[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4925 Introduced in House (IH)]

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116th CONGRESS
  1st Session
                                H. R. 4925

 To require the Secretary of Health and Human Services to award grants 
 to support community-based coverage entities to carry out a coverage 
  program that provides to qualifying individuals health coverage and 
     educational and occupational training, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 30, 2019

 Mr. Huizenga introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
Education and Labor, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
 To require the Secretary of Health and Human Services to award grants 
 to support community-based coverage entities to carry out a coverage 
  program that provides to qualifying individuals health coverage and 
     educational and occupational training, 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 COMMUNITY-BASED COVERAGE ENTITIES TO CARRY OUT A 
              COVERAGE PROGRAM THAT PROVIDES HEALTH COVERAGE AND 
              EDUCATIONAL AND OCCUPATIONAL TRAINING.

    (a) In General.--Not later than 180 days after the date of the 
enactment of the Community Multi-share Coverage Program Act, the 
Secretary shall award at least 3 and not more than 5 grants to support 
community-based coverage entities to carry out qualifying coverage 
benefit pilot 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; and
            (2) test the feasibility of moving individuals eligible for 
        medical assistance under a State plan under the Medicaid 
        program under title XIX of the Social Security Act (42 U.S.C. 
        1396 et seq.) with full-time employment into such programs.
    (b) Qualifying Coverage Benefit Program Requirements.--For purposes 
of this section, the term ``qualifying coverage benefit program'' means 
a program that satisfies each of the following program requirements:
            (1) Health coverage.--Under the program, a community-based 
        coverage entity shall provide to qualifying individuals health 
        coverage offered in connection with a qualifying coverage 
        benefit program that satisfies the following:
                    (A) First-dollar coverage (where such coverage is 
                furnished by network providers and community resources) 
                for--
                            (i) diagnostic laboratory tests and x-rays;
                            (ii) emergency ambulance services that are 
                        provided by ground transportation;
                            (iii) emergency services (as defined in 
                        section 2719A(b)(2)(B) of the Public Health 
                        Service Act (42 U.S.C. 300gg-19a(b)(2)(B)));
                            (iv) inpatient and outpatient hospital 
                        services;
                            (v) mental health services;
                            (vi) physician services;
                            (vii) population health improvement 
                        services;
                            (viii) preventatives services;
                            (ix) prescription drugs; and
                            (x) substance abuse services.
                    (B) Coverage for--
                            (i) community and individual assessment 
                        tools to identify any negative influences of 
                        health and economic self-sufficiency to assist 
                        physicians in understanding the social 
                        determinants of health impacting an individual;
                            (ii) a planning process to resolve any 
                        negative influences identified pursuant to 
                        clause (i) and promote well-being through 
                        community partnerships between the community-
                        based coverage entity and--
                                    (I) businesses;
                                    (II) educational institutions;
                                    (III) investors;
                                    (IV) local, State, and Federal 
                                governmental agencies; and
                                    (V) organizations described in 
                                section 501(c)(3) of the Internal 
                                Revenue Code of 1986 that focuses on 
                                human service needs relating to 
                                behavioral health, poverty, education, 
                                and access and safety;
                            (iii) the monitoring of and support 
                        (including health coaching services and 
                        coordination of services within a community to 
                        address the needs of an individual) with 
                        respect to financial, emotional, and physical 
                        health; and
                            (iv) any other benefit the community-based 
                        coverage entity determines appropriate.
            (2) Educational and occupational training.--Under the 
        program, a community-based coverage entity shall--
                    (A) connect and foster ongoing relationships 
                between qualifying individuals and educational and 
                occupational training (including classes, workshops, 
                mentorships, and apprenticeships) designed to enhance 
                preparation for work and support economic self-
                sufficiency in a manner that reflects the needs of such 
                individuals and opportunities in the community;
                    (B) with respect to the comprehensive health 
                improvement process described in subsection 
                (e)(1)(C)(vi), identify and address barriers to 
                employment and increasing income for qualifying 
                individuals; and
                    (C) measure and assess the effectiveness of the 
                program in increasing employment and increasing income 
                for qualifying individuals.
