,,ii  #aai? ,,congress  #b;d ,session   
,s4 #edbd  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,septemb] #ag1         
#bjbf,ms4 ,blunt ,ro*e/] introduc$ !    
foll[+ bill2 :i* 0 read twice & ref]r$  
to ! ,committee on ,f9ance  ,a ,,bill   
,to am5d titles ,,xviii & ,,xix ( !     
,social ,security ,act to increase      
access to community heal? work]s "u !   
,m$ic>e & ,m$icaid programs4  #a4 ,%ort 
title ,?is ,act may be cit$ z !         
,community ,heal? ,work] ,access ,act4  
#b4 ,cov]age ( community heal? s]vices  
"u "p ,b ( ! ,m$ic>e program  7a7       
,cov]age ( ,s]vices  7#a7 ,9 g5]al      
,section #ahfa7s77#b7 ( ! ,social       
,security ,act 7#db ,u4,s4,c4           
#aciex7s77#b77 is am5d$-- 7,a7 9        
subp>agraph 7,,jj71 by ins]t+ & aft] !  
semicolon at ! end2  7,b7 9 subp>agraph 
7,,kk71 by ins]t+ & aft] ! semicolon2 & 
7,c7 by add+ at ! end ! foll[+ new      
subp>agraph3 7,,ll7 community heal?     
s]vices 7z def9$ 9 subsection 7ooo77#a77
 furni%$ on or aft] ,janu>y #a1 #bjbg2 4

  7#b7 ,def9itions ,section #ahfa ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#aciex7 is am5d$ by add+ at ! end !     
foll[+ new subsection3  7ooo7 ,community
 heal? s]vices2 community heal? ag5cy   
7#a7 ,community heal? s]vices  7,a7 ,9  
g5]al ,! t]m community heal? s]vices    
means ! s]vices describ$ 9 subp>agraph  
7,b7 t are furni%$-- 7i7 by a community 
heal? ag5cy 7z def9$ 9 p>agraph 7#b772 &
  7ii7 9 accordance ) an individual ne$s
 assessm5t t meets requirem5ts e/abli%$ 
by ! ,secret>y & is conduct$ "u !       
sup]vision ( an applicable provid]2 &   
7,b7 ,s]vices describ$ ,! s]vices       
describ$ 9 ?is subp>agraph are ! foll[+3
 7i7 ,prev5tive s]vices ,diagno/ic1     
scre5+1 & prev5tive s]vices to prev5t   
illness1 disease1 injury1 or any o!r    
physical or m5tal heal? condition1 r$uce
 physical or m5tal disability1 & re/ore 
an individual to ! be/ possible         
functional level1 includ+ ! foll[+3 7,i7
 ,s]vices describ$ 9 section            
#aije7;a77#ac74  7,,ii7 ,conta9m5t (    

infecti\s disease outbreaks1 includ+    
provid+ 9-language1 culturally specific1
 & tru/$ support s]vices1 su* z public  
heal? outrea*4  7,,iii7 ,direct         
provision ( scre5+s & basic heal?       
s]vices1 z recomm5d$ by an applicable   
provid]4  7,,iv7 ,provision ( coa*+ &   
social support1 su* z support =         
individuals to obta9 heal? c>e1 support 
to r$uce /ress & social isolation1      
support = self-managem5t ( disease1 &   
o!r support necess>y = ! prev5tion &    
managem5t ( heal? conditions4  7,v7 ,c>e
 coord9ation & connection to prev5tive  
c>e s]vices1 includ+ = *ronic           
conditions1 su* z diabetes1 a/hma1      
*ronic ob/ructive pulmon>y disease1     
conge/ive he>t disease1 autoimmune      
disease1 or behavioral heal? conditions4
  7,,vi7 ,facilitation ( transportation 
to ne$$ s]vices4  7,,vii7 ,promotion (  
heal?y behaviors1 su* z physical        
activity & smok+ cessation4  7,,viii7   
,case managem5t & l9kage to res\rces t  
connect p ) disabilities to assi/ive    

