,i #aafth ,,congress #ast ,session ,h4 ,r4 #dibe ,,in ,,the ,,house ,,of ,,representatives ,october #cj1 #bjai,mr4 ,huizenga introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,education and ,labor1 for a period to be subsequently determined by the ,speaker1 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 training1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,community ,multi-share ,coverage ,program ,act4 #b4 ,grants to community-based coverage entities to carry out a coverage program that provides health coverage and educational and occupational training 7a7 ,in general ,not later than #ahj days after the date of the enactment of the ,community ,multi-share ,coverage ,program ,act1 the ,secretary shall award at least #c and not more than #e grants to support community-based coverage entities to carry out qualifying coverage benefit pilot programs4 ,such programs shall-- 7#a7 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 programs2 and 7#b7 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 7#db ,u4,s4,c4 #acif et seq47 with full-time employment into such programs4 7b7 ,qualifying coverage benefit program requirements ,for purposes of this section1 the term qualifying coverage benefit program means a program that satisfies each of the following program requirements3 7#a7 ,health coverage ,under the program1 a community-based coverage entity shall provide to qualifying individuals health coverage offered in connection with a qualifying coverage benefit program that satisfies the following3 7,a7 ,first-dollar coverage 7where such coverage is furnished by network providers and community resources7 for-- 7i7 diagnostic laboratory tests and x-rays2 7ii7 emergency ambulance services that are provided by ground transportation2 7iii7 emergency services 7as defined in section #bgai;,a7b77#b77;,b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ai;a7b77#b77;,b7772 7iv7 inpatient and outpatient hospital services2 7v7 mental health services2 7vi7 physician services2 7vii7 population health improvement services2 7viii7 preventatives services2 7ix7 prescription drugs2 and 7x7 substance abuse services4 7,b7 ,coverage for-- 7i7 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 individual2 7ii7 a planning process to resolve any negative influences identified pursuant to clause 7i7 and promote well-being through community partnerships between the community-based coverage entity and-- 7,i7 businesses2 7,,ii7 educational institutions2 7,,iii7 investors2 7,,iv7 local1 ,state1 and ,federal governmental agencies2 and 7,v7 organizations described in section #eja7;c77#c7 of the ,internal ,revenue ,code of #aihf that focuses on human service needs relating to behavioral health1 poverty1 education1 and access and safety2 7iii7 the monitoring of and support 7including health coaching services and coordination of services within a community to address the needs of an individual7 with respect to financial1 emotional1 and physical health2 and 7iv7 any other benefit the community-based coverage entity determines appropriate4 7#b7 ,educational and occupational training ,under the program1 a community-based coverage entity shall-- 7,a7 connect and foster ongoing relationships between qualifying individuals and educational and occupational training 7including classes1 workshops1 mentorships1 and apprenticeships7 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 community2 7,b7 with respect to the comprehensive health improvement process described in subsection 7e77#a77;,c77vi71 identify and address barriers to employment and increasing income for qualifying individuals2 and 7,c7 measure and assess the effectiveness of the program in increasing employment and increasing income for qualifying individuals4 7#c7 ,board of directors ,for the purpose of carrying out the program1 the community-based coverage entity shall form a board of directors1 or utilize an existing board of directors1 in accordance with subsection 7e74 7c7 ,community-,based coverage entity ,for the purposes of this section1 the term community-based coverage entity means an entity that maintains a physical presence within close geographic proximity to the individuals it is serving1 with a focus on mitigating barriers to engagement by enabling face-to-face interactions between the entity staff1 the individuals served1 and community organizations4 7d7 ,qualifying individual ,for the purposes of this section1 the term qualifying individual means an individual who meets the following requirements3 7#a7 ,subject to any modification made by such program pursuant to subsection 7e77#b77;,c77vii71 an income that exceeds #ajj percent but does not exceed #djj percent of the poverty line applicable to a family of the size involved4 7#b7 ,not enrolled under a qualified health plan during the #ahj-;day period preceding the date on which such qualifying individual seeks to enroll under the coverage program under this section4 7#c7 ,ineligibility for enrollment in a ,federal health care program 7including ineligibility to receive health services through the ,indian ,health ,service74 7#d7 ,resides or works within the catchment area of a hospital described in subsection 7g77#b77;,c74 7#e7 ,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-- 7,a7 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 7#b7 of section #acaa7;b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;b771 the ,american ,health ,benefit ,exchange 7as such term is used in paragraph 7#a7 of such section7 for the plan year in which such qualifying individual seeks health insurance coverage described in subsection 7b77#a7 from a qualifying coverage benefit program2 and 7,b7 in the case that a ,state retains separate exchanges for qualifying individuals and qualified small employers1 the ,small ,business ,health ,options ,program 7as such term is used in section #acaa7;b77#b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;b77#b777 for the plan year in which such qualifying individual seeks health insurance coverage described in subsection 7b77#a7 from a qualifying coverage benefit program4 7#f7 ,any other requirement the ,secretary determines appropriate4 7e7 ,board of directors 7#a7 ,composition ,a board of directors formed pursuant to subsection 7b77#c7 shall be composed of at least #i members and not more than #ae members with representation from-- 7,a7 local health care providers1 of which not more than two individuals may be from the sponsoring health care organization2 7,b7 qualifying individuals2 7,c7 contributing employers2 7,d7 government representatives2 7,e7 the local health authority2 7,f7 local education systems2 and 7,g7 other representatives as necessary to reflect the community composition4 7#b7 ,duties 7,a7 ,enactment of bylaws ,a board of directors shall enact bylaws relating to-- 7i7 public engagement with the board of directors2 7ii7 a shared goal of improving health access and increasing affordability2 7iii7 outcome-based goals for the program that considers the needs of the community2 7iv7 program costs2 and 7v7 an intent to receive comments regarding the health improvement goals for the community4 7,b7 ,meetings ,a board of directors shall meet at least bimonthly4 7,c7 ,qualifying coverage benefits program ,a board of directors shall-- 7i7 carry out the qualifying coverage benefit program described in subsection 7b72 7ii7 determine the share of payments for benefits under the health coverage described in subsection 7b77#a7 that are attributable to-- 7,i7 the amount awarded to a community-based coverage entity2 7,,ii7 a sponsoring health care organization2 7,,iii7 a qualifying individual2 and 7,,iv7 an employer of a qualifying individual or a skilled trade organization of a qualifying individual2 7iii7 determine the premiums and limitations on payments 7including deductibles and coinsurance amounts7 for the health coverage described in subsection 7b77#a7 for a qualifying individual enrolled under such coverage and the extent1 if any1 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 involved2 7iv7 establish a procedure to-- 7,i7 assist qualifying individuals in enrolling under the health coverage described in subsection 7b77#a72 7,,ii7 assist a qualifying individual that does not meet the requirements of a qualified individual specified under subsection 7d71 is eligible for medical assistance under a ,state plan under the ,medicaid program under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq471 and resides in the catchment area of the hospital described in subsection 7g77#b77;,c7 in enrolling under the appropriate ,state plan under such program2 7,,iii7 bill and collect the share of payments for benefits described in clause 7ii72 7,,iv7 bill and collect the premiums and limitations on payment described in clause 7iii72 7,v7 for the purposes of integrating community resources1 form partnerships with community population health initiatives2 7,,vi7 remove a qualifying individual from the health insurance coverage described in subsection 7b77#a7 in the case the qualifying individual-- 7aa7 has been enrolled under the qualifying covered benefits program for a #d-year period2 and 7bb7 fails to meet the milestones identified pursuant to clause 7vi72 and 7,,vii7 determine a maximum enrollment period for individual participation1 including required milestones for addressing social determinants of health while enrolled2 7v7 for the purpose of encouraging a qualifying individual to seek a primary care physician1 establish incentives for a qualifying individual to initially seek such physician for care 7including the reduction of benefits until a primary care physician is engaged in the care of such qualifying individual72 7vi7 for the purpose of making progress toward health and economic self-sufficiency1 establish routine milestones and supportive services 7to be known as the comprehensive health improvement process7 that a qualifying individual enrolled under health coverage described in subsection 7b77#a7 shall meet to maintain enrollment and such milestones shall include-- 7,i7 an assessment relating to social determinants of health1 health risks1 and any other assessment that is appropriate as determined by the circumstances of the qualifying individual2 7,,ii7 meetings with a health coach to address social influences of health and to support the physical1 emotional1 and financial health of the qualifying individual2 7,,iii7 connections with local community linkage partners to offer health-related programs and services2 and 7,,iv7 enrollment in group classes that address barriers to physical1 emotional1 and financial health2 7vii7 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 7g77#b77;,c71 determine the extent1 if any1 to narrow the income range specified in subsection 7d77#a7 with respect to first-time enrollees and continuing enrollees2 7viii7 incorporate population health improvement strategies into the benefits of health coverage described in subsection 7b77#a71 including strategies that align with the objectives of the program of the ,secretary regarding health-status goals for #bjbj1 commonly referred to as ,healthy ,people #bjbj2 7ix7 select a plan administrator pursuant to subsection 7g77#b77;,e7 to carry out administrative and accounting responsibilities of the health coverage described in subsection 7b77#a72 and 7x7 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 services4 7#c7 ,advisory committee ,a board of directors shall establish a finance advisory committee and a clinical and population health improvement advisory committee4 7f7 ,grant