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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5387 Introduced in House (IH)]
<DOC>
118th CONGRESS
1st Session
H. R. 5387
To improve the provision of health care to unsheltered homeless
individuals, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 12, 2023
Mrs. Chavez-DeRemer (for herself and Ms. Lee of Pennsylvania)
introduced the following bill; which was referred to the Committee on
Energy and Commerce, and in addition to the Committees on Education and
the Workforce, and Financial Services, 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 improve the provision of health care to unsheltered homeless
individuals, 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 ``DIRECT Care for the Homeless Act of
2023'' or the ``Delivering Integral, Rehabilitating, Empathetic,
Comprehensive and Targeted Care for the Homeless Act of 2023.''
SEC. 2. DEFINITIONS.
(1) The terms ``eligible city or county'' and ``eligible
cities and counties'' refer to cities and counties, as
applicable, in the United States that, according to the
Department of Housing and Urban Development, have a homeless
population of 150 or more per 100,000 residents.
(2) The terms ``homeless'' and ``homeless individual'' have
the meanings given to such terms in section 103 of the
McKinney-Vento Homeless Assistance Act (42 U.S.C. 11302).
(3) The term ``street medicine'' refers to health
professionals providing preventive, screening, diagnostic, and/
or treatment services to unsheltered homeless individuals where
said individuals live in a non-permanent location on the street
or found environment.
(4) The term ``unsheltered'' means not residing in a
permanent residence or shelter.
SEC. 3. GAO REPORT.
Not later than the end of fiscal year 2027, the Comptroller General
of the United States shall submit to the Congress an interim report
assessing the results achieved through this Act and the amendments made
by this Act, including--
(1) the number of patients who moved into temporary or
permanent housing;
(2) the number of patients who have established within
their respective Continuum of Care awaiting housing placement;
(3) patients diagnosed with a substance use disorder and
number who received treatment;
(4) the number of health care professionals providing care
to unsheltered homeless individuals;
(5) how efficient and sufficient reimbursements were for
provided care, including any difficulties health care
professionals experienced in being reimbursed;
(6) the number of unique people receiving street medicine
services;
(7) the number of total patient visits provided by street
medicine teams;
(8) a report from street medicine providers detailing
barriers to accessing non-street medicine primary care
healthcare services such as specialty care, medications, and
diagnostic studies; and
(9) an analysis of participating street medicine providers'
ability to sustain a sufficient amount of street medicine
providers to provide adequate care to its unsheltered homeless
population,
No later than 120 days after enactment of this Act, the Secretary of
the Department of Health and Human Services shall promulgate rules for
data collection necessary to complete this report, without creating
barriers which negatively impact the effective provision of health
care. To ensure this, the Secretary shall also create and maintain an
online platform through which health care professional participating in
the Program may provide feedback on the Program as a whole, and such
platform must be open for submissions 24/7. The online platform must be
compliant with the Health Insurance Portability and Accountability Act
of 1996.
SEC. 4. SUNSET.
The provisions of this Act and the amendments made by this Act
shall cease to be effective at the end of fiscal year 2028.
TITLE I--STREET MEDICINE
SEC. 101. STREET MEDICINE PILOT PROGRAM.
(a) In General.--Beginning on the first day of the first fiscal
year following the date of enactment of this Act, the Secretary of
Health and Human Services (referred to in this section as the
``Secretary'') shall conduct a pilot program (referred to in this
section as the ``Program'') to provide payments to providers in
eligible cities and counties for furnishing medical services to covered
individuals.
(b) Program Requirements.--
(1) Application.--A street medicine provider seeking
participation in the Program shall submit an application to the
Secretary, at such time, in such manner, and containing such
information, as the Secretary may require.
(2) Provider requirements.--
(A) In general.--In order to participate in the
Program, a provider must--
(i) be an eligible provider (as defined in
subsection (e)(3));
(ii) be enrolled--
(I) under section 1886(j) of the
Social Security Act (42 U.S.C.
1395cc(j)); or
(II) as a participating provider
under a State plan (or waiver of such
plan) under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.);
(iii) be affiliated with a hospital,
university, non-profit organization, city
government, county government, state
government, or private health care practice;
(iv) use a qualified electronic health
record to document interactions with, and
medical services furnished to, covered
individuals under the Program;
(v) maintain medical malpractice insurance
in the State in which such provider is
furnishing medical services under the Program;
and
(vi) in the case of a provider prescribing
opioid medication, meet the requirement
described in subparagraph (B).
(B) Requirement for prescribing opioid
medication.--In the case of a provider prescribing an
opioid medication to a covered individual under the
Program, such provider shall meet the standards of
their respective State.
