[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 3892 Introduced in Senate (IS)]

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118th CONGRESS
  2d Session
                                S. 3892

 To amend titles XVIII and XIX of the Social Security Act to increase 
  access to community health workers under the Medicare and Medicaid 
                               programs.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 7, 2024

   Mr. Casey introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 To amend titles XVIII and XIX of the Social Security Act to increase 
  access to community health workers under the Medicare and Medicaid 
                               programs.

    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 Health Worker Access 
Act''.

SEC. 2. COVERAGE OF COMMUNITY HEALTH SERVICES UNDER PART B OF THE 
              MEDICARE PROGRAM.

    (a) Coverage of Services.--
            (1) In general.--Section 1861(s)(2) of the Social Security 
        Act (42 U.S.C. 1395x(s)(2)) is amended--
                    (A) in subparagraph (II), by striking ``subsection 
                (lll)(3))'' and all that follows and inserting 
                ``subsection (lll)(3));'';
                    (B) in subparagraph (JJ), by inserting ``and'' 
                after the semicolon at the end; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(KK) community health services (as defined in subsection 
        (nnn)(1)) furnished on or after January 1, 2025;''.
            (2) Definitions.--Section 1861 of the Social Security Act 
        (42 U.S.C. 1395x) is amended by adding at the end the following 
        new subsection:
    ``(nnn) Community Health Services; Community Health Agency.--
            ``(1) Community health services.--
                    ``(A) In general.--The term `community health 
                services' means the services described in subparagraph 
                (B) that are furnished--
                            ``(i) by a community health agency (as 
                        defined in paragraph (2)); and
                            ``(ii) in accordance with an individual 
                        needs assessment that meets requirements 
                        established by the Secretary and is conducted 
                        under the supervision of an applicable 
                        provider; and
                    ``(B) Services described.--The services described 
                in this subparagraph are the following:
                            ``(i) Preventive services.--Diagnostic, 
                        screening, and preventive services to prevent 
                        illness, disease, injury, or any other physical 
                        or mental health condition, reduce physical or 
                        mental disability, and restore an individual to 
                        the best possible functional level, including 
                        the following:
                                    ``(I) Services described in section 
                                1905(a)(13).
                                    ``(II) Containment of infectious 
                                disease outbreaks, including providing 
                                in-language, culturally specific, and 
                                trusted support services, such as 
                                public health outreach.
                                    ``(III) Direct provision of 
                                screenings and basic health services, 
                                as recommended by an applicable 
                                provider.
                                    ``(IV) Provision of coaching and 
                                social support, such as support for 
                                individuals to obtain health care, 
                                support to reduce stress and social 
                                isolation, support for self-management 
                                of disease, and other support necessary 
                                for the prevention and management of 
                                health conditions.
                                    ``(V) Care coordination and 
                                connection to preventive care services, 
                                including for chronic conditions, such 
                                as diabetes, asthma, chronic 
                                obstructive pulmonary disease, 
                                congestive heart disease, autoimmune 
                                disease, or behavioral health 
                                conditions.
                                    ``(VI) Facilitation of 
                                transportation to needed services.
                                    ``(VII) Promotion of healthy 
                                behaviors, such as physical activity 
                                and smoking cessation.
                                    ``(VIII) Case management and 
                                linkage to resources that connect 
                                people with disabilities to assistive 
                                technology, home modifications, and 
                                other adaptations to increase their 
                                ability to live independently in the 
                                community.
                                    ``(IX) Provision of support for 
                                health literacy and cross-cultural 
                                communication.
                                    ``(X) Provision of culturally and 
                                linguistically appropriate health 
                                education.
                                    ``(XI) Other services, as the 
                                Secretary determines appropriate to 
                                preserve and improve individual and 
                                public health.
                            ``(ii) Services to address social 