            (3) Board of directors.--For the purpose of carrying out 
        the program, the community-based coverage entity shall form a 
        board of directors, or utilize an existing board of directors, 
        in accordance with subsection (e).
    (c) Community-Based Coverage Entity.--For the purposes of this 
section, the term ``community-based coverage entity'' means an entity 
that maintains a physical presence within close geographic proximity to 
the individuals it is serving, with a focus on mitigating barriers to 
engagement by enabling face-to-face interactions between the entity 
staff, the individuals served, and community organizations.
    (d) Qualifying Individual.--For the purposes of this section, the 
term ``qualifying individual'' means an individual who meets the 
following requirements:
            (1) Subject to any modification made by such program 
        pursuant to subsection (e)(2)(C)(vii), an income that exceeds 
        100 percent but does not exceed 400 percent of the poverty line 
        applicable to a family of the size involved.
            (2) Not enrolled under a qualified health plan during the 
        180-day period preceding the date on which such qualifying 
        individual seeks to enroll under the coverage program under 
        this section.
            (3) Ineligibility for enrollment in a Federal health care 
        program (including ineligibility to receive health services 
        through the Indian Health Service).
            (4) Resides or works within the catchment area of a 
        hospital described in subsection (g)(2)(C).
            (5) Works for a small employer that does not make 
        enrollment in qualified health plans in the small group market 
        such that the combined premium plus deductible cost to cover 
        the employee's household is less than seven percent of the 
        employee's household income available to its employees 
        through--
                    (A) in the case that a State elects to provide one 
                exchange in the State for both qualifying individuals 
                and qualified small employers pursuant to paragraph (2) 
                of section 1311(b) of the Patient Protection and 
                Affordable Care Act (42 U.S.C. 18031(b)), the American 
                Health Benefit Exchange (as such term is used in 
                paragraph (1) of such section) for the plan year in 
                which such qualifying individual seeks health insurance 
                coverage described in subsection (b)(1) from a 
                qualifying coverage benefit program; and
                    (B) in the case that a State retains separate 
                exchanges for qualifying individuals and qualified 
                small employers, the Small Business Health Options 
                Program (as such term is used in section 1311(b)(2) of 
                the Patient Protection and Affordable Care Act (42 
                U.S.C. 18031(b)(2))) for the plan year in which such 
                qualifying individual seeks health insurance coverage 
                described in subsection (b)(1) from a qualifying 
                coverage benefit program.
            (6) Any other requirement the Secretary determines 
        appropriate.
    (e) Board of Directors.--
            (1) Composition.--A board of directors formed pursuant to 
        subsection (b)(3) shall be composed of at least 9 members and 
        not more than 15 members with representation from--
                    (A) local health care providers, of which not more 
                than two individuals may be from the sponsoring health 
                care organization;
                    (B) qualifying individuals;
                    (C) contributing employers;
                    (D) government representatives;
                    (E) the local health authority;
                    (F) local education systems; and
                    (G) other representatives as necessary to reflect 
                the community composition.
            (2) Duties.--
                    (A) Enactment of bylaws.--A board of directors 
                shall enact bylaws relating to--
                            (i) public engagement with the board of 
                        directors;
                            (ii) a shared goal of improving health 
                        access and increasing affordability;
                            (iii) outcome-based goals for the program 
                        that considers the needs of the community;
                            (iv) program costs; and
                            (v) an intent to receive comments regarding 
                        the health improvement goals for the community.
                    (B) Meetings.--A board of directors shall meet at 
                least bimonthly.