te*nology1 home modifications1 & o!r    
adaptations to increase _! ability to   
live indep5d5tly 9 ! community4  7,,ix7 
,provision ( support = heal? lit]acy &  
cross-cultural communication4  7,x7     
,provision ( culturally & l+ui/ically   
appropriate heal? education4  7,,xi7    
,o!r s]vices1 z ! ,secret>y det]m9es    
appropriate to pres]ve & improve        
individual & public heal?4  7ii7        
,s]vices to address social det]m9ants ( 
heal? ,s]vices to address social        
det]m9ants ( heal?1 includ+ ! foll[+3   
7,i7 ,assessm5t ( individual & community
 ne$s & communicat+ id5tifi$ ne$s to    
public heal?1 heal? c>e1 & social s]vice
 ag5cies4  7,,ii7 ,provision ( outrea* &
 education reg>d+ heal? insurance1 & o!r
 heal? & social s]vice sy/ems4  7,,iii7 
,provision ( education1 assessm5t (     
ne$s1 & social support ?r\gh home       
visit+4  7,,iv7 ,provision ( case       
managem5t 7z def9$ 9 section            
#aiae7;g77#b77 & l9kage to res\rces to  
alleviate f9ancial /ra91 includ+ food1  

h\s+1 *ild s]vices1 te*nology1          
educational s]vices1 employm5t s]vices1 
& o!r s]vices4  7,v7 ,id5tification (   
und]s]v$ populations & ref]r+ !m to     
appropriate heal? c>e ag5cies &         
community-bas$ programs & organizations 
9 ord] to increase access to quality    
heal? & social s]vices & to /reaml9e    
c>e1 includ+ s]v+ z a liaison betwe5    
individuals & communities & heal? &     
social s]vice organizations4  7,c7      
,applicable provid] ,= purposes (       
subp>agraphs 7,a77ii7 & 7,b77i77,,iii71 
! t]m applicable provid] means-- 7i7 a  
physician 7z def9$ 9 section #ahfa7r772 
7ii7 a physician assi/ant1 a nurse      
practition]2 & a cl9ical nurse speciali/
 7z su* t]ms are def9$ 9 section        
#ahfa7;aa77#e772 &  7iii7 any o!r       
practition] describ$ 9 section          
#ahdb7;b77#ah77;,c7 t ! ,secret>y       
det]m9es appropriate4  7#b7 ,community  
heal? ag5cy ,! t]m community heal? ag5cy
 means an entity1 includ+ a             
community-bas$ organization1 a nonpr(it 

organization1 an urban ,indian          
organization1 a community heal? work]   
network1 a ,f$]ally qualifi$ heal? c5t]1
 a rural heal? cl9ic1 a local or ,/ate  
public heal? dep>tm5t1 an academic      
in/itution1 a heal? c>e provid]1 & any  
o!r organization deem$ appropriate by ! 
,secret>y1 t meets requirem5ts e/abli%$ 
by ! ,secret>y1 :i* may include ! foll[+
 requirem5ts3 7,a7 ,! entity provides = 
! employm5t ( heal? work]s :o %>e liv$  
exp]i5ces ) ! community s]v$ & m9imize  
b>ri]s to employm5t1 includ+ =mal       
educational requirem5ts4  7,b7 ,! entity
 provides = m>ket wage comp5sation &    
pr(essional developm5t & c>e] advancem5t
 opportunities = heal? work]s1 z well z 
tra9+ on core compet5cies4  7,c7 ,!     
entity has e/abli%$ "w practices &      
manageable caseloads t all[ heal? work]s
 to provide tailor$1 holi/ic1           
p]son-c5t]$ support4  7,d7 ,! entity    
ensures-- 7i7 ! safety ( heal? work]s1 9
 accordance ) applicable fair labor     
laws2  7ii7 ! sup]vision1 coa*+1 &      

