Community Multi-Share Coverage Program Act
Bill: H.R.8245 | Sponsor: Rep. Huizenga, Bill (R-MI)
Policy area: Health

Summary:
Community Multi-Share Coverage Program Act
This bill establishes a pilot program to provide health coverage and employment supports for low-income individuals through partnerships between community organizations and hospitals.

To require the Secretary of Health and Human Services to award grants 
      to support community-based coverage entities to carry out a 
comprehensive coverage program that provides to qualifying individuals 
and small businesses health coverage and integrated social determinant 
   of health support services to small business workers that promote 
 improved health, long-term economic self-sufficiency, employment and 
                   retention, 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 ``Community Multi-Share Coverage 
Program Act''.

SEC. 2. GRANTS TO ESTABLISH COMMUNITY MULTI-SHARE COVERAGE PROGRAMS TO 
              ENABLE SMALL BUSINESSES TO PROVIDE AFFORDABLE HEALTH 
              COVERAGE AND SUPPORT SERVICES TO EMPLOYEES WITH LIMITED 
              INCOME AND ASSETS.

    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary shall award at least 3 and not 
more than 5 grants to support Community Multi-Share Coverage programs. 
Such programs shall--
            (1) reduce the number of uninsured individuals through 
        hospital-community partnership initiatives that provide an 
        affordable health coverage option for such individuals and 
        provide a coverage transition for those limited to coverage 
        through government-sponsored programs;
            (2) promote workforce development for small business by 
        addressing the influencers of health that directly impact 
        employment success and create barriers to exiting Medicaid, 
        resulting in better health and workplace success; and
            (3) support small business economic recovery by allowing 
        small businesses to be competitive in their hiring, and to 
        provide high quality, affordable health coverage to workers who 
        are otherwise hesitant to lose Medicaid eligibility.
    (b) Community Multi-Share Coverage Program Requirements.--For 
purposes of this section, the term ``Community Multi-Share Coverage 
Program'' means a program that satisfies each of the following program 
requirements--
            (1) Physical presence in the community.--The program 
        maintains a physical presence within close geographic proximity 
        to the enrollees it is serving, with a focus on mitigating 
        barriers to engagement by enabling face-to-face interactions 
        between the program staff, enrollees, and community 
        organizations.
            (2) Health coverage.--The program provides enrolled 
        qualifying individuals with health coverage that satisfies the 
        following:
                    (A) Services covered.--Provides coverage for the 
                following categories of services when furnished by 
                network providers and community resources--
                            (i) physician services;
                            (ii) inpatient and outpatient hospital 
                        services;
                            (iii) behavioral health services, including 
                        services for substance use disorder prevention 
                        and treatment;
                            (iv) preventative services;
                            (v) diagnostic laboratory tests and x-rays;
                            (vi) prescription drugs;
                            (vii) emergency ambulance services that are 
                        provided by ground transportation;
                            (viii) emergency services (as defined in 
                        section 2719A(b)(2)(B) of the Public Health 
                        Service Act (42 U.S.C. 300gg-1719a(b)(2)(B))); 
                        and
                            (ix) population health improvement 
                        services.
                    (B) Cost-sharing.--Imposes no deductible on covered 
                services provided by network providers and community 
                resources, and limits co-payments for in-network 
                covered services to levels that do not create a barrier 
                to patient access.
                    (C) Network providers.--Establishes agreements with 
                hospitals and health care providers located within the 
                community to provide care for qualifying individuals.
            (3) Integrated continuous health improvement services.--The 
        program provides, either directly or through contract, 
        integrated continuous health improvement services that satisfy 
        the following:
                    (A) Regular assessments of community factors and 
                resources that potentially impact enrollees' physical, 
                emotional, and economic health.
