Patient Navigation Assistance Act
Bill: H.R.9285 | Sponsor: Rep. DeSaulnier, Mark (D-CA)
Policy area: Health

Summary:
Patient Navigation Assistance Act
This bill requires state Medicaid programs to cover patient navigator services for enrollees.

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 Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Patient Navigation Assistance Act''.

SEC. 2. MEDICAID COVERAGE FOR PATIENT NAVIGATOR SERVICES.

    (a) In General.--Section 1902(a) of the Social Security Act (42 
U.S.C. 1396a(a)) is amended--
            (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 following 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 subsection (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 subsection:
    ``(tt) Patient Navigator Services Definitions.--For purposes of 
this section:
            ``(1) Eligible entity.--The term `eligible entity' 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
                    ``(B) complies with the following requirements of 
                such section (insofar as they apply to a grant 
                recipient under such section):
                            ``(i) Subsection (b) (relating to patient 
                        navigator duties and community knowledge).
                            ``(ii) Subsection (c) (relating to 
                        prohibitions).
                            ``(iii) Subsection (e) (relating to 
                        applications).
                            ``(iv) Subsection (j)(3) (relating to 
                        reports).
            ``(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 provides 
                        individualized education and resources to 
                        facilitate informed decision-making and timely 
                        access to quality health and psychosocial care; 
                        and
                            ``(ii) has obtained and complies with 
                        education, licensure, or certification, 
                        including at least--
                                    ``(I) a bachelor's degree in 
                                nursing 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 
                                requirements, 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 
                                professionals, as applicable; or
                                    ``(IV) subject to subparagraph (B), 
                                completion of a training program 
                                approved by the Secretary for purposes 
                                of section 340A(l)(3) of the Public 
                                Health Service Act.
                    ``(B) Transitional limitation.--The training 
                described in subclause (IV) of subparagraph (A)(ii) 
                shall not satisfy the requirement 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 services pursuant to section 2(c) of 
                the Patient Navigator Assistance Act.
            ``(3) Patient navigator services.--The term `patient 
        navigator service' means a service provided by a patient 
        navigator to an individual, including--
                    ``(A) referrals and related activities to help the 
                individual obtain needed services, including activities 
                that help link the individual with medical, social, 
                logistical, financial, or other programs or services to 
                address identified or specified 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 Secretary.''.
    (b) Treatment as Medical Assistance for Purposes 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;
            (2) by redesignating paragraph (31) as paragraph (32); and
            (3) by inserting after paragraph (30) the following 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 Social Security Act, which 
        the Secretary of Health and Human Services determines requires 
        State legislation in order for the respective plan to meet any 
        requirement imposed by amendments made by this Act, the 
        respective plan shall not be regarded as failing to comply with 
        the requirements of such title solely on the basis of its 
        failure to meet such an additional requirement before the first 
        day of the first calendar quarter beginning after the close of 
        the first regular session of the State legislature that begins 
        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.
                                 <all>