,i #aai? ,,congress #b;d ,session ,h4 ,r4 #hehe ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,april #bi1 #bjbf,mr4 ,mool5a> 7= himself & ,mr4 ,huiz5ga7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce1 & 9 addition to ! ,committee on ,education & ,work=ce1 = a p]iod to be subsequ5tly det]m9$ by ! ,speak]1 9 ea* case = consid]ation ( su* provisions z fall )9 ! jurisdiction ( ! committee conc]n$ ,a ,,bill ,to require ! ,secret>y ( ,heal? & ,human ,s]vices to aw>d grants to support community-bas$ cov]age entities to c>ry out a compreh5sive cov]age program t provides qualify+ individuals & small bus9esses heal? cov]age & integrat$ heal?-relat$ social ne$ s]vices to small bus9ess work]s t promote improv$ heal?1 long-t]m economic self-suffici5cy1 employm5t & ret5tion1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,community ,multi-,%>e ,cov]age ,program ,act ( #bjbf4 #b4 ,grants to e/abli% community multi-%>e cov]age programs to enable small bus9esses to provide af=dable heal? cov]age & support s]vices to employees ) limit$ income & assets 7a7 ,9 g5]al ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices %all aw>d at lea/ #c & n m ?an #e grants to support ,community ,multi-,%>e ,cov]age programs4 ,su* programs %all-- 7#a7 r$uce ! numb] ( un9sur$ individuals ?r\gh hospital-community p>tn]%ip initiatives t provide an af=dable heal? cov]age option = su* individuals & provide a cov]age transition = ^? limit$ to cov]age ?r\gh gov]nm5t-sponsor$ programs2 7#b7 promote work=ce developm5t = small bus9esses by address+ ! psy*o-social b>ri]s t directly impact employm5t success & create b>ri]s to exit+ ,m$icaid1 result+ 9 bett] heal? & workplace success2 & 7#c7 support small bus9ess economic recov]y by all[+ small bus9esses to be competitive 9 _! hir+1 & to provide high quality1 af=dable heal? cov]age to work]s :o are o!rwise hesitant to lose ,m$icaid eligibility4 7b7 ,community multi-,%>e cov]age program requirem5ts ,= purposes ( ?is section1 ! t]m ,community ,multi-,%>e ,cov]age ,program means a program t satisfies ea* ( ! foll[+ program requirem5ts3 7#a7 ,physical pres5ce 9 ! community ,! program ma9ta9s a physical pres5ce )9 close geographic proximity to ! enrollees x is s]v+1 ) a focus on mitigat+ b>ri]s to engagem5t by enabl+ face-to-face int]actions betwe5 ! program /aff1 enrollees1 & community organizations4 7#b7 ,heal? cov]age ,! program provides enroll$ qualify+ individuals ) heal? cov]age t satisfies ! foll[+3 7,a7 ,s]vices cov]$ ,provides cov]age = ! foll[+ categories ( s]vices :5 furni%$ by network provid]s & community res\rces3 7i7 ,physician s]vices4 7ii7 ,inpati5t & outpati5t hospital s]vices4 7iii7 ,behavioral heal? s]vices1 includ+ s]vices = sub/ance use disord] prev5tion & treatm5t4 7iv7 ,prev5tative s]vices4 7v7 ,diagno/ic laboratory te/s & x-rays4 7vi7 ,prescription drugs4 7vii7 ,em]g5cy ambulance s]vices t are provid$ by gr\nd transportation4 7viii7 ,em]g5cy s]vices 7z def9$ 9 section #bgai;,a7b77#b77;,b7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#agai;a7b77#b77;,b7774 7ix7 ,population heal? improvem5t s]vices4 7,b7 ,co/-%>+ ,imposes no d$uctible on cov]$ s]vices provid$ by network provid]s & community res\rces1 & limits co-paym5ts = 9-network cov]$ s]vices to levels t d n create a b>ri] to pati5t access4 7,c7 ,network provid]s ,e/abli%es agreem5ts ) hospitals & heal? c>e provid]s locat$ )9 ! community to provide c>e = qualify+ individuals4 7#c7 ,community collaboration & alignm5t ,! program is c>ri$ out 9 p>tn]%ip )1 or 9 =mal coord9ation )1 an exi/+ community-bas$ collaborative1 int]m$i>y1 or coord9at+ entity t-- 7,a7 has demon/rat$ exp]i5ce align+ safety-net heal?1 human s]vice1 & work=ce-relat$ s]vices )9 ! community2 7,b7 supports ! id5tification ( community-def9$ ne$s1 priorities1 & s]vice gaps ?r\gh ongo+ engagem5t ) community /akehold]s2 & 7,c7 facilitates coord9ation among p>ticipat+ heal? c>e provid]s1 community-bas$ organizations1 employ]s1 & o!r relevant p>tn]s to avoid duplication & promote effective use ( community res\rces4 7#d7 ,integrat$ cont9u\s heal? improvem5t s]vices ,! program provides1 ei!r directly or ?r\gh contract1 integrat$ cont9u\s heal? improvem5t s]vices t satisfy ! foll[+3 7,a7 ,regul> assessm5ts ( community factors & res\rces t pot5tially impact enrollees' physical1 emotional1 & economic heal?4 7,b7 ,a community-bas$ plann+ process to id5tify & address any negative influ5ces id5tifi$ pursuant to subp>agraph 7,a71 & promote well-be+ ?r\gh p>tn]%ips & alignm5t ef=ts betwe5 ! community-bas$ cov]age entity &-- 7i7 local small employ]s2 7ii7 entities t provide educational & occupational tra9+ 7includ+ classes1 work%ops1 m5tor%ips1 & appr5tice%ips7 design$ to enhance prep>ation = "w & support economic self-suffici5cy2 7iii7 community heal? & heal?-relat$ social ne$ initiatives2 7iv7 inve/ors2 7v7 local1 ,/ate1 & ,f$]al gov]nm5tal ag5cies2 & 7vi7 organizations describ$ 9 section #eja7;c77#c7 ( ! ,int]nal ,rev5ue ,code ( #aihf t focuses on human s]vice ne$s relat+ to physical heal?1 behavioral heal?1 pov]ty1 education1 access to heal? c>e1 & safety4 7,c7 ,individualiz$ assessm5t ( ea* enrollee to id5tify any negative influ5ces on _! physical1 emotional1 & economic heal?1 & ability to a*ieve economic self-suffici5cy1 :i* %all include-- 7i7 an assessm5t ( any ( ! enrollee's psy*o-social b>ri]s1 heal? risks1 b>ri]s to long-t]m employm5t1 & b>ri]s to increas+ income2 & 7ii7 a det]m9ation ( ! enrollee's heal? doma9 score1 :i* is a measurem5t ( specific influ5ces ( physical1 emotional1 & f9ancial heal? ) respect to a qualify+ individual4 7,d7 ,e/abli%m5t ( an individualiz$ plan to support ea* enrollee 9 a*iev+ bett] heal? & economic self-suffici5cy1 :i* %all-- 7i7 id5tify community res\rces t w support ! enrollee 9 improv+ _! physical1 behavioral1 or economic heal?1 :i* may include-- 7,i7 gr\p classes t address b>ri]s to physical1 emotional1 & economic heal?2 & 7,,ii7 educational & occupational tra9+ opportunities t enhance "w prep>$ness & support economic self-suffici5cy2 & 7ii7 conta9 engagem5t mile/ones1 ) a goal ( id5tify+ & ov]com+ ob/acles to engagem5t 9 p]sonal heal? improvem5t & mitigation ( root-cause b>ri]s1 :i* %all include-- 7,i7 p>ticipation 9 individualiz$ heal? coa*+ s]vices to address ! enrollee's heal?