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)in paragraph (86), by striking and at the end;(2)in paragraph (87), by striking at the end the period and inserting ; and;(3)by inserting after paragraph (87) the following new paragraph:

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

; and

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

(tt)

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 means an individual who—(i)is employed by a health care or community-based organization and provides individualized education and resources to facilitate informed decision-making and timely access to quality health and psychosocial care; and(ii)has obtained and complies with education, licensure, or certification, including at least—(I)a bachelor’s degree in nursing from an accredited university, master’s degree in social work from an accredited university, or bachelor’s degree in a health-related field from an accredited university; (II)licensing and certification requirements for a registered nurse, social work, or clinical practitioner, as applicable, and scope of practice requirements, as defined by the State or jurisdiction in which the individual is licensed or certified;(III)completion of competency-based navigation training sessions or courses for clinical or non-clinical professionals, as applicable; or(IV)subject to subparagraph (B), completion of a training program approved by the Secretary for purposes of section 340A(l)(3) of the Public Health Service Act.(B)

Transitional limitation

The training described in subclause (IV) of subparagraph (A)(ii) shall not satisfy the requirement of subparagraph (A)(ii) after the date that is 3 years after the date on which the provisions of this subsection apply to patient navigator services pursuant to section 2(c) of the Patient Navigator Assistance Act.(3)

Patient navigator services

The term patient navigator service means a service provided by a patient navigator to an individual, including—(A)referrals and related activities to help the individual obtain needed services, including activities that help link the individual with medical, social, logistical, financial, or other programs or services to address identified or specified needs of the individual;(B)services specified under paragraphs (1) through (6) of subsection (b) of section 340A of the Public Health Service Act; and(C)other services specified by the Secretary.

(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 (30), by striking and at the end;(2)by redesignating paragraph (31) as paragraph (32); and(3)by inserting after paragraph (30) the following new paragraph:

(31)patient navigator services (as defined in section 1902(tt)(3)) that are provided in a manner that meets the requirements of section 1902(a)(88); 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.