II Calendar No. 115 109th CONGRESS 1st Session S. 898 [Report No. 109–73] IN THE SENATE OF THE UNITED STATES April 25, 2005 Mrs. Hutchison (for herself, Mr. Bingaman, Mr. Brownback, Mr. Kennedy, and Mr. Cochran) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions May 25, 2005 Reported by Mr. Enzi, with an amendment Strike out all after the enacting clause and insert the part printed in italic A BILL To amend the Public Health Service Act to authorize a demonstration grant program to provide patient navigator services to reduce barriers and improve health care outcomes, and for other purposes.
1.
Short title
This Act may be cited as the Patient Navigator Outreach and Chronic Disease Prevention Act of 2005.
2.
Patient navigator grants
Subpart V of part D of title III of the Public Health Service Act (42 U.S.C. 256) is amended by adding at the end the following:
340A.
Patient navigator grants
(a)
Grants
The Secretary, acting through the Administrator of the Health Resources and Services Administration, may make grants to eligible entities for the development and operation of demonstration programs to provide patient navigator services to improve health care outcomes. The Secretary shall coordinate with, and ensure the participation of, the Indian Health Service, the National Cancer Institute, the Office of Rural Health Policy, and such other offices and agencies as deemed appropriate by the Secretary, regarding the design and evaluation of the demonstration programs. (b)
Use of funds
The Secretary shall require each recipient of a grant under this section to use the grant to recruit, assign, train, and employ patient navigators who have direct knowledge of the communities they serve to facilitate the care of individuals, including by performing each of the following duties: (1)Acting as contacts, including by assisting in the coordination of health care services and provider referrals, for individuals who are seeking prevention or early detection services for, or who following a screening or early detection service are found to have a symptom, abnormal finding, or diagnosis of, cancer or other chronic disease. (2)Facilitating the involvement of community organizations in assisting individuals who are at risk for or who have cancer or other chronic diseases to receive better access to high-quality health care services (such as by creating partnerships with patient advocacy groups, charities, health care centers, community hospice centers, other health care providers, or other organizations in the targeted community). (3)Notifying individuals of clinical trials and, on request, facilitating enrollment of eligible individuals in these trials. (4)Anticipating, identifying, and helping patients to overcome barriers within the health care system to ensure prompt diagnostic and treatment resolution of an abnormal finding of cancer or other chronic disease. (5)Coordinating with the relevant health insurance ombudsman programs to provide information to individuals who are at risk for or who have cancer or other chronic diseases about health coverage, including private insurance, health care savings accounts, and other publicly funded programs (such as Medicare, Medicaid, health programs operated by the Department of Veterans Affairs or the Department of Defense, the State children’s health insurance program, and any private or governmental prescription assistance programs). (6)Conducting ongoing outreach to health disparity populations, including the uninsured, rural populations, and other medically underserved populations, in addition to assisting other individuals who are at risk for or who have cancer or other chronic diseases to seek preventative care. (c)
Prohibitions
(1)
Referral fees
The Secretary shall require each recipient of a grant under this section to prohibit any patient navigator providing services under the grant from accepting any referral fee, kickback, or other thing of value in return for referring an individual to a particular health care provider. (2)
Legal fees and costs
The Secretary shall prohibit the use of any grant funds received under this section to pay any fees or costs resulting from any litigation, arbitration, mediation, or other proceeding to resolve a legal dispute. (d)
Grant period
(1)
In general
Subject to paragraphs (2) and (3), the Secretary may award grants under this section for periods of not more than 3 years. (2)
Extensions
Subject to paragraph (3), the Secretary may extend the period of a grant under this section. Each such extension shall be for a period of not more than 1 year. (3)
Limitations on grant period
In carrying out this section, the Secretary— (A)shall ensure that the total period of a grant does not exceed 4 years; and (B)may not authorize any grant period ending after September 30, 2010. (e)
Application
(1)
In general
To seek a grant under this section, an eligible entity shall submit an application to the Secretary in such form, in such manner, and containing such information as the Secretary may require. (2)
Contents
At a minimum, the Secretary shall require each such application to outline how the eligible entity will establish baseline measures and benchmarks that meet the Secretary’s requirements to evaluate program outcomes. (f)
Uniform baseline measures
The Secretary shall establish uniform baseline measures in order to properly evaluate the impact of the demonstration projects under this section. (g)
Preference
In making grants under this section, the Secretary shall give preference to eligible entities that demonstrate in their applications plans to utilize patient navigator services to overcome significant barriers in order to improve health care outcomes in their respective communities. (h)
Duplication of services
