,,ii #aahth ,,congress #b;d ,session ,s4 #chib ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #g1 #bjbd,mr4 ,casey introduced the following bill2 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 programs4 #a4 ,short title ,this ,act may be cited as the ,community ,health ,worker ,access ,act4 #b4 ,coverage of community health services under part ,b of the ,medicare program 7a7 ,coverage of ,services 7#a7 ,in general ,section #ahfa7s77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b77 is amended-- 7,a7 in subparagraph 7,,ii71 by striking subsection 7lll77#c77 and all that follows and inserting subsection 7lll77#c7722 7,b7 in subparagraph 7,,jj71 by inserting and after the semicolon at the end2 and 7,c7 by adding at the end the following new subparagraph3 7,,kk7 community health services 7as defined in subsection 7nnn77#a77 furnished on or after ,january #a1 #bjbe2 4 7#b7 ,definitions ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is amended by adding at the end the following new subsection3 7nnn7 ,community health services2 community health agency 7#a7 ,community health services 7,a7 ,in general ,the term community health services means the services described in subparagraph 7,b7 that are furnished-- 7i7 by a community health agency 7as defined in paragraph 7#b772 and 7ii7 in accordance with an individual needs assessment that meets requirements established by the ,secretary and is conducted under the supervision of an applicable provider2 and 7,b7 ,services described ,the services described in this subparagraph are the following3 7i7 ,preventive services ,diagnostic1 screening1 and preventive services to prevent illness1 disease1 injury1 or any other physical or mental health condition1 reduce physical or mental disability1 and restore an individual to the best possible functional level1 including the following3 7,i7 ,services described in section #aije7;a77#ac74 7,,ii7 ,containment of infectious disease outbreaks1 including providing in-language1 culturally specific1 and trusted support services1 such as public health outreach4 7,,iii7 ,direct provision of screenings and basic health services1 as recommended by an applicable provider4 7,,iv7 ,provision of coaching and social support1 such as support for individuals to obtain health care1 support to reduce stress and social isolation1 support for self-management of disease1 and other support necessary for the prevention and management of health conditions4 7,v7 ,care coordination and connection to preventive care services1 including for chronic conditions1 such as diabetes1 asthma1 chronic obstructive pulmonary disease1 congestive heart disease1 autoimmune disease1 or behavioral health conditions4 7,,vi7 ,facilitation of transportation to needed services4 7,,vii7 ,promotion of healthy behaviors1 such as physical activity and smoking cessation4 7,,viii7 ,case management and linkage to resources that connect people with disabilities to assistive technology1 home modifications1 and other adaptations to increase their ability to live independently in the community4 7,,ix7 ,provision of support for health literacy and cross-cultural communication4 7,x7 ,provision of culturally and linguistically appropriate health education4 7,,xi7 ,other services1 as the ,secretary determines appropriate to preserve and improve individual and public health4 7ii7 ,services to address social determinants of health ,services to address social determinants of health1 including the following3 7,i7 ,assessment of individual and community needs and communicating identified needs to public health1 health care1 and social service agencies4 7,,ii7 ,provision of outreach and education regarding health insurance1 and other health and social service systems4 7,,iii7 ,provision of education1 assessment of needs1 and social support through home visiting4 7,,iv7 ,provision of case management 7as defined in section #aiae7;g77#b77 and linkage to resources to alleviate financial strain1 including food1 housing1 child services1 technology1 educational services1 employment services1 and other services4 7,v7 ,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 care1 including serving as a liaison between individuals and communities and health and social service organizations4 7,c7 ,applicable provider ,for purposes of subparagraphs 7,a77ii7 and 7,b77i77,,iii71 the term applicable provider means-- 7i7 a physician 7as defined in section #ahfa7r772 7ii7 a physician assistant1 a nurse practitioner2 and a clinical nurse specialist 7as such terms are defined in section #ahfa7;aa77#e772 and 7iii7 any other practitioner described in section #ahdb7;b77#ah77;,c7 that the ,secretary determines appropriate4 7#b7 ,community health agency ,the term community health agency means an entity1 including a community-based organization1 a nonprofit organization1 an urban ,indian organization1 a community health worker network1 a ,federally qualified health center1 a rural health clinic1 a local or ,state public health department1 an academic institution1 a health care provider1 and any other organization deemed appropriate by the ,secretary1 that meets requirements established by the ,secretary1 which may include the following requirements3 7,a7 ,the entity provides for the employment of health workers who share lived experiences with the community served and minimize barriers to employment1 including formal educational requirements4 7,b7 ,the entity provides for market wage compensation and professional development and career advancement opportunities for health workers1 as well as training on core competencies4 7,c7 ,the entity has established work practices and manageable caseloads that allow health workers to provide tailored1 holistic1 person-centered support4 7,d7 ,the entity ensures-- 7i7 the safety of health workers1 in accordance with applicable fair labor laws2 7ii7 the supervision1 coaching1 and evaluation of health workers1 through the use of evidence-informed