I 112th CONGRESS 2d Session H. R. 6521 IN THE HOUSE OF REPRESENTATIVES September 21, 2012 Mr. Israel (for himself, Mr. Rangel, Mr. Lewis of Georgia, Mr. Ackerman, Mrs. McCarthy of New York, Mr. Serrano, Ms. Slaughter, Mr. Owens, Mrs. Christensen, Mrs. Lowey, Mr. Crowley, Mr. Bishop of New York, and Mr. Deutch) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To provide payment for patient navigator services under title XIX of the Social Security Act.

1.

Medicaid coverage for patient navigator services

(a)

State Plan requirement

Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)) is amended— (1)in paragraph (82)(C), by striking and at the end; (2)in paragraph (83), by striking the period at the end and inserting ; and; and (3)by inserting after paragraph (83) the following: (84)provide that the State shall reimburse an eligible entity (as such term is defined in subsection (ll)(1)) for any patient navigator service (as such term is defined in subsection (ll)(3)) that is— (A)provided to an individual who is eligible for medical assistance under the State plan; and (B)provided by a patient navigator (as such term is defined in subsection (ll)(2)) through the eligible entity. . (b)

Patient navigator services definitions

Section 1902 of the Social Security Act is amended by adding at the end the following: (ll)

Patient navigator services definitions

For purposes of subsection (a)(84): (1)

Eligible entity

The term eligible entity means an entity that— (A)is an eligible entity (as such term is defined in section 340A(l)(1) of the Public Health Service Act); and (B)complies with the following requirements of section 340A of the Public Health Service Act: (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

(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 subsection (a)(84), 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 and 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 (as defined in section 340A(l)(3) of the Public Health Service Act), through an eligible entity. . (c)

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: (29)patient navigator services (as such term is defined in section 1902(ll)(3)) that are provided in a manner that meets the requirements of section 1902(a)(84); and . (d)

Effective date

(1)

In general

Subject to paragraph (2), the amendments made 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.