(C) During each visit with a patient, there shall
be a prescriber, as defined in (e)(3), present either
in person, via telemedicine, or phone call.
(3) Documentation requirements.--
(A) In general.--A provider furnishing medical
services under the Program shall document in a
qualified electronic health record each interaction
with a covered individual, such documentation shall
include--
(i) the name and date of birth of such
individual;
(ii) whether the covered individual has, or
has history of, a substance use disorder;
(iii) the length of time such individual
has been homeless, and factors contributing to
such individual's lack of permanent housing;
(iv) whether an individual is under the
care of a medical provider other than a street
medicine team or provider;
(v) the contact information, and billing
information for such provider;
(vi) the credentials of such provider; and
(vii) any other information as determined
by the Secretary.
(B) Rules of construction regarding
documentation.--
(i) Nothing in this section shall be
construed as requiring a covered individual to
provide a permanent address in order to receive
medical services under the Program.
(ii) Nothing in this section shall be
construed as requiring a provider to document,
with respect to a covered individual--
(I) the permanent address of such
individual;
(II) the address of the facility
where medical services were furnished
to such individual; or
(III) the name of contact
information of a provider referring
such individual to the program.
(c) Payment.--
(1) In general.--To receive payment for a medical service
furnished to a covered individual under the Program, a provider
shall submit to the Secretary, at such time and in such manner
as determined by the Secretary, a claim for such service.
(A) No later than 120 days after enactment of this
Act, the Secretary shall promulgate rules to establish
and maintain a clear process for reimbursements through
the Program.
(B) No later than 120 days after enactment of this
Act, the Secretary shall create and maintain an online
platform through which health care professional
participating in the Program may provide feedback on
the reimbursement process, and such platform must be
open for submissions 24/7. The online platform must be
compliant with the Health Insurance Portability and
Accountability Act of 1996. This platform may be the
same as referred to in section 3 of this Act.
(2) Payment amount.--The Secretary shall establish payment
amounts for medical services furnished to covered individuals
under the Program. Such payment amounts shall be based upon
payment amounts established with respect to medical assistance
furnished under title XIX of the Social Security Act (42 U.S.C.
1396 et seq.).
(3) Prohibition against supervised consumption.--No payment
may be made under this Program with respect to medical services
providing supervised drug consumption, as defined in (e)(9).
This provision shall not be construed to prohibit States,
counties, and cities which operate their own supervised
consumption programs from accessing the Program.
(d) Direct Access.--
(1) Unsheltered homeless individuals may obtain services
from any qualified street medicine provider, as defined in this
Act, for purposes of the Program.
(2) Individuals enrolled in a primary care case management
system or Medicaid managed care organization (MCO) shall not be
denied freedom of choice of qualified street medicine
providers.
(3) Prior authorization shall not be required for purposes
of an individual receiving care from a street medicine
provider.
(4) If a patient is a Medicaid or Medicare beneficiary,
street medicine providers shall have the authority to refer
patients to medically necessary covered services within the
proper Making Care Primary (MCP) network, to ensure
beneficiaries have access to all medically necessary covered
service.
(A) The Secretary of the Department of Health and
Human Services or Director of the Centers for Medicaid
and Medicare Services shall develop rules to ensure
street medicine providers have the appropriate referral
and authorization mechanisms in place to facilitate
access to needed services in the network without
requiring authorization by an assigned primary care;
and
(B) rules to guarantee a clear and accessible
process for making such referrals.
(5) The Secretary of Health and Human Services or Director
of the Centers for Medicaid and Medicare Services shall develop
rules to ensure providers operating within the Program shall
have appropriate referral and authorization mechanisms for
patients who are not insured, or are not Medicaid or Medicare
beneficiaries.
(6) Delivery network.--If a patient is a Medicaid or
Medicare beneficiary, MCPs must ensure that, they meet the
following requirements:
(A) Maintains and monitors a network of appropriate
providers that is supported by written agreements and
is sufficient to provide adequate access to all
services covered by the Program or patients' other
health care benefits, such as Medicaid or Medicare,
ensuring access to patients with limited English
proficiency or physical or mental disabilities;
(B) provides female patients with direct access to
women's routine and preventive health care services;
(C) arranges for patients to receive a second
opinion, should the patient elect, at no cost to the
patient; and
(D) if its network of street medicine providers are
unable to provide necessary services, that the MCP is
able to adequately and timely cover those services,
without cost to the patient exceeding standards costs
within the Program or the providers' network.
