Community Multi-share Coverage Program Act
This bill establishes a pilot program to provide health coverage and employment supports for low-income individuals through partnerships between community organizations and hospitals.
[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4925 Introduced in House (IH)]
<DOC>
116th CONGRESS
1st Session
H. R. 4925
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 training, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 30, 2019
Mr. Huizenga introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committee on
Education and Labor, for a period to be subsequently determined by the
Speaker, 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 training, and for other purposes.
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 Multi-share Coverage
Program Act''.
SEC. 2. GRANTS TO COMMUNITY-BASED COVERAGE ENTITIES TO CARRY OUT A
COVERAGE PROGRAM THAT PROVIDES HEALTH COVERAGE AND
EDUCATIONAL AND OCCUPATIONAL TRAINING.
(a) In General.--Not later than 180 days after the date of the
enactment of the Community Multi-share Coverage Program Act, the
Secretary shall award at least 3 and not more than 5 grants to support
community-based coverage entities to carry out qualifying coverage
benefit pilot programs. Such programs shall--
(1) 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 programs; and
(2) 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 (42 U.S.C.
1396 et seq.) with full-time employment into such programs.
(b) Qualifying Coverage Benefit Program Requirements.--For purposes
of this section, the term ``qualifying coverage benefit program'' means
a program that satisfies each of the following program requirements:
(1) Health coverage.--Under the program, a community-based
coverage entity shall provide to qualifying individuals health
coverage offered in connection with a qualifying coverage
benefit program that satisfies the following:
(A) First-dollar coverage (where such coverage is
furnished by network providers and community resources)
for--
(i) diagnostic laboratory tests and x-rays;
(ii) emergency ambulance services that are
provided by ground transportation;
(iii) emergency services (as defined in
section 2719A(b)(2)(B) of the Public Health
Service Act (42 U.S.C. 300gg-19a(b)(2)(B)));
(iv) inpatient and outpatient hospital
services;
(v) mental health services;
(vi) physician services;
(vii) population health improvement
services;
(viii) preventatives services;
(ix) prescription drugs; and
(x) substance abuse services.
(B) Coverage for--
(i) 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 individual;
(ii) a planning process to resolve any
negative influences identified pursuant to
clause (i) and promote well-being through
community partnerships between the community-
based coverage entity and--
(I) businesses;
(II) educational institutions;
(III) investors;
(IV) local, State, and Federal
governmental agencies; and
(V) organizations described in
section 501(c)(3) of the Internal
Revenue Code of 1986 that focuses on
human service needs relating to
behavioral health, poverty, education,
and access and safety;
(iii) the monitoring of and support
(including health coaching services and
coordination of services within a community to
address the needs of an individual) with
respect to financial, emotional, and physical
health; and
(iv) any other benefit the community-based
coverage entity determines appropriate.
(2) Educational and occupational training.--Under the
program, a community-based coverage entity shall--
(A) connect and foster ongoing relationships
between qualifying individuals and educational and
occupational training (including classes, workshops,
mentorships, and apprenticeships) 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 community;
(B) with respect to the comprehensive health
improvement process described in subsection
(e)(1)(C)(vi), identify and address barriers to
employment and increasing income for qualifying
individuals; and
(C) measure and assess the effectiveness of the
program in increasing employment and increasing income
for qualifying individuals.
(3) Board of directors.--For the purpose of carrying out
the program, the community-based coverage entity shall form a
board of directors, or utilize an existing board of directors,
in accordance with subsection (e).
(c) Community-Based Coverage Entity.--For the purposes of this
section, the term ``community-based coverage entity'' means an entity
that maintains a physical presence within close geographic proximity to
the individuals it is serving, with a focus on mitigating barriers to
engagement by enabling face-to-face interactions between the entity
staff, the individuals served, and community organizations.
(d) Qualifying Individual.--For the purposes of this section, the
term ``qualifying individual'' means an individual who meets the
following requirements:
(1) Subject to any modification made by such program
pursuant to subsection (e)(2)(C)(vii), an income that exceeds
100 percent but does not exceed 400 percent of the poverty line
applicable to a family of the size involved.
(2) Not enrolled under a qualified health plan during the
180-day period preceding the date on which such qualifying
individual seeks to enroll under the coverage program under
this section.
(3) Ineligibility for enrollment in a Federal health care
program (including ineligibility to receive health services
through the Indian Health Service).
(4) Resides or works within the catchment area of a
hospital described in subsection (g)(2)(C).