                    (B) A community-based planning process to identify 
                and address any negative influences identified pursuant 
                to subparagraph (A), and promote well-being through 
                partnerships and alignment efforts between the 
                community-based coverage entity and--
                            (i) local small employers;
                            (ii) entities that provide educational and 
                        occupational training (including classes, 
                        workshops, mentorships, and apprenticeships) 
                        designed to enhance preparation for work and 
                        support economic self-sufficiency;
                            (iii) community health initiatives;
                            (iv) investors;
                            (v) local, State, and Federal governmental 
                        agencies; and
                            (vi) organizations described in section 
                        501(c)(3) of the Internal Revenue Code of 1986 
                        that focus on human service needs relating to 
                        physical health, behavioral health, poverty, 
                        education, access to health care, and safety.
                    (C) Individualized assessment of each enrollee to 
                identify any negative influences on their physical, 
                emotional, and economic health, and ability to achieve 
                economic self-sufficiency. This shall include--
                            (i) an assessment of any of the enrollee's 
                        social determinants of health, health risks, 
                        barriers to long-term employment, and barriers 
                        to increasing income; and
                            (ii) a determination of the enrollee's 
                        health domain score, which is a measurement of 
                        specific influences of physical, emotional, and 
                        financial health with respect to a qualifying 
                        individual.
                    (D) Establishment of an individualized plan to 
                support each enrollee in achieving better health and 
                economic self-sufficiency. Each individualized plan 
                shall--
                            (i) identify community resources that will 
                        support the enrollee in improving their 
                        physical, behavioral, or economic health. These 
                        may include, but are not limited to--
                                    (I) group classes that address 
                                barriers to physical, emotional, and 
                                economic health; and
                                    (II) educational and occupational 
                                training opportunities that enhance 
                                work preparedness and support economic 
                                self-sufficiency; and
                            (ii) contain engagement milestones, with a 
                        goal of identifying and overcoming obstacles to 
                        engagement in personal health improvement and 
                        mitigation of root-cause barriers. These 
                        milestones shall include, but are not limited 
                        to--
                                    (I) participation in individualized 
                                health coaching services to address the 
                                enrollee's social determinants of 
                                health and to support their physical, 
                                emotional, and financial health; and
                                    (II) engagement with community 
                                resources, such as participating in 
                                group classes, as recommended by the 
                                health coach.
            (4) Funding structure.--The direct costs of the program are 
        shared among the following entities, each of which makes a 
        direct financial contribution--
                    (A) the public sector;
                    (B) local health care providers;
                    (C) enrollees; and
                    (D) enrollees' employers or skilled trade 
                organizations.
            (5) Enrollees.--
                    (A) In the event that a Program is unable to 
                provide services to all qualifying individuals in its 
                catchment area, the Program has a written policy for 
                determining which qualifying individuals are offered 
                enrollment. This policy is publicly available and does 
                not discriminate based on age, race, ethnicity, 
                religion, gender, or sexual orientation.
                    (B) The program may rescind a qualifying 
                individual's enrollment due to sustained failure to 
                meet minimum engagement thresholds, which shall be 
                participatory and not health-contingent, and provide 
                for reasonable alternatives, in their individual plan 
                described in subsection (b)(2)(C).
            (6) Evaluation.--The program formally evaluates its impact 
        on enrollees' employment status, physical and behavioral 
        health, income, and economic self-sufficiency.
    (c) Qualifying Individual.--The term ``qualifying individual'' 
means an individual who--
            (1) resides or works within the catchment area of a partner 
        hospital described in subsection (e)(1)(A);
            (2) subject to any modification made by such program to 
        narrow the income eligibility range, has a household income 
        that exceeds the Medicaid eligibility limit applicable to the 
        qualifying individual in their State of residence but does not 
        exceed 400 percent of the Federal poverty line applicable to 
        their household size;
            (3) is not enrolled in a qualified health plan during the 
        180-day period preceding the date on which such qualifying 
        individual seeks to enroll in the Community Multi-Share 
        Coverage Program, unless a such coverage is terminated due to a 
        qualifying special event;
            (4) is ineligible for enrollment in a Federal health care 
        program other than Affordable Care Act Plans, (including but 
        not limited to ineligibility to receive health services through 
        the Indian Health Service or Veterans Administration);
            (5) works for a small employer which does not offer its 
        employees coverage in a qualified health plan under which the 
        combined premium plus deductible cost to cover the employee's 
        household is less than seven percent of the employee's 
        household income; and
            (6) other requirements the Secretary determines 
        appropriate.