process and outcome indicators developed in consultation with community health workers1 promotoras1 and community health representatives 7as such terms are defined in section #aijc7;cc77#d772 and 7iii7 leadership and engagement of health workers in organization- and program-level decision making1 including decision making related to the improvement of processes and outcomes4 4 7#c7 ,amount of payment ,section #ahcc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a77 is amended-- 7,a7 by striking and before 7,,hh72 and 7,b7 by inserting before the semicolon3 1 and 7,,ii7 with respect to community health services under section #ahfa7s77#b77,,kk71 the amounts paid shall be #ajj 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 services4 7#d7 ,waiver of application of deductible ,the first sentence of section #ahcc7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7b77 is amended-- 7,a7 by striking 1 and 7#ac7 and inserting 7#ac72 and 7,b7 by striking #ahfa7n744 and inserting #ahfa7n71 and 7#ad7 such deductible shall not apply with respect to community health services 7as defined in section #ahfa7nnn77#a7744 #c4 ,state ,medicaid option to support community health workforce for sustainable community health ,section #aijc of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7 is amended by adding at the end the following new subsection3 7cc7 ,community health workforce support 7#a7 ,in general ,notwithstanding section #aijb7;a77#a7 7relating to statewideness71 section #aijb7;a77#aj77;,b7 7relating to comparability71 and any other provision of this title that the ,secretary determines is necessary to waive in order to implement this subsection1 beginning ,january #a1 #bjbe1 a ,state1 at its option as a ,state plan amendment1 may provide for medical assistance for preventive services and services to address the social determinants of health furnished by a community health worker1 promotora1 or community health representative4 7#b7 ,guidance ,the ,secretary shall issue guidance on the components that are necessary for a ,state plan amendment to receive approval under this subsection1 including3 7,a7 ,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 worker1 promotora1 or community health representative4 7,b7 ,plans to make medical assistance available for each category of preventive services and services to address the social determinants of health4 7,c7 ,plans to ensure that the preventive services furnished by community health workers1 promotoras1 or community health representatives under the amendment will respond to public health emergencies4 7,d7 ,plans to minimize barriers to community health worker1 promotora1 or community health representative program participation in the ,state plan1 such as by providing guidance and technical assistance on requirements for participation4 7,e7 ,plans to coordinate with and build the capacity of community health worker networks within the state or region4 7,f7 ,plans to address barriers to participation experienced by community health agencies that do not bill insurance for other services1 such as community-based and nonprofit organizations1 academic institutions1 faith-based organizations1 tribal organizations1 or other organizations that employ community health workers1 promotoras1 or community health representatives1 including by implementing a mechanism to reimburse such community health agencies for preventive services and services to address the social determinants of health4 7#c7 ,increased ,,fmap 7,a7 ,in general ,notwithstanding section #aije7;b71 for calendar quarters beginning on or after ,january #a1 #bjbe1 the ,federal medical assistance percentage determined under such section for a ,state shall be increased by #f 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 worker1 promotora1 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 7#b74 7,b7 ,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 7,a71 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 7f7 and 7g7 of section #aajh4 7#d7 ,definitions ,in this subsection3 7,a7 ,community health agency ,the term community health agency has the meaning given that term in section #ahfa7nnn74 7,b7 ,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 community1 language1 and traditions that enables the worker to serve as a liaison between health and social services and the community1 facilitate access to services1 and improve the quality and cultural competence of service delivery4 7,c7 ,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 relationships1 serve as a liaison between health and social services and the community1 facilitate access to services1 and improve the quality and cultural competence of service delivery4 7,d7 ,community health worker network ,the term community health worker network means a statewide1 regional1 or local association or coalition with leadership and membership that is composed of at least #ej percent community health workers1 promotoras1 or community health representatives and whose activities include training1 workforce development1 mentoring1 and other initiatives to support community health worker1 promotora1 and community health representative programs4 7,e7 ,preventive services ,the term preventive services means services described in clause 7i7 of section #ahfa7nnn77#a77;,b74 7,f7 ,promotora ,the term promotora means a trusted frontline worker who primarily works in ,spanish-speaking communities and who shares lived experiences1 language1 and culture with the populations served that enables the worker to improve individual1 family and community health outcomes by serving as a liaison between health and social services and the community1 facilitating access to services1 and improving the quality and cultural competence of service delivery4 7,g7 ,services to address the social determinants of health ,the term services to address the social determinants of health means services described in clause 7ii7 of section #ahfa7nnn77#a77;,b74 4