                    (C) Qualifying coverage benefits program.--A board 
                of directors shall--
                            (i) carry out the qualifying coverage 
                        benefit program described in subsection (b);
                            (ii) determine the share of payments for 
                        benefits under the health coverage described in 
                        subsection (b)(1) that are attributable to--
                                    (I) the amount awarded to a 
                                community-based coverage entity;
                                    (II) a sponsoring health care 
                                organization;
                                    (III) a qualifying individual; and
                                    (IV) an employer of a qualifying 
                                individual or a skilled trade 
                                organization of a qualifying 
                                individual;
                            (iii) determine the premiums and 
                        limitations on payments (including deductibles 
                        and coinsurance amounts) for the health 
                        coverage described in subsection (b)(1) for a 
                        qualifying individual enrolled under such 
                        coverage and the extent, if any, to which such 
                        premiums and limitations for a qualifying 
                        individual shall increase as the income of such 
                        qualifying individual increases relative to the 
                        poverty line applicable to a family of the size 
                        involved;
                            (iv) establish a procedure to--
                                    (I) assist qualifying individuals 
                                in enrolling under the health coverage 
                                described in subsection (b)(1);
                                    (II) assist a qualifying individual 
                                that does not meet the requirements of 
                                a qualified individual specified under 
                                subsection (d), is eligible for medical 
                                assistance under a State plan under the 
                                Medicaid program under title XIX of the 
                                Social Security Act (42 U.S.C. 1396 et 
                                seq.), and resides in the catchment 
                                area of the hospital described in 
                                subsection (g)(2)(C) in enrolling under 
                                the appropriate State plan under such 
                                program;
                                    (III) bill and collect the share of 
                                payments for benefits described in 
                                clause (ii);
                                    (IV) bill and collect the premiums 
                                and limitations on payment described in 
                                clause (iii);
                                    (V) for the purposes of integrating 
                                community resources, form partnerships 
                                with community population health 
                                initiatives;
                                    (VI) remove a qualifying individual 
                                from the health insurance coverage 
                                described in subsection (b)(1) in the 
                                case the qualifying individual--
                                            (aa) has been enrolled 
                                        under the qualifying covered 
                                        benefits program for a 4-year 
                                        period; and
                                            (bb) fails to meet the 
                                        milestones identified pursuant 
                                        to clause (vi); and
                                    (VII) determine a maximum 
                                enrollment period for individual 
                                participation, including required 
                                milestones for addressing social 
                                determinants of health while enrolled;
                            (v) for the purpose of encouraging a 
                        qualifying individual to seek a primary care 
                        physician, establish incentives for a 
                        qualifying individual to initially seek such 
                        physician for care (including the reduction of 
                        benefits until a primary care physician is 
                        engaged in the care of such qualifying 
                        individual);
                            (vi) for the purpose of making progress 
                        toward health and economic self-sufficiency, 
                        establish routine milestones and supportive 
                        services (to be known as the ``comprehensive 
                        health improvement process'') that a qualifying 
                        individual enrolled under health coverage 
                        described in subsection (b)(1) shall meet to 
                        maintain enrollment and such milestones shall 
                        include--
                                    (I) an assessment relating to 
                                social determinants of health, health 
                                risks, and any other assessment that is 
                                appropriate as determined by the 
                                circumstances of the qualifying 
                                individual;
                                    (II) meetings with a health coach 
                                to address social influences of health 
                                and to support the physical, emotional, 
                                and financial health of the qualifying 
                                individual;
                                    (III) connections with local 
                                community linkage partners to offer 
                                health-related programs and services; 
                                and
                                    (IV) enrollment in group classes 
                                that address barriers to physical, 
                                emotional, and financial health;
                            (vii) for the purpose of tailoring a 
                        qualifying coverage benefits program to the 
                        needs and resources of the catchment area of 
                        the hospital described in subsection (g)(2)(C), 
                        determine the extent, if any, to narrow the 
                        income range specified in subsection (d)(1) 
                        with respect to first-time enrollees and 
                        continuing enrollees;
                            (viii) incorporate population health 
                        improvement strategies into the benefits of 
                        health coverage described in subsection (b)(1), 
                        including strategies that align with the 
                        objectives of the program of the Secretary 
                        regarding health-status goals for 2020, 
                        commonly referred to as Healthy People 2020;
                            (ix) select a plan administrator pursuant 
                        to subsection (g)(2)(E) to carry out 
                        administrative and accounting responsibilities 
                        of the health coverage described in subsection 
                        (b)(1); and
                            (x) conduct a community asset assessment to 
                        determine the services to be made available in 
                        the community to address social determinants of 
                        health and the eligibility requirements for 
                        such services.
