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 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8245 Introduced in House (IH)]
<DOC>
117th CONGRESS
2d Session
H. R. 8245
To require the Secretary of Health and Human Services to award grants
to support community-based coverage entities to carry out a
comprehensive coverage program that provides to qualifying individuals
and small businesses health coverage and integrated social determinant
of health support services to small business workers that promote
improved health, long-term economic self-sufficiency, employment and
retention, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 28, 2022
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
comprehensive coverage program that provides to qualifying individuals
and small businesses health coverage and integrated social determinant
of health support services to small business workers that promote
improved health, long-term economic self-sufficiency, employment and
retention, 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 ESTABLISH COMMUNITY MULTI-SHARE COVERAGE PROGRAMS TO
ENABLE SMALL BUSINESSES TO PROVIDE AFFORDABLE HEALTH
COVERAGE AND SUPPORT SERVICES TO EMPLOYEES WITH LIMITED
INCOME AND ASSETS.
(a) In General.--Not later than 180 days after the date of the
enactment of this Act, the Secretary shall award at least 3 and not
more than 5 grants to support Community Multi-Share Coverage 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;
(2) promote workforce development for small business by
addressing the influencers of health that directly impact
employment success and create barriers to exiting Medicaid,
resulting in better health and workplace success; and
(3) support small business economic recovery by allowing
small businesses to be competitive in their hiring, and to
provide high quality, affordable health coverage to workers who
are otherwise hesitant to lose Medicaid eligibility.
(b) Community Multi-Share Coverage Program Requirements.--For
purposes of this section, the term ``Community Multi-Share Coverage
Program'' means a program that satisfies each of the following program
requirements--
(1) Physical presence in the community.--The program
maintains a physical presence within close geographic proximity
to the enrollees it is serving, with a focus on mitigating
barriers to engagement by enabling face-to-face interactions
between the program staff, enrollees, and community
organizations.
(2) Health coverage.--The program provides enrolled
qualifying individuals with health coverage that satisfies the
following:
(A) Services covered.--Provides coverage for the
following categories of services when furnished by
network providers and community resources--
(i) physician services;
(ii) inpatient and outpatient hospital
services;
(iii) behavioral health services, including
services for substance use disorder prevention
and treatment;
(iv) preventative services;
(v) diagnostic laboratory tests and x-rays;
(vi) prescription drugs;
(vii) emergency ambulance services that are
provided by ground transportation;
(viii) emergency services (as defined in
section 2719A(b)(2)(B) of the Public Health
Service Act (42 U.S.C. 300gg-1719a(b)(2)(B)));
and
(ix) population health improvement
services.
(B) Cost-sharing.--Imposes no deductible on covered
services provided by network providers and community
resources, and limits co-payments for in-network
covered services to levels that do not create a barrier
to patient access.
(C) Network providers.--Establishes agreements with
hospitals and health care providers located within the
community to provide care for qualifying individuals.
(3) Integrated continuous health improvement services.--The
program provides, either directly or through contract,
integrated continuous health improvement services that satisfy
the following:
(A) Regular assessments of community factors and
resources that potentially impact enrollees' physical,
emotional, and economic health.
(B) A community-based planning process to identify
and address any negative influences identified pursuant
to subparagraph (A), and promote well-being through
partnerships and alignment efforts between the
community-based coverage entity and--
(i) local small employers;
(ii) entities that provide educational and
occupational training (including classes,
workshops, mentorships, and apprenticeships)
designed to enhance preparation for work and
support economic self-sufficiency;
(iii) community health initiatives;
(iv) investors;
(v) local, State, and Federal governmental
agencies; and
(vi) organizations described in section
501(c)(3) of the Internal Revenue Code of 1986
that focus on human service needs relating to
physical health, behavioral health, poverty,
education, access to health care, and safety.
(C) Individualized assessment of each enrollee to
identify any negative influences on their physical,
emotional, and economic health, and ability to achieve
economic self-sufficiency. This shall include--
(i) an assessment of any of the enrollee's
social determinants of health, health risks,
barriers to long-term employment, and barriers
to increasing income; and
(ii) a determination of the enrollee's
health domain score, which is a measurement of
specific influences of physical, emotional, and
financial health with respect to a qualifying
individual.