terms 7#a7 ,duration ,a grant awarded under this section shall be made for a period of #d years4 7#b7 ,amount ,the ,secretary shall determine the maximum amount of each grant awarded under subsection 7a74 7#c7 ,number ,the ,secretary may not award more than #d grants under subsection 7a74 7g7 ,applications 7#a7 ,in general ,to be eligible to be awarded a grant under subsection 7a71 a community-based coverage entity shall submit to the ,secretary an application at such time1 in such manner1 and containing the certification described in paragraph 7#b7 and such other information as the ,secretary may require4 7#b7 ,certification ,an application described in paragraph 7#a7 shall include a certification by the community-based coverage entity that the entity will-- 7,a7 not impose any preexisting condition exclusion 7as such term is defined in section #bgjd7;b77#a77;,a77 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#c7;b77#a77;,a77 with respect to the health coverage described in subsection 7b77#a72 7,b7 not later than #b years after the date on which a grant is awarded under subsection 7a71 establish a plan to measure quality and efficiency of care provided under the coverage program2 7,c7 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 7b77#a72 7,d7 seek to provide to #g percent of individuals whose household income is more than #cjj percent of the poverty line for a family of the size involved and less than the basic cost of living 7as determined in a manner consistent the ,asset ,limited1 ,income ,constrained1 ,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 7,c7 health coverage described in subsection 7b77#a7 is located7 for the size of the family involved living in such catchment area2 and 7,e7 select an entity to carry out administrative and accounting responsibilities 7including monthly billing1 verification of eligibility of qualifying individuals1 enrollment of qualifying individuals1 maintenance of a list of active enrollees1 and operation of a benefit utilization management program7 necessary with respect to the health insurance coverage described in subsection 7b77#a74 7h7 ,reporting ,not later than #a year after the date of the enactment of this section and annually for each of the #c succeeding years1 the board of directors formed pursuant to subsection 7b77#c7 shall submit to the ,secretary a report that-- 7#a7 evaluates the progress of the qualifying coverage benefits program2 and 7#b7 evaluates measurements relating to quality and efficiency of care described in subsection 7g77#b77;,b7 collected by the community-based coverage entity4 7i7 ,definitions ,in this section3 7#a7 ,agency ,the term agency means a local1 ,state1 or ,federal agency4 7#b7 ,federal health care program ,the term ,federal health care program has the meaning given such term in section #aabh;,b7f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7f774 7#c7 ,first dollar coverage ,the term first dollar coverage means coverage of a benefit by health coverage described in subsection 7b77#a7 without requiring any payment by the qualifying individual4 7#d7 ,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 7including health improvement program services74 7#e7 ,hospital ,the term hospital means an institution that-- 7,a7 meets the requirements of section #ahfa7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7e772 and 7,b7 is an organization described in paragraphs 7c77#c7 and 7r77#c7 of section #eja of the ,internal ,revenue ,code of #aihf and is exempt from taxation under section #eja7;a7 of such ,code4 7#f7 ,population health improvement service 7,a7 ,in general ,the term population health improvement service means a service that supports the physical1 emotional1 and financial health of a qualifying individual through-- 7i7 health coaching that-- 7,i7 identifies any social determinant of health that prevents a qualifying individual from obtaining physical1 emotional1 and financial health2 7,,ii7 develops a personalized plan to improve the physical1 emotional1 and financial health of a qualifying individual based on the circumstances and health domain score of such qualifying individual2 and 7,,iii7 measures and evaluates the health domain score of an individual2 7ii7 health education courses2 and 7iii7 integrated community linkage partnerships with organizations serving the catchment area of a hospital described in subsection 7g77#b77;,c7 that provide health programs and services to qualifying individuals that-- 7,i7 support a qualifying individual with respect to any appropriate social determinant of health2 and 7,,ii7 support a qualifying individual in job retention1 including jobs in childcare and transportation4 7,b7 ,health domain score defined ,in this paragraph1 the term health domain score means a measurement of specific influences of physical1 emotional1 and financial health with respect to a qualifying individual4 7#g7 ,qualified health plan ,the term qualified health plan has the meaning given such term in section #acja7;a7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjba7;a774 7#h7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 7#i7 ,small ,business ,health ,options ,program ,the term ,small ,business ,health ,options ,program has the meaning given such term in section #acaa7;b77#b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;b77#b774 7#aj7 ,small employer ,the term small employer has the meaning given such term in section #acjd7;b77#b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjbd7;b77#b774 7#aa7 ,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 ,prevention4 7j7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section-- 7#a7 #d1hjj1jjj for fiscal year #bjbj2 7#b7 #g1bjj1jjj for fiscal year #bjba2 and 7#c7 #ab1jjj1jjj for each of fiscal years #bjbb and #bjbc4