            (3) Advisory committee.--A board of directors shall 
        establish a finance advisory committee and a clinical and 
        population health improvement advisory committee.
    (f) 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.--The Secretary may not award more than 4 grants 
        under subsection (a).
    (g) Applications.--
            (1) In general.--To be eligible to be awarded a grant under 
        subsection (a), a community-based coverage entity shall 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.--An application described in paragraph 
        (1) shall include a certification by the community-based 
        coverage entity that the entity will--
                    (A) 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)(1);
                    (B) not later than 2 years after the date on which 
                a grant is awarded under subsection (a), establish a 
                plan to measure quality and efficiency of care provided 
                under the coverage program;
                    (C) partner with a hospital that will establish a 
                network of health care providers sufficient to provide 
                services to qualifying individuals enrolled under the 
                health insurance coverage described in subsection 
                (b)(1);
                    (D) seek to provide to 7 percent of individuals 
                whose household income is more than 300 percent of the 
                poverty line for a family of the size involved and less 
                than the basic cost of living (as determined in a 
                manner consistent the ``Asset Limited, Income 
                Constrained, Employed'' or ``ALICE'' methodology that 
                determines the cost of a basic household budget in the 
                county of a State in which the catchment area of the 
                hospital described in subparagraph (C) health coverage 
                described in subsection (b)(1) is located) for the size 
                of the family involved living in such catchment area; 
                and
                    (E) 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 insurance coverage 
                described in subsection (b)(1).
    (h) Reporting.--Not later than 1 year after the date of the 
enactment of this section and annually for each of the 3 succeeding 
years, the board of directors formed pursuant to subsection (b)(3) 
shall submit to the Secretary a report that--
            (1) evaluates the progress of the qualifying coverage 
        benefits program; and
            (2) evaluates measurements relating to quality and 
        efficiency of care described in subsection (g)(2)(B) collected 
        by the community-based coverage entity.
    (i) 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) First dollar coverage.--The term ``first dollar 
        coverage'' means coverage of a benefit by health coverage 
        described in subsection (b)(1) without requiring any payment by 
        the qualifying individual.
            (4) 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).
            (5) 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 paragraphs 
                (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.
            (6) Population health improvement service.--
                    (A) In general.--The term ``population health 
                improvement service'' means a service that supports the 
                physical, emotional, and financial health of a 
                qualifying individual through--
                            (i) health coaching that--
                                    (I) identifies any social 
                                determinant of health that prevents a 
                                qualifying individual from obtaining 
                                physical, emotional, and financial 
                                health;
                                    (II) develops a personalized plan 
                                to improve the physical, emotional, and 
                                financial health of a qualifying 
                                individual based on the circumstances 
                                and health domain score of such 
                                qualifying individual; and
                                    (III) measures and evaluates the 
                                health domain score of an individual;
                            (ii) health education courses; and
                            (iii) integrated community linkage 
                        partnerships with organizations serving the 
                        catchment area of a hospital described in 
                        subsection (g)(2)(C) that provide health 
                        programs and services to qualifying individuals 
                        that--
                                    (I) support a qualifying individual 
                                with respect to any appropriate social 
                                determinant of health; and
                                    (II) support a qualifying 
                                individual in job retention, including 
                                jobs in childcare and transportation.
                    (B) Health domain score defined.--In this 
                paragraph, the term ``health domain score'' means a 
                measurement of specific influences of physical, 
                emotional, and financial health with respect to a 
                qualifying individual.
            (7) 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)).
            (8) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (9) Small business health options program.--The term 
        ``Small Business Health Options Program'' has the meaning given 
        such term in section 1311(b)(2) of the Patient Protection and 
        Affordable Care Act (42 U.S.C. 18031(b)(2)).
            (10) 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)).
            (11) 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.
    (j) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section--
            (1) $4,800,000 for fiscal year 2020;
            (2) $7,200,000 for fiscal year 2021; and
            (3) $12,000,000 for each of fiscal years 2022 and 2023.
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