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)by inserting after paragraph (77) the following new paragraph:

(78)provide that the State shall reimburse an eligible entity (as defined in subsection (ll)(1)) for any patient navigator service (as defined in subsection (ll)(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 (ll)(2)) through the eligible entity.

; and

(2)by adding at the end the following new subsection:

(ll)

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 has the meaning given such term in section 340A(l)(3) of the Public Health Service Act. (B)

Consultation with advisory committee

(i)

In general

The Secretary shall consult with the patient navigation advisory committee to the extent necessary to further clarify the definition of the term patient navigator for purposes of this section, including establishing requirements to ensure adequate training for such navigators, such as developing a training curriculum. (ii)

Membership

The Secretary shall convene a patient navigation advisory committee. The members of such committee shall include— (I)representatives from relevant Federal departments and agencies, including the National Institutes of Health, the Centers for Disease Control and Prevention, the Health Resources and Services Administration, and the Centers for Medicare & Medicaid Services; and (II)individuals and representatives of public and private organizations with expertise in patient navigation. (3)

Patient navigator services

The term patient navigator service means a service that is a duty specified under paragraphs (1) through (6) of subsection (b) of section 340A of the Public Health Service Act and that is provided by a patient navigator through an eligible entity.

(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 (28), by striking and at the end; (2)by redesignating paragraph (29) as paragraph (30); and (3)by inserting after paragraph (28) the following new paragraph:

(29)patient navigator services (as defined in section 1902(ll)(3)) that are provided in a manner that meets the requirements of section 1902(a)(78); 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.