(5) 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--
(A) 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 (2)
of section 1311(b) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18031(b)), the American
Health Benefit Exchange (as such term is used in
paragraph (1) of such section) for the plan year in
which such qualifying individual seeks health insurance
coverage described in subsection (b)(1) from a
qualifying coverage benefit program; and
(B) in the case that a State retains separate
exchanges for qualifying individuals and qualified
small employers, the Small Business Health Options
Program (as such term is used in section 1311(b)(2) of
the Patient Protection and Affordable Care Act (42
U.S.C. 18031(b)(2))) for the plan year in which such
qualifying individual seeks health insurance coverage
described in subsection (b)(1) from a qualifying
coverage benefit program.
(6) Any other requirement the Secretary determines
appropriate.
(e) Board of Directors.--
(1) Composition.--A board of directors formed pursuant to
subsection (b)(3) shall be composed of at least 9 members and
not more than 15 members with representation from--
(A) local health care providers, of which not more
than two individuals may be from the sponsoring health
care organization;
(B) qualifying individuals;
(C) contributing employers;
(D) government representatives;
(E) the local health authority;
(F) local education systems; and
(G) other representatives as necessary to reflect
the community composition.
(2) Duties.--
(A) Enactment of bylaws.--A board of directors
shall enact bylaws relating to--
(i) public engagement with the board of
directors;
(ii) a shared goal of improving health
access and increasing affordability;
(iii) outcome-based goals for the program
that considers the needs of the community;
(iv) program costs; and
(v) an intent to receive comments regarding
the health improvement goals for the community.
(B) Meetings.--A board of directors shall meet at
least bimonthly.
(C) Qualifying coverage benefits program.--A board
of directors shall--
(i) carry out the qualifying coverage
benefit program described in subsection (b);
(ii) determine the share of payments for
benefits under the health coverage described in
subsection (b)(1) that are attributable to--
(I) the amount awarded to a
community-based coverage entity;
(II) a sponsoring health care
organization;
(III) a qualifying individual; and
(IV) an employer of a qualifying
individual or a skilled trade
organization of a qualifying
individual;
(iii) determine the premiums and
limitations on payments (including deductibles
and coinsurance amounts) for the health
coverage described in subsection (b)(1) for a
qualifying individual enrolled under such
coverage and the extent, if any, 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
involved;
(iv) establish a procedure to--
(I) assist qualifying individuals
in enrolling under the health coverage
described in subsection (b)(1);
(II) assist a qualifying individual
that does not meet the requirements of
a qualified individual specified under
subsection (d), is eligible for medical
assistance under a State plan under the
Medicaid program under title XIX of the
Social Security Act (42 U.S.C. 1396 et
seq.), and resides in the catchment
area of the hospital described in
subsection (g)(2)(C) in enrolling under
the appropriate State plan under such
program;
(III) bill and collect the share of
payments for benefits described in
clause (ii);
(IV) bill and collect the premiums
and limitations on payment described in
clause (iii);
(V) for the purposes of integrating
community resources, form partnerships
with community population health
initiatives;
(VI) remove a qualifying individual
from the health insurance coverage
described in subsection (b)(1) in the
case the qualifying individual--
(aa) has been enrolled
under the qualifying covered
benefits program for a 4-year
period; and
(bb) fails to meet the
milestones identified pursuant
to clause (vi); and
(VII) determine a maximum
enrollment period for individual
participation, including required
milestones for addressing social
determinants of health while enrolled;
(v) for the purpose of encouraging a
qualifying individual to seek a primary care
physician, establish incentives for a
qualifying individual to initially seek such
physician for care (including the reduction of
benefits until a primary care physician is
engaged in the care of such qualifying
individual);
(vi) for the purpose of making progress
toward health and economic self-sufficiency,
establish routine milestones and supportive
services (to be known as the ``comprehensive
health improvement process'') that a qualifying
individual enrolled under health coverage
described in subsection (b)(1) shall meet to
maintain enrollment and such milestones shall
include--
(I) an assessment relating to
social determinants of health, health
risks, and any other assessment that is
appropriate as determined by the
circumstances of the qualifying
individual;
(II) meetings with a health coach
to address social influences of health
and to support the physical, emotional,
and financial health of the qualifying
individual;
(III) connections with local
community linkage partners to offer
health-related programs and services;
and
(IV) enrollment in group classes
that address barriers to physical,
emotional, and financial health;
(vii) 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 (g)(2)(C),
determine the extent, if any, to narrow the
income range specified in subsection (d)(1)
with respect to first-time enrollees and
continuing enrollees;
(viii) incorporate population health
improvement strategies into the benefits of
health coverage described in subsection (b)(1),
including strategies that align with the
objectives of the program of the Secretary
regarding health-status goals for 2020,
commonly referred to as Healthy People 2020;
(ix) select a plan administrator pursuant
to subsection (g)(2)(E) to carry out
administrative and accounting responsibilities
of the health coverage described in subsection
(b)(1); and
(x) 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 services.
(3) Advisory committee.--A board of directors shall
establish a finance advisory committee and a clinical and
population health improvement advisory committee.