evaluation ( heal? work]s1 ?r\gh ! use (
 evid5ce-in=m$ process & outcome        
indicators develop$ 9 consultation )    
community heal? work]s1 promotoras1 &   
community heal? repres5tatives 7z su*   
t]ms are def9$ 9 section                
#aijc7;cc77#d772 &  7iii7 lead]%ip &    
engagem5t ( heal? work]s 9 organization-
 & program-level decision mak+1 includ+ 
decision mak+ relat$ to ! improvem5t (  
processes & outcomes4  4  7#c7 ,am\nt ( 
paym5t ,section #ahcc7;a77#a7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#aciel7a77#a77 is am5d$-- 7,a7 by /rik+ 
& be=e 7,,hh72 &  7,b7 by ins]t+ be=e ! 
semicolon3 1 & 7,,ii7 ) respect to      
community heal? s]vices "u section      
#ahfa7s77#b77,,kk71 ! am\nts paid %all  
be #ajj p]c5t ( ! less] ( ! actual *>ge 
= ! s]vices or ! am\nt det]m9$ "u a fee 
s*$ule e/abli%$ by ! ,secret>y = su*    
s]vices4  7#d7 ,waiv] ( application (   
d$uctible ,! fir/ s5t5ce ( section      
#ahcc7;b7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #aciel7b77 is am5d$--    

7,a7 by /rik+ 1 & 7#ac7 & ins]t+ 7#ac72 
&  7,b7 by /rik+ #ahfa7n744 & ins]t+    
#ahfa7n71 & 7#ad7 su* d$uctible %all n  
apply ) respect to community heal?      
s]vices 7z def9$ 9 section              
#ahfa7ooo77#a7744  #c4 ,/ate ,m$icaid   
option to support community heal?       
work=ce = su/a9able community heal?     
,section #aijc ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acif;b7 is am5d$ by
 add+ at ! end ! foll[+ new subsection3 
7cc7 ,community heal? work=ce support   
7#a7 ,9 g5]al ,not)/&+ section          
#aijb7;a77#a7 7relat+ to /atewid5ess71  
section #aijb7;a77#aj77;,b7 7relat+ to  
comp>ability71 & any o!r provision ( ?is
 title t ! ,secret>y det]m9es is        
necess>y to waive 9 ord] to implem5t ?is
 subsection1 beg9n+ ,janu>y #a1 #bjbg1 a
 ,/ate1 at its option z a ,/ate plan    
am5dm5t1 may provide = m$ical assi/ance 
= prev5tive s]vices & s]vices to address
 ! social det]m9ants ( heal? furni%$ by 
a community heal? work]1 promotora1 or  
community heal? repres5tative4  7#b7    

,guidance ,! ,secret>y %all issue       
guidance on ! compon5ts t are necess>y =
 a ,/ate plan am5dm5t to receive        
approval "u ?is subsection1 includ+3    
7,a7 ,plans to recruit community heal?  
ag5cies = ! provision ( prev5tive       
s]vices & s]vices to address ! social   
det]m9ants ( heal? t are furni%$ by a   
community heal? work]1 promotora1 or    
community heal? repres5tative4  7,b7    
,plans to make m$ical assi/ance         
available = ea* category ( prev5tive    
s]vices & s]vices to address ! social   
det]m9ants ( heal?4  7,c7 ,plans to     
ensure t ! prev5tive s]vices furni%$ by 
community heal? work]s1 promotoras1 or  
community heal? repres5tatives "u !     
am5dm5t w respond to public heal?       
em]g5cies4  7,d7 ,plans to m9imize      
b>ri]s to community heal? work]1        
promotora1 or community heal?           
repres5tative program p>ticipation 9 !  
,/ate plan1 su* z by provid+ guidance & 
te*nical assi/ance on requirem5ts =     
p>ticipation4  7,e7 ,plans to coord9ate 

) & build ! capacity ( community heal?  
work] networks )9 ! /ate or region4     
7,f7 ,plans to address b>ri]s to        
p>ticipation exp]i5c$ by community heal?
 ag5cies t d n bill insurance = o!r     
s]vices1 su* z community-bas$ & nonpr(it
 organizations1 academic in/itutions1   
fai?-bas$ organizations1 tribal         
organizations1 or o!r organizations t   
employ community heal? work]s1          
promotoras1 or community heal?          
repres5tatives1 includ+ by implem5t+ a  
me*anism to reimburse su* community     
heal? ag5cies = prev5tive s]vices &     
s]vices to address ! social det]m9ants (
 heal?4  7#c7 ,increas$ ,,fmap  7,a7 ,9 
g5]al ,not)/&+ section #aije7;b71 =     
cal5d> qu>t]s beg9n+ on or aft] ,janu>y 
#a1 #bjbg1 ! ,f$]al m$ical assi/ance    
p]c5tage det]m9$ "u su* section = a     
,/ate %all be increas$ by #f p]c5tage   
po9ts ) respect to am\nts exp5d$ by !   
,/ate = m$ical assi/ance = prev5tive    
s]vices & s]vices to address ! social   
det]m9ants ( heal? furni%$ by a         

