[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5387 Introduced in House (IH)]

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118th CONGRESS
  1st Session
                                H. R. 5387

    To improve the provision of health care to unsheltered homeless 
                  individuals, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 12, 2023

     Mrs. Chavez-DeRemer (for herself and Ms. Lee of Pennsylvania) 
 introduced the following bill; which was referred to the Committee on 
Energy and Commerce, and in addition to the Committees on Education and 
the Workforce, and Financial Services, 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 improve the provision of health care to unsheltered homeless 
                  individuals, 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 ``DIRECT Care for the Homeless Act of 
2023'' or the ``Delivering Integral, Rehabilitating, Empathetic, 
Comprehensive and Targeted Care for the Homeless Act of 2023.''

SEC. 2. DEFINITIONS.

            (1) The terms ``eligible city or county'' and ``eligible 
        cities and counties'' refer to cities and counties, as 
        applicable, in the United States that, according to the 
        Department of Housing and Urban Development, have a homeless 
        population of 150 or more per 100,000 residents.
            (2) The terms ``homeless'' and ``homeless individual'' have 
        the meanings given to such terms in section 103 of the 
        McKinney-Vento Homeless Assistance Act (42 U.S.C. 11302).
            (3) The term ``street medicine'' refers to health 
        professionals providing preventive, screening, diagnostic, and/
        or treatment services to unsheltered homeless individuals where 
        said individuals live in a non-permanent location on the street 
        or found environment.
            (4) The term ``unsheltered'' means not residing in a 
        permanent residence or shelter.

SEC. 3. GAO REPORT.

    Not later than the end of fiscal year 2027, the Comptroller General 
of the United States shall submit to the Congress an interim report 
assessing the results achieved through this Act and the amendments made 
by this Act, including--
            (1) the number of patients who moved into temporary or 
        permanent housing;
            (2) the number of patients who have established within 
        their respective Continuum of Care awaiting housing placement;
            (3) patients diagnosed with a substance use disorder and 
        number who received treatment;
            (4) the number of health care professionals providing care 
        to unsheltered homeless individuals;
            (5) how efficient and sufficient reimbursements were for 
        provided care, including any difficulties health care 
        professionals experienced in being reimbursed;
            (6) the number of unique people receiving street medicine 
        services;
            (7) the number of total patient visits provided by street 
        medicine teams;
            (8) a report from street medicine providers detailing 
        barriers to accessing non-street medicine primary care 
        healthcare services such as specialty care, medications, and 
        diagnostic studies; and
            (9) an analysis of participating street medicine providers' 
        ability to sustain a sufficient amount of street medicine 
        providers to provide adequate care to its unsheltered homeless 
        population,
No later than 120 days after enactment of this Act, the Secretary of 
the Department of Health and Human Services shall promulgate rules for 
data collection necessary to complete this report, without creating 
barriers which negatively impact the effective provision of health 
care. To ensure this, the Secretary shall also create and maintain an 
online platform through which health care professional participating in 
the Program may provide feedback on the Program as a whole, and such 
platform must be open for submissions 24/7. The online platform must be 
compliant with the Health Insurance Portability and Accountability Act 
of 1996.

SEC. 4. SUNSET.

    The provisions of this Act and the amendments made by this Act 
shall cease to be effective at the end of fiscal year 2028.

                        TITLE I--STREET MEDICINE

SEC. 101. STREET MEDICINE PILOT PROGRAM.