-relat$ social ne$s & to support _! physical1 emotional1 & f9ancial heal?2 & 7,,ii7 engagem5t ) community res\rces1 su* z p>ticipat+ 9 gr\p classes1 z recomm5d$ by ! heal? coa*4 7#e7 ,fund+ /ructure 7,a7 ,9 g5]al ,! direct co/s ( ! program are %>$ among ! foll[+ entities1 ea* ( :i* makes a direct f9ancial contribution3 7i7 ,! public sector4 7ii7 ,local heal? c>e provid]s4 7iii7 ,enrollees4 7iv7 ,enrollees' employ]s or skill$ trade organizations4 7,b7 ,%>$ f9ancial responsibility & long-t]m su/a9ability ,! program %all be /ructur$ to support long-t]m f9ancial su/a9ability ?r\gh a %>$ f9ancial responsibility framework t-- 7i7 relies on coord9at$ & ongo+ contributions f multiple levels ( gov]nm5t1 local res\rces1 & hospital community b5efit inve/m5t2 7ii7 avoids dep5d5ce on a s+le fund+ s\rce by e/abli%+ a def9$1 multi-ye> transition t[>d a /able allocation ( f9ancial responsibility across p>ticipat+ sectors2 & 7iii7 demon/rates measurable progress t[>d a mature f9anc+ /ructure 9 :i* ,f$]al support is supplem5t$ by su/a9$ contributions f ,/ate & local gov]nm5t & hospital community b5efit res\rces4 7#f7 ,enrollees 7,a7 ,9 ! ev5t t a ,program is unable to provide s]vices to all qualify+ individuals 9 its cat*m5t area1 ! ,program has a publicly available writt5 policy = det]m9+ :i* qualify+ individuals are (f]$ enrollm5t4 7,b7 ,! program may resc9d a qualify+ individual's enrollm5t due to su/a9$ failure to meet m9imum engagem5t & p]sonal gr[? ?re%olds1 :i* %all be p>ticipatory & n heal?-cont+5t1 & provide = reasonable alt]natives1 9 _! individual plan describ$ 9 subsection 7b77#b77;,d74 7#g7 ,evaluation ,! program =mally evaluates its impact on enrollees' employm5t /atus1 physical & behavioral heal?1 income1 & economic self-suffici5cy4 7c7 ,qualify+ individual ,! t]m qualify+ individual means an individual :o-- 7#a7 resides or works )9 ! cat*m5t area ( a p>tn] hospital describ$ 9 subsection 7e77#a77;,a72 7#b7 subject to any modification made by su* program to n>r[ ! income eligibility range1 has a h\sehold income t exce$s ! ,m$icaid eligibility limit applicable to ! qualify+ individual 9 _! ,/ate ( resid5ce b does n exce$ #djj p]c5t ( ! ,f$]al pov]ty l9e applicable to _! h\sehold size2 7#c7 is n enroll$ 9 a qualifi$ heal? plan dur+ ! #ahj-;day p]iod prec$+ ! date on :i* su* qualify+ individual seeks to enroll 9 ! ,community ,multi-,%>e ,cov]age ,program1 unless a su* cov]age is t]m9at$ due to a qualify+ special ev5t2 7#d7 is ineligible = enrollm5t 9 a ,f$]al heal? c>e program1 includ+ ineligibility to receive heal? s]vices ?r\gh ! ,indian ,heal? ,s]vice or ,vet]ans ,adm9i/ration2 7#e7 works = a small employ] :i* does n (f] its employees cov]age 9 a qualifi$ heal? plan "u :i* ! comb9$ premium plus d$uctible co/ to cov] ! employee's h\sehold is less ?an sev5 p]c5t ( ! employee's h\sehold income2 & 7#f7 meets o!r requirem5ts ! ,secret>y det]m9es appropriate4 7d7 ,grant t]ms 7#a7 ,duration ,a grant aw>d$ "u ?is section %all be made = a p]iod ( #d ye>s4 7#b7 ,am\nt ,! ,secret>y %all det]m9e ! maximum am\nt ( ea* grant aw>d$ "u subsection 7a74 7#c7 ,numb] ,at lea/ "o aw>d mu/ be made to a ,community ,multi-,%>e ,cov]age ,program t is op]at+ at ! "t t ?is section is enact$4 7e7 ,applications 7#a7 ,9 g5]al ,to