community heal? work]1 promotora1 or    
community heal? repres5tative t is      
provid$ 9 accordance ) a ,/ate plan     
am5dm5t approv$ "u ?is subsection or    
o!rwise provid$ 9 accordance ) !        
guidance issu$ "u p>agraph 7#b74  7,b7  
,exclusion ( am\nts attributable to     
increas$ ,,fmap f t]ritorial caps ,)    
respect to paym5ts made to a t]ritory = 
exp5ditures = m$ical assi/ance describ$ 
9 subp>agraph 7,a71 ! portion ( su*     
paym5t t exce$s ! am\nt t w\ld h be5    
paid )\t reg>d to ! increase 9 ! ,f$]al 
m$ical assi/ance p]c5tage "u su*        
subp>agraph %all n be tak5 into acc\nt =
 purposes ( apply+ paym5t limits "u     
subsections 7f7 & 7g7 ( section #aajh4  
7#d7 ,def9itions ,9 ?is subsection3 7,a7
 ,community heal? ag5cy ,! t]m community
 heal? ag5cy has ! mean+ giv5 t t]m 9   
section #ahfa7nnn74  7,b7 ,community    
heal? repres5tative ,! t]m community    
heal? repres5tative means a frontl9e    
heal? work] :o is a tru/$ memb] ( a     
tribal community ) a close und]/&+ ( !  

community1 language1 & traditions t     
enables ! work] to s]ve z a liaison     
betwe5 heal? & social s]vices & !       
community1 facilitate access to s]vices1
 & improve ! quality & cultural         
compet5ce ( s]vice deliv]y4  7,c7       
,community heal? work] ,! t]m community 
heal? work] means a frontl9e heal? work]
 :o is a tru/$ memb] ( ! community 9 :i*
 ! work] s]ves or :o has an unusually   
close und]/&+ ( ! community s]v$ t      
enables ! work] to build tru/$          
relation%ips1 s]ve z a liaison betwe5   
heal? & social s]vices & ! community1   
facilitate access to s]vices1 & improve 
! quality & cultural compet5ce ( s]vice 
deliv]y4  7,d7 ,community heal? work]   
network ,! t]m community heal? work]    
network means a /atewide1 regional1 or  
local association or coalition )        
lead]%ip & memb]%ip t is compos$ ( at   
lea/ #ej p]c5t community heal? work]s1  
promotoras1 or community heal?          
repres5tatives & ^: activities include  
tra9+1 work=ce developm5t1 m5tor+1 & o!r

 initiatives to support community heal? 
work]1 promotora1 & community heal?     
repres5tative programs4  7,e7 ,prev5tive
 s]vices ,! t]m prev5tive s]vices means 
s]vices describ$ 9 clause 7i7 ( section 
#ahfa7nnn77#a77;,b74  7,f7 ,promotora ,!
 t]m promotora means a tru/$ frontl9e   
work] :o prim>ily works 9 ,spani%-speak+
 communities & :o %>es liv$ exp]i5ces1  
language1 & culture ) ! populations s]v$
 t enables ! work] to improve           
individual1 family & community heal?    
outcomes by s]v+ z a liaison betwe5     
heal? & social s]vices & ! community1   
facilitat+ access to s]vices1 & improv+ 
! quality & cultural compet5ce ( s]vice 
deliv]y4  7,g7 ,s]vices to address !    
social det]m9ants ( heal? ,! t]m s]vices
 to address ! social det]m9ants ( heal? 
means s]vices describ$ 9 clause 7ii7 (  
section #ahfa7nnn77#a77;,b74  4