    (a) In General.--Beginning on the first day of the first fiscal 
year following the date of enactment of this Act, the Secretary of 
Health and Human Services (referred to in this section as the 
``Secretary'') shall conduct a pilot program (referred to in this 
section as the ``Program'') to provide payments to providers in 
eligible cities and counties for furnishing medical services to covered 
individuals.
    (b) Program Requirements.--
            (1) Application.--A street medicine provider seeking 
        participation in the Program shall submit an application to the 
        Secretary, at such time, in such manner, and containing such 
        information, as the Secretary may require.
            (2) Provider requirements.--
                    (A) In general.--In order to participate in the 
                Program, a provider must--
                            (i) be an eligible provider (as defined in 
                        subsection (e)(3));
                            (ii) be enrolled--
                                    (I) under section 1886(j) of the 
                                Social Security Act (42 U.S.C. 
                                1395cc(j)); or
                                    (II) as a participating provider 
                                under a State plan (or waiver of such 
                                plan) under title XIX of the Social 
                                Security Act (42 U.S.C. 1396 et seq.);
                            (iii) be affiliated with a hospital, 
                        university, non-profit organization, city 
                        government, county government, state 
                        government, or private health care practice;
                            (iv) use a qualified electronic health 
                        record to document interactions with, and 
                        medical services furnished to, covered 
                        individuals under the Program;
                            (v) maintain medical malpractice insurance 
                        in the State in which such provider is 
                        furnishing medical services under the Program; 
                        and
                            (vi) in the case of a provider prescribing 
                        opioid medication, meet the requirement 
                        described in subparagraph (B).
                    (B) Requirement for prescribing opioid 
                medication.--In the case of a provider prescribing an 
                opioid medication to a covered individual under the 
                Program, such provider shall meet the standards of 
                their respective State.
                    (C) During each visit with a patient, there shall 
                be a prescriber, as defined in (e)(3), present either 
                in person, via telemedicine, or phone call.
            (3) Documentation requirements.--
                    (A) In general.--A provider furnishing medical 
                services under the Program shall document in a 
                qualified electronic health record each interaction 
                with a covered individual, such documentation shall 
                include--
                            (i) the name and date of birth of such 
                        individual;
                            (ii) whether the covered individual has, or 
                        has history of, a substance use disorder;
                            (iii) the length of time such individual 
                        has been homeless, and factors contributing to 
                        such individual's lack of permanent housing;
                            (iv) whether an individual is under the 
                        care of a medical provider other than a street 
                        medicine team or provider;
                            (v) the contact information, and billing 
                        information for such provider;
                            (vi) the credentials of such provider; and
                            (vii) any other information as determined 
                        by the Secretary.
                    (B) Rules of construction regarding 
                documentation.--
                            (i) Nothing in this section shall be 
                        construed as requiring a covered individual to 
                        provide a permanent address in order to receive 
                        medical services under the Program.
                            (ii) Nothing in this section shall be 
                        construed as requiring a provider to document, 
                        with respect to a covered individual--
                                    (I) the permanent address of such 
                                individual;
                                    (II) the address of the facility 
                                where medical services were furnished 
                                to such individual; or
                                    (III) the name of contact 
                                information of a provider referring 
                                such individual to the program.
    (c) Payment.--
            (1) In general.--To receive payment for a medical service 
        furnished to a covered individual under the Program, a provider 
        shall submit to the Secretary, at such time and in such manner 
        as determined by the Secretary, a claim for such service.
                    (A) No later than 120 days after enactment of this 
                Act, the Secretary shall promulgate rules to establish 
                and maintain a clear process for reimbursements through 
                the Program.
                    (B) No later than 120 days after enactment of this 
                Act, the Secretary shall create and maintain an online 
                platform through which health care professional 
                participating in the Program may provide feedback on 
                the reimbursement process, and such platform must be 
                open for submissions 24/7. The online platform must be 
                compliant with the Health Insurance Portability and 
                Accountability Act of 1996. This platform may be the 
                same as referred to in section 3 of this Act.
            (2) Payment amount.--The Secretary shall establish payment 
        amounts for medical services furnished to covered individuals 
        under the Program. Such payment amounts shall be based upon 
        payment amounts established with respect to medical assistance 
        furnished under title XIX of the Social Security Act (42 U.S.C. 
        1396 et seq.).