    (d) Grant Terms.--
            (1) Duration.--A grant awarded under this section shall be 
        made for a period of 4 years.
            (2) Amount.--The Secretary shall determine the maximum 
        amount of each grant awarded under subsection (a).
            (3) Number.--At least one award must be made to a Community 
        Multi-Share Coverage Program that is operating at the time that 
        this section is enacted.
    (e) Applications.--
            (1) In general.--To be eligible to be awarded a grant under 
        subsection (a), an applicant must--
                    (A) be a nonprofit entity with documented 
                commitments from local partner hospitals and small 
                employers to participate in a Community Multi-Share 
                Coverage Plan; and
                    (B) submit to the Secretary an application at such 
                time, in such manner, and containing the certification 
                described in paragraph (2) and such other information 
                as the Secretary may require.
            (2) Certification.--To be eligible for funding under this 
        section, an application described in paragraph (1) shall 
        include certifications that the program--
                    (A) will not impose any preexisting condition 
                exclusion (as such term is defined in section 
                2704(b)(1)(A)) of the Public Health Service Act (42 
                U.S.C. 300gg-3(b)(1)(A)) with respect to the health 
                coverage described in subsection (b)(2);
                    (B) has or will establish a network of health care 
                providers and community resources sufficient to provide 
                services to qualifying individuals enrolled under the 
                health coverage described in subsection (b)(2);
                    (C) will seek to enroll eligible individuals whose 
                household income is less than the basic cost of living 
                (as determined in a manner consistent with the ``Asset 
                Limited, Income Constrained, Employed'' or ``ALICE'' 
                methodology);
                    (D) select an entity to carry out administrative 
                and accounting responsibilities (including monthly 
                billing, verification of eligibility of qualifying 
                individuals, enrollment of qualifying individuals, 
                maintenance of a list of active enrollees, and 
                operation of a benefit utilization management program) 
                necessary with respect to the health coverage described 
                in subsection (b)(2); and
                    (E) shall submit written reports to the Secretary 
                on an annual basis evaluating the progress on advancing 
                access to health care, increasing economic self-
                sufficiency, and other elements that the Secretary 
                requires.
    (f) Definitions.--In this section:
            (1) Agency.--The term ``agency'' means a local, State, or 
        Federal agency.
            (2) Federal health care program.--The term ``Federal health 
        care program'' has the meaning given such term in section 
        1128B(f) of the Social Security Act (42 U.S.C. 1320a-7b(f)).
            (3) Health coach.--The term ``health coach'' means an 
        individual who is a member of the staff of the community-based 
        coverage entity that has received training to provide health 
        coaching services (including health improvement program 
        services).
            (4) Hospital.--The term ``hospital'' means an institution 
        that--
                    (A) meets the requirements of section 1861(e) of 
                the Social Security Act (42 U.S.C. 1395x(e)); and
                    (B) is an organization described in subsections 
                (c)(3) and (r)(3) of section 501 of the Internal 
                Revenue Code of 1986 and is exempt from taxation under 
                section 501(a) of such Code.
            (5) Qualified health plan.--The term ``qualified health 
        plan'' has the meaning given such term in section 1301(a) of 
        the Patient Protection and Affordable Care Act (42 U.S.C. 
        18021(a)).
            (6) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (7) Small employer.--The term ``small employer'' has the 
        meaning given such term in section 1304(b)(2) of the Patient 
        Protection and Affordable Care Act (42 U.S.C. 18024(b)(2)).
            (8) Social determinants of health.--The term ``social 
        determinants of health'' has the meaning given such term by the 
        Director of the Centers for Disease Control and Prevention.
    (g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section--
            (1) $4,800,000 for fiscal year 2022;
            (2) $7,200,000 for fiscal year 2023; and
            (3) $12,000,000 for each of fiscal years 2024 and 2025.
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