John Lewis Equality in Medicare and Medicaid Treatment Act of 2022
Bill: S.4067 | Sponsor: Sen. Booker, Cory A. (D-NJ)
Policy area: Health

Summary:
John Lewis Equality in Medicare and Medicaid Treatment Act of 2022
This bill requires the Center for Medicare and Medicaid Innovation to test a payment model that addresses social determinants of health and health disparities, particularly with respect to minorities, underserved areas, and high-risk individuals. The bill also generally incorporates consideration of such factors into the selection, implementation, and evaluation of other models, including the decision as to whether to expand a model's duration and scope.

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.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``John Lewis Equality in Medicare and 
Medicaid Treatment Act of 2022''.

SEC. 2. IMPROVING ACCESS TO CARE FOR MEDICARE AND MEDICAID 
              BENEFICIARIES.

    Section 1115A of the Social Security Act (42 U.S.C. 1315a) is 
amended--
            (1) in subsection (a)--
                    (A) in paragraph (1), by inserting ``advance health 
                equity and'' before ``improve the coordination''; and
                    (B) in paragraph (3)--
                            (i) by inserting ``(including the Office of 
                        Minority Health of the Centers for Medicare & 
                        Medicaid Services, the Office of Rural Health 
                        Policy of the Health Resources and Services 
                        Administration, and the Office on Women's 
                        Health of the Department of Health and Human 
                        Services)'' after ``relevant Federal 
                        agencies''; and
                            (ii) by striking ``experts with expertise 
                        in medicine'' and inserting ``experts with 
                        expertise in medicine, the causes of health 
                        disparities and the social determinants of 
                        health, and'';
            (2) in subsection (b)--
                    (A) in paragraph (2)--
                            (i) in subparagraph (A)--
                                    (I) by inserting the following 
                                after the first sentence: ``Prior to 
                                selecting a model under this paragraph, 
                                the Secretary shall consult with the 
                                Office of Minority Health of the 
                                Centers for Medicare & Medicaid 
                                Services, the Office of Rural Health 
                                Policy of the Health Resources and 
                                Services Administration, and the Office 
                                on Women's Health of the Department of 
                                Health and Human Services to ensure 
                                that models under consideration address 
                                health disparities and social 
                                determinants of health as appropriate 
                                for populations to be cared for under 
                                the model.'';
                                    (II) by inserting ``and, for models 
                                for which testing begins on or after 
                                January 1, 2023, address health equity 
                                as well as improving access to care 
                                received by individuals receiving 
                                benefits under such title'' after 
                                ``applicable title''; and
                                    (III) by adding at the end the 
                                following: ``The models selected under 
                                this subparagraph shall include the 
                                social determinants of health payment 
                                model described in subsection (h), the 
                                testing of which shall begin not later 
                                than December 31, 2023.''; and
                            (ii) in subparagraph (C), by adding at the 
                        end the following new clauses:
                            ``(ix) Whether the model will affect access 
                        to care from providers and suppliers caring for 
                        high risk patients or operating in underserved 
                        areas.
                            ``(x) Whether the model has the potential 
                        to reduce health disparities, including 
                        minority and rural health disparities.'';
                    (B) in paragraph (3)(B)--
                            (i) in clause (i), by inserting ``or health 
                        equity'' after ``quality of care'';
                            (ii) in clause (ii), by inserting ``or 
                        increasing health inequities'' after ``quality 
                        of care''; and
                            (iii) in clause (iii), by inserting ``or 
                        health equity'' after ``quality of care''; and
                    (C) in paragraph (4)(A)--
                            (i) in clause (i), by striking ``; and'' 
                        and inserting a semicolon;
                            (ii) in clause (ii), by striking the period 
                        and inserting ``; and''; and
                            (iii) by adding at the end the following 
                        new clause:
                            ``(iii) for models for which testing begins 
                        on or after January 1, 2023, the extent to 
                        which the model improves health equity.'';
            (3) in subsection (c)--
                    (A) in paragraph (1)--
                            (i) in subparagraph (A), by inserting ``or, 
                        beginning on or after January 1, 2023, 
                        increasing health inequities'' before the 
                        semicolon; and
                            (ii) in subparagraph (B), by inserting 
                        ``or, beginning on or after January 1, 2023, 
                        health equity'' after ``patient care''; and
                    (B) in paragraph (3), by inserting ``or increase 
                health disparities experienced by beneficiaries, 
                including low-income, minority, or rural beneficiaries, 
                or that such expansion would improve health equity'' 
                before the period;
            (4) in subsection (g), by adding at the end the following: 
        ``For reports submitted after the date of enactment of the John 
        Lewis Equality in Medicare and Medicaid Treatment Act of 2022, 
        each such report shall include information on the following:
            ``(1) The interventions that address social determinants of 
        health, health disparities, or health equity in payment models 
        selected by the CMI for testing under this section.
            ``(2) Estimated Federal savings achieved through reducing 
        disparities, including rural and minority health disparities, 
        improving health equity, or addressing social determinants of 
        health.
            ``(3) The effectiveness of interventions in mitigating 
        negative health outcomes and higher costs associated with 
        social determinants of health within models selected by the 
        Center for Medicare and Medicaid Innovation for testing.
            ``(4) Other areas determined appropriate by the 
        Secretary.''; and
            (5) by adding at the end the following new subsection:
    ``(h) Social Determinants of Health Payment Model.--
            ``(1) In general.--The social determinants of health 
        payment model described in this subsection is a payment model 
        that tests each of the payment and service delivery innovations 
        described in paragraph (2) in a region determined appropriate 
        by the Secretary.
            ``(2) Payment and service delivery innovations described.--
        For purposes of paragraph (1), the payment and service delivery 
        innovations described in this clause are the following:
                    ``(A) Payment and service delivery innovations for 
                behavioral health services, focusing on gathering 
                actionable data to address the higher costs associated 
                with beneficiaries with diagnosed behavioral 
                conditions.
                    ``(B) Payment and service delivery innovations 
                targeting conditions or comorbidities of individuals 
                entitled or enrolled under the Medicare program under 
                title XVIII and enrolled under a State plan under the 
                Medicaid program under title XIX to increase capacity 
                in underserved areas.
                    ``(C) Payment and service delivery innovations 
                targeting conditions or comorbidities of applicable 
                individuals to increase capacity in underserved areas.
                    ``(D) Payment and service delivery innovations 
                targeted on Medicaid eligible pregnant and postpartum 
                women, up to one year after delivery.''.
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