An eligible entity that is receiving Federal funds for activities described in subsection (b) on the date on which the entity submits an application under subsection (e), may not receive a grant under this section unless the entity can demonstrate that amounts received under the grant will be utilized to expand services or provide new services to individuals who would not otherwise be served. (i)
Coordination with other programs
The Secretary shall ensure coordination of the demonstration grant program under this section with existing authorized programs in order to facilitate access to high-quality health care services. (j)
Study; reports
(1)
Final report by secretary
Not later than 6 months after the completion of the demonstration grant program under this section, the Secretary shall conduct a study of the results of the program and submit to the Congress a report on such results that includes the following: (A)An evaluation of the program outcomes, including— (i)quantitative analysis of baseline and benchmark measures; and (ii)aggregate information about the patients served and program activities. (B)Recommendations on whether patient navigator programs could be used to improve patient outcomes in other public health areas. (2)
Reports by secretary
The Secretary may provide interim reports to the Congress on the demonstration grant program under this section at such intervals as the Secretary determines to be appropriate. (3)
Interim reports by grantees
The Secretary may require grant recipients under this section to submit interim and final reports on grant program outcomes. (k)
Rule of construction
This section shall not be construed to authorize funding for the delivery of health care services (other than the patient navigator duties listed in subsection (b)). (l)
Definitions
In this section: (1)The term eligible entity means a public or nonprofit private health center (including a Federally qualified health center (as that term is defined in section 1861(aa)(4) of the Social Security Act)), a health facility operated by or pursuant to a contract with the Indian Health Service, a hospital, a cancer center, a rural health clinic, an academic health center, or a nonprofit entity that enters into a partnership or coordinates referrals with such a center, clinic, facility, or hospital to provide patient navigator services. (2)The term health disparity population means a population that, as determined by the Secretary, has a significant disparity in the overall rate of disease incidence, prevalence, morbidity, mortality, or survival rates as compared to the health status of the general population. (3)The term patient navigator means an individual who has completed a training program approved by the Secretary to perform the duties listed in subsection (b). (m)
Authorization of appropriations
(1)
In general
To carry out this section, there are authorized to be appropriated $2,000,000 for fiscal year 2006, $5,000,000 for fiscal year 2007, $8,000,000 for fiscal year 2008, $6,500,000 for fiscal year 2009, and $3,500,000 for fiscal year 2010. (2)
Availability
The amounts appropriated pursuant to paragraph (1) shall remain available for obligation through the end of fiscal year 2010.
.
1.
Short title
This Act may be cited as the Patient Navigator Outreach and Chronic Disease Prevention Act of 2005.
2.
Patient navigator grants
Subpart V of part D of title III of the Public Health Service Act (42 U.S.C. 256) is amended by adding at the end the following:
340A.
Patient navigator grants
(a)
Grants
The Secretary, acting through the Administrator of the Health Resources and Services Administration, may make grants to eligible entities for the development and operation of demonstration programs to provide patient navigator services to improve health care outcomes. The Secretary shall coordinate with, and ensure the participation of, the Indian Health Service, the National Cancer Institute, the Office of Rural Health Policy, and such other offices and agencies as deemed appropriate by the Secretary, regarding the design and evaluation of the demonstration programs. (b)
Use of funds
The Secretary shall require each recipient of a grant under this section to use the grant to recruit, assign, train, and employ patient navigators who have direct knowledge of the communities they serve to facilitate the care of individuals, including by performing each of the following duties: (1)Acting as contacts, including by assisting in the coordination of health care services and provider referrals, for individuals who are seeking prevention or early detection services for, or who following a screening or early detection service are found to have a symptom, abnormal finding, or diagnosis of, cancer or other chronic disease. (2)Facilitating the involvement of community organizations in assisting individuals who are at risk for or who have cancer or other chronic diseases to receive better access to high-quality health care services (such as by creating partnerships with patient advocacy groups, charities, health care centers, community hospice centers, other health care providers, or other organizations in the targeted community). (3)Notifying individuals of clinical trials and, on request, facilitating enrollment of eligible individuals in these trials. (4)Anticipating, identifying, and helping patients to overcome barriers within the health care system to ensure prompt diagnostic and treatment resolution of an abnormal finding of cancer or other chronic disease. (5)Coordinating with the relevant health insurance ombudsman programs to provide information to individuals who are at risk for or who have cancer or other chronic diseases about health coverage, including private insurance, health care savings accounts, and other publicly funded programs (such as Medicare, Medicaid, health programs operated by the Department of Veterans Affairs or the Department of Defense, the State children’s health insurance program, and any private or governmental prescription assistance programs). (6)Conducting ongoing outreach to health disparity populations, including the uninsured, rural populations, and other medically underserved populations, in addition to assisting other individuals who are at risk for or who have cancer or other chronic diseases to seek preventative care. (c)