be eligible to be aw>d$ a grant "u subsection 7a71 an applicant mu/-- 7,a7 be a non-pr(it entity ) docum5t$ commitm5ts f local p>tn] hospitals & small employ]s to p>ticipate 9 a ,community ,multi-,%>e ,cov]age ,plan2 & 7,b7 submit to ! ,secret>y an application at su* "t1 9 su* mann]1 & conta9+ ! c]tification describ$ 9 p>agraph 7#b7 & su* o!r in=mation z ! ,secret>y may require4 7#b7 ,c]tification ,to eligible = fund+ "u ?is section1 an application describ$ 9 p>agraph 7#a7 %all include c]tifications t ! program-- 7,a7 w n impose any preexi/+ condition exclusion 7z su* t]m is def9$ 9 section #bgjd7;b77#a77;,a77 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#c7;b77#a77;,a77 ) respect to ! heal? cov]age describ$ 9 subsection 7b77#a72 7,b7 has or w e/abli% a network ( heal? c>e provid]s & community res\rces suffici5t to provide s]vices to qualify+ individuals enroll$ "u ! heal? cov]age describ$ 9 subsection 7b77#b72 7,c7 w seek to enroll individuals ^: h\sehold income is less ?an ! basic co/ ( liv+ 7z det]m9$ 9 a mann] consi/5t ) ! ,asset ,limit$1 ,income ,con/ra9$1 ,employ$ or ,,alice me?odology72 7,d7 select an entity to c>ry out adm9i/rative & acc\nt+ responsibilities 7includ+ mon?ly bill+1 v]ification ( eligibility ( qualify+ individuals1 enrollm5t ( qualify+ individuals1 ma9t5ance ( a li/ ( active enrollees1 & op]ation ( a b5efit utilization managem5t program7 necess>y ) respect to ! heal? insurance cov]age describ$ 9 subsection 7b77#b72 & 7,e7 %all submit writt5 reports to ! ,secret>y on an annual basis evaluat+ ! progress on advanc+ access to heal? c>e1 increas+ economic self-suffici5cy1 & o!r elem5ts t ! ,secret>y requires4 7f7 ,def9itions ,9 ?is section3 7#a7 ,ag5cy ,! t]m ag5cy means a local1 ,/ate1 or ,f$]al ag5cy4 7#b7 ,f$]al heal? c>e program ,! t]m ,f$]al heal? c>e program has ! mean+ giv5 su* t]m 9 section #aabh;,b7f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7f774 7#c7 ,heal? coa* ,! t]m heal? coa* means an individual :o is a memb] ( ! /aff ( ! community-bas$ cov]age entity t has receiv$ tra9+ to provide heal? coa*+ s]vices 7includ+ heal? improvem5t program s]vices74 7#d7 ,hospital ,! t]m hospital means an in/itution t-- 7,a7 meets ! requirem5ts ( section #ahfa7;e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #caciex7e772 & 7,b7 is an organization describ$ 9 subsections 7c77#c7 & 7r77#c7 ( section #eja ( ! ,int]nal ,rev5ue ,code ( #aihf & is exempt f taxation "u section #eja7;a7 ( su* code4 7#e7 ,qualifi$ heal? plan ,! t]m qualifi$ heal? plan has ! mean+ giv5 su* t]m 9 section #acja7;a7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjba7;a774 7#f7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4 7#g7 ,small employ] ,! t]m small employ] has ! mean+ giv5 su* t]m 9 section #acjd7;b77#b7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjbd7;b77#b774 7#h7 ,heal?-relat$ social ne$s ,! t]m heal?-relat$ social ne$s has ! mean+ giv5 su* t]m by ! ,director ( ! ,c5t]s = ,disease ,control & ,prev5tion4 7g7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section-- 7#a7 #d1hjj1jjj = fiscal ye> #bjbf2 7#b7 #g1bjj1jjj = fiscal ye> #bjbg2 & 7#c7 #ab1jjj1jjj = ea* ( fiscal ye>s #bjbh & #bjbi4