            (3) Prohibition against supervised consumption.--No payment 
        may be made under this Program with respect to medical services 
        providing supervised drug consumption, as defined in (e)(9). 
        This provision shall not be construed to prohibit States, 
        counties, and cities which operate their own supervised 
        consumption programs from accessing the Program.
    (d) Direct Access.--
            (1) Unsheltered homeless individuals may obtain services 
        from any qualified street medicine provider, as defined in this 
        Act, for purposes of the Program.
            (2) Individuals enrolled in a primary care case management 
        system or Medicaid managed care organization (MCO) shall not be 
        denied freedom of choice of qualified street medicine 
        providers.
            (3) Prior authorization shall not be required for purposes 
        of an individual receiving care from a street medicine 
        provider.
            (4) If a patient is a Medicaid or Medicare beneficiary, 
        street medicine providers shall have the authority to refer 
        patients to medically necessary covered services within the 
        proper Making Care Primary (MCP) network, to ensure 
        beneficiaries have access to all medically necessary covered 
        service.
                    (A) The Secretary of the Department of Health and 
                Human Services or Director of the Centers for Medicaid 
                and Medicare Services shall develop rules to ensure 
                street medicine providers have the appropriate referral 
                and authorization mechanisms in place to facilitate 
                access to needed services in the network without 
                requiring authorization by an assigned primary care; 
                and
                    (B) rules to guarantee a clear and accessible 
                process for making such referrals.
            (5) The Secretary of Health and Human Services or Director 
        of the Centers for Medicaid and Medicare Services shall develop 
        rules to ensure providers operating within the Program shall 
        have appropriate referral and authorization mechanisms for 
        patients who are not insured, or are not Medicaid or Medicare 
        beneficiaries.
            (6) Delivery network.--If a patient is a Medicaid or 
        Medicare beneficiary, MCPs must ensure that, they meet the 
        following requirements:
                    (A) Maintains and monitors a network of appropriate 
                providers that is supported by written agreements and 
                is sufficient to provide adequate access to all 
                services covered by the Program or patients' other 
                health care benefits, such as Medicaid or Medicare, 
                ensuring access to patients with limited English 
                proficiency or physical or mental disabilities;
                    (B) provides female patients with direct access to 
                women's routine and preventive health care services;
                    (C) arranges for patients to receive a second 
                opinion, should the patient elect, at no cost to the 
                patient; and
                    (D) if its network of street medicine providers are 
                unable to provide necessary services, that the MCP is 
                able to adequately and timely cover those services, 
                without cost to the patient exceeding standards costs 
                within the Program or the providers' network.
    (e) Funding.--The Secretary has the authority to allocate existing 
funds for the Program.
    (f) Definitions.--In this Act:
            (1) Covered individual.--The term ``covered individual'' 
        means an unsheltered homeless individual over the age of zero 
        who resides in an eligible city or county.
            (2) Eligible city or county; eligible cities and 
        counties.--The terms ``eligible city or county'' and ``eligible 
        cities and counties'' refer to cities and counties, as 
        applicable, in the United States that, according to the 
        Department of Housing and Urban Development, have a homeless 
        population of 150 or more per 100,000.
            (3) Prescriber.--The term ``prescriber'' means a person 
        permitted under State law, or agent of such person, to issue 
        prescriptions for drugs in compliance with applicable 
        requirements established by the Food and Drug Administration.
            (4) Eligible provider.--The term ``eligible provider'' 
        includes--
                    (A) a physician (as defined in section 1861(r) of 
                the Social Security Act (42 U.S.C. 1395(aa)(5)(A));
                    (B) a physician assistant or nurse practitioner (as 
                such terms are defined in section 1861(aa)(5)(A) of the 
                Social Security Act (42 U.S.C. 1395(aa)(5)(A));
                    (C) a behavioral health therapist;
                    (D) a supplier (as defined in section 1861(d) of 
                the Social Security Act (42 U.S.C. 1395(d));
                    (E) a psychologist (as defined in section 799B(11) 
                of the Public Health Service Act (42 U.S.C. 295p(11));
                    (F) a physical therapist;
                    (G) occupational therapist;
                    (H) an emergency medical technician responding to a 
                call or case in which health care is administered to an 
                unhoused homeless individual; or
                    (I) any provider as determined by the Secretary.
            (5) Homeless; homeless individual.--The term ``homeless'' 
        and ``homeless individual'' have the meaning given such terms 
        in section 103 of the McKinney-Vento Homeless Assistance Act 
        (42 U.S.C. 300jj(13)).
            (6) Medical services.--The term ``medical services'' mean 
        the medical care and services described in section 1905(a) of 
        the Social Security Act (42 U.S.C. 1396d(a)).
            (7) Qualified electronic health record.--The term 
        ``qualified electronic health record'' has the meaning given 
        such term in section 3000(13) of the Public Health Service Act 
        (42 U.S.C. 300jj(13)).
            (8) Street medicine.--The term ``street medicine'' means 
        the direct provision of medical services to unsheltered 
        homeless individuals where such individuals live in a non-
        permanent location on the street or found environment.
            (9) Supervised consumption.--The consumption of schedule I 
        drugs, fentanyl, cocaine, and methamphetamine under the 
        supervision of health care professionals.