(f) Grant Terms.--
(1) Duration.--A grant awarded under this section shall be
made for a period of 4 years.
(2) Amount.--The Secretary shall determine the maximum
amount of each grant awarded under subsection (a).
(3) Number.--The Secretary may not award more than 4 grants
under subsection (a).
(g) Applications.--
(1) In general.--To be eligible to be awarded a grant under
subsection (a), a community-based coverage entity shall submit
to the Secretary an application at such time, in such manner,
and containing the certification described in paragraph (2) and
such other information as the Secretary may require.
(2) Certification.--An application described in paragraph
(1) shall include a certification by the community-based
coverage entity that the entity will--
(A) not impose any preexisting condition exclusion
(as such term is defined in section 2704(b)(1)(A)) of
the Public Health Service Act (42 U.S.C. 300gg-
3(b)(1)(A)) with respect to the health coverage
described in subsection (b)(1);
(B) not later than 2 years after the date on which
a grant is awarded under subsection (a), establish a
plan to measure quality and efficiency of care provided
under the coverage program;
(C) 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
(b)(1);
(D) seek to provide to 7 percent of individuals
whose household income is more than 300 percent of the
poverty line for a family of the size involved and less
than the basic cost of living (as determined in a
manner consistent the ``Asset Limited, Income
Constrained, 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 (C) health coverage
described in subsection (b)(1) is located) for the size
of the family involved living in such catchment area;
and
(E) select an entity to carry out administrative
and accounting responsibilities (including monthly
billing, verification of eligibility of qualifying
individuals, enrollment of qualifying individuals,
maintenance of a list of active enrollees, and
operation of a benefit utilization management program)
necessary with respect to the health insurance coverage
described in subsection (b)(1).
(h) Reporting.--Not later than 1 year after the date of the
enactment of this section and annually for each of the 3 succeeding
years, the board of directors formed pursuant to subsection (b)(3)
shall submit to the Secretary a report that--
(1) evaluates the progress of the qualifying coverage
benefits program; and
(2) evaluates measurements relating to quality and
efficiency of care described in subsection (g)(2)(B) collected
by the community-based coverage entity.
(i) Definitions.--In this section:
(1) Agency.--The term ``agency'' means a local, State, or
Federal agency.
(2) Federal health care program.--The term ``Federal health
care program'' has the meaning given such term in section
1128B(f) of the Social Security Act (42 U.S.C. 1320a-7b(f)).
(3) First dollar coverage.--The term ``first dollar
coverage'' means coverage of a benefit by health coverage
described in subsection (b)(1) without requiring any payment by
the qualifying individual.
(4) 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 (including health improvement program
services).
(5) Hospital.--The term ``hospital'' means an institution
that--
(A) meets the requirements of section 1861(e) of
the Social Security Act (42 U.S.C. 1395x(e)); and
(B) is an organization described in paragraphs
(c)(3) and (r)(3) of section 501 of the Internal
Revenue Code of 1986 and is exempt from taxation under
section 501(a) of such Code.
(6) Population health improvement service.--
(A) In general.--The term ``population health
improvement service'' means a service that supports the
physical, emotional, and financial health of a
qualifying individual through--
(i) health coaching that--
(I) identifies any social
determinant of health that prevents a
qualifying individual from obtaining
physical, emotional, and financial
health;
(II) develops a personalized plan
to improve the physical, emotional, and
financial health of a qualifying
individual based on the circumstances
and health domain score of such
qualifying individual; and
(III) measures and evaluates the
health domain score of an individual;
(ii) health education courses; and
(iii) integrated community linkage
partnerships with organizations serving the
catchment area of a hospital described in
subsection (g)(2)(C) that provide health
programs and services to qualifying individuals
that--
(I) support a qualifying individual
with respect to any appropriate social
determinant of health; and
(II) support a qualifying
individual in job retention, including
jobs in childcare and transportation.
(B) Health domain score defined.--In this
paragraph, the term ``health domain score'' means a
measurement of specific influences of physical,
emotional, and financial health with respect to a
qualifying individual.
(7) Qualified health plan.--The term ``qualified health
plan'' has the meaning given such term in section 1301(a) of
the Patient Protection and Affordable Care Act (42 U.S.C.
18021(a)).
(8) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(9) Small business health options program.--The term
``Small Business Health Options Program'' has the meaning given
such term in section 1311(b)(2) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18031(b)(2)).
(10) Small employer.--The term ``small employer'' has the
meaning given such term in section 1304(b)(2) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18024(b)(2)).
(11) 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 Prevention.
(j) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section--
(1) $4,800,000 for fiscal year 2020;
(2) $7,200,000 for fiscal year 2021; and
(3) $12,000,000 for each of fiscal years 2022 and 2023.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Education and Labor, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Education and Labor, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
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