.—The 
training described in subclause (IV) of subpara-
graph (A)(ii) shall not satisfy the requirement 
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of subparagraph (A)(ii) after the date that is 3 
years after the date on which the provisions of 
this subsection apply to patient navigator serv-
ices pursuant to section 2(c) of the Patient 
Navigator Assistance Act. 
‘‘(3) PATIENT
NAVIGATOR
SERVICES.—The 
term ‘patient navigator service’ means a service pro-
vided by a patient navigator to an individual, includ-
ing— 
‘‘(A) referrals and related activities to help 
the individual obtain needed services, including 
activities that help link the individual with med-
ical, social, logistical, financial, or other pro-
grams or services to address identified or speci-
fied needs of the individual; 
‘‘(B) services specified under paragraphs 
(1) through (6) of subsection (b) of section 
340A of the Public Health Service Act; and 
‘‘(C) other services specified by the Sec-
retary.’’. 
(b) TREATMENT AS MEDICAL ASSISTANCE FOR PUR-
POSES OF FMAP.—Section 1905(a) of the Social Security 
Act (42 U.S.C. 1396d(a)) is amended— 
(1) in paragraph (30), by striking ‘‘and’’ at the 
end; 
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(2) by redesignating paragraph (31) as para-
graph (32); and 
(3) by inserting after paragraph (30) the fol-
lowing new paragraph: 
‘‘(31) patient navigator services (as defined in 
section 1902(tt)(3)) that are provided in a manner 
that meets the requirements of section 1902(a)(88); 
and’’. 
(c) EFFECTIVE DATE.— 
(1) IN GENERAL.—Subject to paragraph (2), 
the amendments made by this section shall apply to 
patient navigator services provided after the first 
day of the first calendar year that begins after the 
date of enactment of this Act. 
(2) EXCEPTION FOR STATE LEGISLATION.—In 
the case of a State plan under title XIX of the So-
cial Security Act, which the Secretary of Health and 
Human Services determines requires State legisla-
tion in order for the respective plan to meet any re-
quirement imposed by amendments made by this 
Act, the respective plan shall not be regarded as fail-
ing to comply with the requirements of such title 
solely on the basis of its failure to meet such an ad-
ditional requirement before the first day of the first 
calendar quarter beginning after the close of the 
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first regular session of the State legislature that be-
gins after the date of enactment of this Act. For 
purposes of the previous sentence, in the case of a 
State that has a 2-year legislative session, each year 
of the session shall be considered to be a separate 
regular session of the State legislature. 
Æ 
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