                        determinants of health.--Services to address 
                        social determinants of health, including the 
                        following:
                                    ``(I) Assessment of individual and 
                                community needs and communicating 
                                identified needs to public health, 
                                health care, and social service 
                                agencies.
                                    ``(II) Provision of outreach and 
                                education regarding health insurance, 
                                and other health and social service 
                                systems.
                                    ``(III) Provision of education, 
                                assessment of needs, and social support 
                                through home visiting.
                                    ``(IV) Provision of case management 
                                (as defined in section 1915(g)(2)) and 
                                linkage to resources to alleviate 
                                financial strain, including food, 
                                housing, child services, technology, 
                                educational services, employment 
                                services, and other services.
                                    ``(V) Identification of underserved 
                                populations and referring them to 
                                appropriate health care agencies and 
                                community-based programs and 
                                organizations in order to increase 
                                access to quality health and social 
                                services and to streamline care, 
                                including serving as a liaison between 
                                individuals and communities and health 
                                and social service organizations.
                    ``(C) Applicable provider.--For purposes of 
                subparagraphs (A)(ii) and (B)(i)(III), the term 
                `applicable provider' means--
                            ``(i) a physician (as defined in section 
                        1861(r));
                            ``(ii) a physician assistant, a nurse 
                        practitioner; and a clinical nurse specialist 
                        (as such terms are defined in section 
                        1861(aa)(5)); and
                            ``(iii) any other practitioner described in 
                        section 1842(b)(18)(C) that the Secretary 
                        determines appropriate.
            ``(2) Community health agency.--The term `community health 
        agency' means an entity, including a community-based 
        organization, a nonprofit organization, an urban Indian 
        organization, a community health worker network, a Federally 
        qualified health center, a rural health clinic, a local or 
        State public health department, an academic institution, a 
        health care provider, and any other organization deemed 
        appropriate by the Secretary, that meets requirements 
        established by the Secretary, which may include the following 
        requirements:
                    ``(A) The entity provides for the employment of 
                health workers who share lived experiences with the 
                community served and minimize barriers to employment, 
                including formal educational requirements.
                    ``(B) The entity provides for market wage 
                compensation and professional development and career 
                advancement opportunities for health workers, as well 
                as training on core competencies.
                    ``(C) The entity has established work practices and 
                manageable caseloads that allow health workers to 
                provide tailored, holistic, person-centered support.
                    ``(D) The entity ensures--
                            ``(i) the safety of health workers, in 
                        accordance with applicable fair labor laws;
                            ``(ii) the supervision, coaching, and 
                        evaluation of health workers, through the use 
                        of evidence-informed process and outcome 
                        indicators developed in consultation with 
                        community health workers, promotoras, and 
                        community health representatives (as such terms 
                        are defined in section 1903(cc)(4)); and
                            ``(iii) leadership and engagement of health 
                        workers in organization- and program-level 
                        decision making, including decision making 
                        related to the improvement of processes and 
                        outcomes.''.
            (3) Amount of payment.--Section 1833(a)(1) of the Social 
        Security Act (42 U.S.C. 1395l(a)(1)) is amended--
                    (A) by striking ``and'' before ``(HH)''; and
                    (B) by inserting before the semicolon: ``, and (II) 
                with respect to community health services under section 
                1861(s)(2)(KK), the amounts paid shall be 100 percent 
                of the lesser of the actual charge for the services or 
                the amount determined under a fee schedule established 
                by the Secretary for such services''.
            (4) Waiver of application of deductible.--The first 
        sentence of section 1833(b) of the Social Security Act (42 
        U.S.C. 1395l(b)) is amended--
                    (A) by striking ``, and (13)'' and inserting 
                ``(13)''; and
                    (B) by striking ``1861(n)..'' and inserting 
                ``1861(n), and (14) such deductible shall not apply 
                with respect to community health services (as defined 
                in section 1861(nnn)(1)).''.