               TITLE II--FEDERAL LOAN REPAYMENT PROGRAMS

SEC. 201. PUBLIC HEALTH LOAN REPAYMENT PROGRAMS.

    (a) In General.--In carrying out programs under the Public Health 
Service Act (42 U.S.C. 201 et seq.) for loan repayments for health care 
professionals, the Secretary of Health and Human Services shall include 
awards to applicants seeking to practice street medicine in eligible 
cities and counties.
    (b) National Health Service Corps.--In assigning members of the 
National Health Service Corps to health professional shortage areas 
pursuant to section 333 of the Public Health Service Act (42 U.S.C. 
254f) to fulfill a period of obligated service under the National 
Health Service Corps Loan Repayment Program, the Secretary of Health 
and Human Services shall assign an appropriate number of Corps members 
to practice street medicine in eligible cities and counties.
    (c) Treatment of Mobile Clinics as HPSAS.--The Secretary of Health 
and Human Services shall treat mobile clinics providing street medicine 
in an eligible city or county as a health professional shortage area 
eligible for designation under section 332 of the Public Health Service 
Act (42 U.S.C. 254e).

SEC. 202. COMMUNITY SERVICE OFFICERS.

    (a) In General.--Public Service Loan Forgiveness (PSLF) Program 
eligibility shall include individuals who spend at least one year as a 
community service officer (CSO), including those working less than 30 
hours per week, employed by a local law enforcement agency.
    (b) Section 455(m) of the Higher Education Act of 1965 (20 U.S.C. 
1087e(m)) is amended--
            (1) by striking the period at the end of (3)(B)(ii) and 
        inserting ``; or'';
            (2) by adding at the end of (3)(B) the following:
                            ``(iii) serving, for a calendar year, full-
                        time or part-time as a community service 
                        officer''; and
            (3) by inserting after subparagraph (B) the following:
                    ``(C) Community service officers are professionals 
                or paraprofessional law enforcement who do not respond 
                to emergencies, do not carry firearms, and do not have 
                power of arrest; this includes those persons training 
                to be full-time law enforcement.''.
    (c) The Department of Education.--The Secretary of Education must 
treat local law enforcement agencies, including those of tribal 
governments, as qualifying employers as defined in 34 CFR 685.219.
            (1) No later than 120 days after enactment of this Act, the 
        Secretary of Education must promulgate rules to provide a clear 
        and accessible process for community service officers to apply 
        for loan forgiveness. These rules must ensure that community 
        service officers employed by local law enforcement agencies 
        receive Public Service Loan Forgiveness benefits no later than 
        one year after applying for and being determined eligible for 
        this program.
            (2) No later than 120 days after enactment of this Act, the 
        Secretary of Education must create and maintain a clear and 
        accessible appeals process for all borrowers who are denied 
        participation in the PSLF Program. The appeals process must 
        meet, but is not limited to, the following requirements:
                    (A) petition for appeal must be submitted through 
                an online program which is clearly displayed on the 
                department website and is accessible to non-English 
                speakers;
                    (B) the Department must provide notice of the 
                appeals process when a borrower initially applies for 
                the PSLF Program;
                    (C) the Department must provide for accessible 
                communication with borowers;
                    (D) the Department must provide the borrower 
                detailed information about which loans did not qualify, 
                which payments did not qualify, and what information is 
                necessary for a successful appeal;
                    (E) borrowers who were denied loan forgiveness 
                prior to enactment of this Act have 180 days to request 
                reconsideration; and
                    (F) for any months in which a borrower postponed 
                monthly payments under a deferment or forbearance and 
                was employed full-time or part-time at a qualifying 
                employer as defined in 34 CFR 685.219 but was in a 
                deferment or forbearance status, the borrower may 
                obtain credit towards forgiveness for those months.

                   TITLE III--LOAN AND INTEREST PAUSE

SEC. 301. STUDENT LOAN AND INTEREST PAUSE.

    (a) Section 455(f) of the Higher Education Act of 1965 (20 U.S.C. 
1087e(f)) is amended--
            (1) in paragraph (1), in the matter preceding subparagraph 
        (A), by striking ``A borrower'' and inserting ``Except as 
        provided in paragraph (6), a borrower'';
            (2) in paragraph (2)(A)--
                    (A) in clause (i), by striking ``or'' after the 
                semicolon;
                    (B) by striking the matter following clause (ii);
                    (C) in clause (ii), by striking the comma at the 
                end and inserting ``; or''; and
                    (D) by adding at the end the following:
                            ``(iii) is serving in a medical or 
                        residency program which, in part, focuses on 
                        the provision of street medicine;''; and
            (3) by adding at the end the following:
            ``(6) Special rule for certain in school deferment.--
        Notwithstanding any other provision of this Act, a borrower 
        described in paragraph (2)(A)(ii) shall be eligible for a 
        deferment, during which periodic installments of principal need 
        not be paid and interest shall not accrue on any loan made to 
        the borrower under this part.''.

               TITLE IV--IMPROVED STANDARDS FOR SHELTERS

SEC. 401. SAFE SHELTERS.

    Whereas homeless shelters should always be safe for residents;
    Whereas a significant number of homeless women report feeling safer 
spending the night in a car as opposed to a shelter;
    Whereas approximately thirty-two percent of homeless women report 
being sexually or physically assaulted each year;
    Whereas homeless individuals accrue citations for sleeping in their 
car or parking their car in a certain spot for too long, resulting in 
criminal records which might prevent an employer from providing them 
employment;
    Whereas a significant number of homeless women are unable to afford 
menstrual products; and
    Whereas transgender men frequently experience discrimination by 
being denied necessary menstrual products.

SEC. 402. IMPROVED STANDARDS.

    (a) Section 415 of the McKinney-Vento Homeless Assistance Act (42 
U.S.C. 1137) is amended by adding at the end the following:
    ``(c) Emergency Shelter Requirements.--No amount provided under 
this subtitle may be allocated to an emergency shelter unless such 
emergency shelter--
            ``(1) provides menstrual products for each menstruating 
        resident; and
            ``(2) maintains a security camera system with no less than 
        two functional security cameras and consideration for 
        residents' personal privacy.''.
    (b) There shall be no restrictions on the kind of security cameras 
a shelter may install and maintain to be in compliance with this Act.
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