(D) Establishment of an individualized plan to
support each enrollee in achieving better health and
economic self-sufficiency. Each individualized plan
shall--
(i) identify community resources that will
support the enrollee in improving their
physical, behavioral, or economic health. These
may include, but are not limited to--
(I) group classes that address
barriers to physical, emotional, and
economic health; and
(II) educational and occupational
training opportunities that enhance
work preparedness and support economic
self-sufficiency; and
(ii) contain engagement milestones, with a
goal of identifying and overcoming obstacles to
engagement in personal health improvement and
mitigation of root-cause barriers. These
milestones shall include, but are not limited
to--
(I) participation in individualized
health coaching services to address the
enrollee's social determinants of
health and to support their physical,
emotional, and financial health; and
(II) engagement with community
resources, such as participating in
group classes, as recommended by the
health coach.
(4) Funding structure.--The direct costs of the program are
shared among the following entities, each of which makes a
direct financial contribution--
(A) the public sector;
(B) local health care providers;
(C) enrollees; and
(D) enrollees' employers or skilled trade
organizations.
(5) Enrollees.--
(A) In the event that a Program is unable to
provide services to all qualifying individuals in its
catchment area, the Program has a written policy for
determining which qualifying individuals are offered
enrollment. This policy is publicly available and does
not discriminate based on age, race, ethnicity,
religion, gender, or sexual orientation.
(B) The program may rescind a qualifying
individual's enrollment due to sustained failure to
meet minimum engagement thresholds, which shall be
participatory and not health-contingent, and provide
for reasonable alternatives, in their individual plan
described in subsection (b)(2)(C).
(6) Evaluation.--The program formally evaluates its impact
on enrollees' employment status, physical and behavioral
health, income, and economic self-sufficiency.
(c) Qualifying Individual.--The term ``qualifying individual''
means an individual who--
(1) resides or works within the catchment area of a partner
hospital described in subsection (e)(1)(A);
(2) subject to any modification made by such program to
narrow the income eligibility range, has a household income
that exceeds the Medicaid eligibility limit applicable to the
qualifying individual in their State of residence but does not
exceed 400 percent of the Federal poverty line applicable to
their household size;
(3) is not enrolled in a qualified health plan during the
180-day period preceding the date on which such qualifying
individual seeks to enroll in the Community Multi-Share
Coverage Program, unless a such coverage is terminated due to a
qualifying special event;
(4) is ineligible for enrollment in a Federal health care
program other than Affordable Care Act Plans, (including but
not limited to ineligibility to receive health services through
the Indian Health Service or Veterans Administration);
(5) works for a small employer which does not offer its
employees coverage in a qualified health plan under which the
combined premium plus deductible cost to cover the employee's
household is less than seven percent of the employee's
household income; and
(6) other requirements the Secretary determines
appropriate.
(d) 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.--At least one award must be made to a Community
Multi-Share Coverage Program that is operating at the time that
this section is enacted.
(e) Applications.--
(1) In general.--To be eligible to be awarded a grant under
subsection (a), an applicant must--
(A) be a nonprofit entity with documented
commitments from local partner hospitals and small
employers to participate in a Community Multi-Share
Coverage Plan; and
(B) 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.--To be eligible for funding under this
section, an application described in paragraph (1) shall
include certifications that the program--
(A) will 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)(2);
(B) has or will establish a network of health care
providers and community resources sufficient to provide
services to qualifying individuals enrolled under the
health coverage described in subsection (b)(2);
(C) will seek to enroll eligible individuals whose
household income is less than the basic cost of living
(as determined in a manner consistent with the ``Asset
Limited, Income Constrained, Employed'' or ``ALICE''
methodology);
(D) 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 coverage described
in subsection (b)(2); and
(E) shall submit written reports to the Secretary
on an annual basis evaluating the progress on advancing
access to health care, increasing economic self-
sufficiency, and other elements that the Secretary
requires.
(f) 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) 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).
(4) 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 subsections
(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.
(5) 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)).
(6) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(7) 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)).
(8) 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.
(g) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section--
(1) $4,800,000 for fiscal year 2022;
(2) $7,200,000 for fiscal year 2023; and
(3) $12,000,000 for each of fiscal years 2024 and 2025.
<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.
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