SEC. 3. STATE MEDICAID OPTION TO SUPPORT COMMUNITY HEALTH WORKFORCE FOR 
              SUSTAINABLE COMMUNITY HEALTH.

    Section 1903 of the Social Security Act (42 U.S.C. 1396b) is 
amended by adding at the end the following new subsection:
    ``(cc) Community Health Workforce Support.--
            ``(1) In general.--Notwithstanding section 1902(a)(1) 
        (relating to statewideness), section 1902(a)(10)(B) (relating 
        to comparability), and any other provision of this title that 
        the Secretary determines is necessary to waive in order to 
        implement this subsection, beginning January 1, 2025, a State, 
        at its option as a State plan amendment, may provide for 
        medical assistance for preventive services and services to 
        address the social determinants of health furnished by a 
        community health worker, promotora, or community health 
        representative.
            ``(2) Guidance.--The Secretary shall issue guidance on the 
        components that are necessary for a State plan amendment to 
        receive approval under this subsection, including:
                    ``(A) Plans to recruit community health agencies 
                for the provision of preventive services and services 
                to address the social determinants of health that are 
                furnished by a community health worker, promotora, or 
                community health representative.
                    ``(B) Plans to make medical assistance available 
                for each category of preventive services and services 
                to address the social determinants of health.
                    ``(C) Plans to ensure that the preventive services 
                furnished by community health workers, promotoras, or 
                community health representatives under the amendment 
                will respond to public health emergencies.
                    ``(D) Plans to minimize barriers to community 
                health worker, promotora, or community health 
                representative program participation in the State plan, 
                such as by providing guidance and technical assistance 
                on requirements for participation.
                    ``(E) Plans to coordinate with and build the 
                capacity of community health worker networks within the 
                state or region.
                    ``(F) Plans to address barriers to participation 
                experienced by community health agencies that do not 
                bill insurance for other services, such as community-
                based and nonprofit organizations, academic 
                institutions, faith-based organizations, tribal 
                organizations, or other organizations that employ 
                community health workers, promotoras, or community 
                health representatives, including by implementing a 
                mechanism to reimburse such community health agencies 
                for preventive services and services to address the 
                social determinants of health.
            ``(3) Increased fmap.--
                    ``(A) In general.--Notwithstanding section 1905(b), 
                for calendar quarters beginning on or after January 1, 
                2025, the Federal medical assistance percentage 
                determined under such section for a State shall be 
                increased by 6 percentage points with respect to 
                amounts expended by the State for medical assistance 
                for preventive services and services to address the 
                social determinants of health furnished by a community 
                health worker, promotora, or community health 
                representative that is provided in accordance with a 
                State plan amendment approved under this subsection or 
                otherwise provided in accordance with the guidance 
                issued under paragraph (2).
                    ``(B) Exclusion of amounts attributable to 
                increased fmap from territorial caps.--With respect to 
                payments made to a territory for expenditures for 
                medical assistance described in subparagraph (A), the 
                portion of such payment that exceeds the amount that 
                would have been paid without regard to the increase in 
                the Federal medical assistance percentage under such 
                subparagraph shall not be taken into account for 
                purposes of applying payment limits under subsections 
                (f) and (g) of section 1108.
            ``(4) Definitions.-- In this subsection:
                    ``(A) Community health agency.--The term `community 
                health agency' has the meaning given that term in 
                section 1861(nnn).
                    ``(B) Community health representative.--The term 
                `community health representative' means a frontline 
                health worker who is a trusted member of a tribal 
                community with a close understanding of the community, 
                language, and traditions that enables the worker to 
                serve as a liaison between health and social services 
                and the community, facilitate access to services, and 
                improve the quality and cultural competence of service 
                delivery.
                    ``(C) Community health worker.--The term `community 
                health worker' means a frontline health worker who is a 
                trusted member of the community in which the worker 
                serves or who has an unusually close understanding of 
                the community served that enables the worker to build 
                trusted relationships, serve as a liaison between 
                health and social services and the community, 
                facilitate access to services, and improve the quality 
                and cultural competence of service delivery.
                    ``(D) Community health worker network.--The term 
                `community health worker network' means a statewide, 
                regional, or local association or coalition with 
                leadership and membership that is composed of at least 
                50 percent community health workers, promotoras, or 
                community health representatives and whose activities 
                include training, workforce development, mentoring, and 
                other initiatives to support community health worker, 
                promotora, and community health representative 
                programs.
                    ``(E) Preventive services.--The term `preventive 
                services' means services described in clause (i) of 
                section 1861(nnn)(1)(B).
                    ``(F) Promotora.--The term `promotora' means a 
                trusted frontline worker who primarily works in 
                Spanish-speaking communities and who shares lived 
                experiences, language, and culture with the populations 
                served that enables the worker to improve individual, 
                family and community health outcomes by serving as a 
                liaison between health and social services and the 
                community, facilitating access to services, and 
                improving the quality and cultural competence of 
                service delivery.
                    ``(G) Services to address the social determinants 
                of health.--The term `services to address the social 
                determinants of health' means services described in 
                clause (ii) of section 1861(nnn)(1)(B).''.
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