Prohibitions
(1)
Referral fees
The Secretary shall require each recipient of a grant under this section to prohibit any patient navigator providing services under the grant from accepting any referral fee, kickback, or other thing of value in return for referring an individual to a particular health care provider. (2)
Legal fees and costs
The Secretary shall prohibit the use of any grant funds received under this section to pay any fees or costs resulting from any litigation, arbitration, mediation, or other proceeding to resolve a legal dispute. (d)
Grant period
(1)
In general
Subject to paragraphs (2) and (3), the Secretary may award grants under this section for periods of not more than 3 years. (2)
Extensions
Subject to paragraph (3), the Secretary may extend the period of a grant under this section. Each such extension shall be for a period of not more than 1 year. (3)
Limitations on grant period
In carrying out this section, the Secretary— (A)shall ensure that the total period of a grant does not exceed 4 years; and (B)may not authorize any grant period ending after September 30, 2010. (e)
Application
(1)
In general
To seek a grant under this section, an eligible entity shall submit an application to the Secretary in such form, in such manner, and containing such information as the Secretary may require. (2)
Contents
At a minimum, the Secretary shall require each such application to outline how the eligible entity will establish baseline measures and benchmarks that meet the Secretary’s requirements to evaluate program outcomes. (f)
Uniform baseline measures
The Secretary shall establish uniform baseline measures in order to properly evaluate the impact of the demonstration projects under this section. (g)
Preference
In making grants under this section, the Secretary shall give preference to eligible entities that demonstrate in their applications plans to utilize patient navigator services to overcome significant barriers in order to improve health care outcomes in their respective communities. (h)
Duplication of services
An eligible entity that is receiving Federal funds for activities described in subsection (b) on the date on which the entity submits an application under subsection (e), may not receive a grant under this section unless the entity can demonstrate that amounts received under the grant will be utilized to expand services or provide new services to individuals who would not otherwise be served. (i)
Coordination with other programs
The Secretary shall ensure coordination of the demonstration grant program under this section with existing authorized programs in order to facilitate access to high-quality health care services. (j)
Study; reports
(1)
Final report by secretary
Not later than 180 days after the completion of the demonstration grant program under this section, the Secretary shall conduct a study of the results of the program and submit to the Congress a report on such results that includes the following: (A)An evaluation of the program outcomes, including— (i)quantitative analysis of baseline and benchmark measures; and (ii)aggregate information about the patients served and program activities. (B)Recommendations on whether patient navigator programs could be used to improve patient outcomes in other public health areas. (2)
Reports by secretary
The Secretary may provide interim reports to the Congress on the demonstration grant program under this section at such intervals as the Secretary determines to be appropriate. (3)
Interim reports by grantees
The Secretary may require grant recipients under this section to submit interim and final reports on grant program outcomes. (k)
Rule of construction
This section shall not be construed to authorize funding for the delivery of health care services (other than the patient navigator duties listed in subsection (b)). (l)
Definitions
In this section: (1)The term eligible entity means a public or nonprofit private health center (including a Federally qualified health center (as that term is defined in section 1861(aa)(4) of the Social Security Act)), a health facility operated by or pursuant to a contract with the Indian Health Service, a hospital, a cancer center, a rural health clinic, an academic health center, or a nonprofit entity that enters into a partnership or coordinates referrals with such a center, clinic, facility, or hospital to provide patient navigator services. (2)The term health disparity population means a population that, as determined by the Secretary, has a significant disparity in the overall rate of disease incidence, prevalence, morbidity, mortality, or survival rates as compared to the health status of the general population. (3)The term patient navigator means an individual who has completed a training program approved by the Secretary to perform the duties listed in subsection (b). (m)
Authorization of appropriations
(1)
In general
To carry out this section, there are authorized to be appropriated $2,000,000 for fiscal year 2006, $5,000,000 for fiscal year 2007, $8,000,000 for fiscal year 2008, $6,500,000 for fiscal year 2009, and $3,500,000 for fiscal year 2010. (2)
Availability
The amounts appropriated pursuant to paragraph (1) shall remain available for obligation through the end of fiscal year 2010.
.
May 25, 2005 Reported with an amendment