(e) Funding.--The Secretary has the authority to allocate existing
funds for the Program.
(f) Definitions.--In this Act:
(1) Covered individual.--The term ``covered individual''
means an unsheltered homeless individual over the age of zero
who resides in an eligible city or county.
(2) Eligible city or county; eligible cities and
counties.--The terms ``eligible city or county'' and ``eligible
cities and counties'' refer to cities and counties, as
applicable, in the United States that, according to the
Department of Housing and Urban Development, have a homeless
population of 150 or more per 100,000.
(3) Prescriber.--The term ``prescriber'' means a person
permitted under State law, or agent of such person, to issue
prescriptions for drugs in compliance with applicable
requirements established by the Food and Drug Administration.
(4) Eligible provider.--The term ``eligible provider''
includes--
(A) a physician (as defined in section 1861(r) of
the Social Security Act (42 U.S.C. 1395(aa)(5)(A));
(B) a physician assistant or nurse practitioner (as
such terms are defined in section 1861(aa)(5)(A) of the
Social Security Act (42 U.S.C. 1395(aa)(5)(A));
(C) a behavioral health therapist;
(D) a supplier (as defined in section 1861(d) of
the Social Security Act (42 U.S.C. 1395(d));
(E) a psychologist (as defined in section 799B(11)
of the Public Health Service Act (42 U.S.C. 295p(11));
(F) a physical therapist;
(G) occupational therapist;
(H) an emergency medical technician responding to a
call or case in which health care is administered to an
unhoused homeless individual; or
(I) any provider as determined by the Secretary.
(5) Homeless; homeless individual.--The term ``homeless''
and ``homeless individual'' have the meaning given such terms
in section 103 of the McKinney-Vento Homeless Assistance Act
(42 U.S.C. 300jj(13)).
(6) Medical services.--The term ``medical services'' mean
the medical care and services described in section 1905(a) of
the Social Security Act (42 U.S.C. 1396d(a)).
(7) Qualified electronic health record.--The term
``qualified electronic health record'' has the meaning given
such term in section 3000(13) of the Public Health Service Act
(42 U.S.C. 300jj(13)).
(8) Street medicine.--The term ``street medicine'' means
the direct provision of medical services to unsheltered
homeless individuals where such individuals live in a non-
permanent location on the street or found environment.
(9) Supervised consumption.--The consumption of schedule I
drugs, fentanyl, cocaine, and methamphetamine under the
supervision of health care professionals.
TITLE II--FEDERAL LOAN REPAYMENT PROGRAMS
SEC. 201. PUBLIC HEALTH LOAN REPAYMENT PROGRAMS.
(a) In General.--In carrying out programs under the Public Health
Service Act (42 U.S.C. 201 et seq.) for loan repayments for health care
professionals, the Secretary of Health and Human Services shall include
awards to applicants seeking to practice street medicine in eligible
cities and counties.
(b) National Health Service Corps.--In assigning members of the
National Health Service Corps to health professional shortage areas
pursuant to section 333 of the Public Health Service Act (42 U.S.C.
254f) to fulfill a period of obligated service under the National
Health Service Corps Loan Repayment Program, the Secretary of Health
and Human Services shall assign an appropriate number of Corps members
to practice street medicine in eligible cities and counties.
(c) Treatment of Mobile Clinics as HPSAS.--The Secretary of Health
and Human Services shall treat mobile clinics providing street medicine
in an eligible city or county as a health professional shortage area
eligible for designation under section 332 of the Public Health Service
Act (42 U.S.C. 254e).
SEC. 202. COMMUNITY SERVICE OFFICERS.
(a) In General.--Public Service Loan Forgiveness (PSLF) Program
eligibility shall include individuals who spend at least one year as a
community service officer (CSO), including those working less than 30
hours per week, employed by a local law enforcement agency.
(b) Section 455(m) of the Higher Education Act of 1965 (20 U.S.C.
1087e(m)) is amended--
(1) by striking the period at the end of (3)(B)(ii) and
inserting ``; or'';
(2) by adding at the end of (3)(B) the following:
``(iii) serving, for a calendar year, full-
time or part-time as a community service
officer''; and
(3) by inserting after subparagraph (B) the following:
``(C) Community service officers are professionals
or paraprofessional law enforcement who do not respond
to emergencies, do not carry firearms, and do not have
power of arrest; this includes those persons training
to be full-time law enforcement.''.
(c) The Department of Education.--The Secretary of Education must
treat local law enforcement agencies, including those of tribal
governments, as qualifying employers as defined in 34 CFR 685.219.
(1) No later than 120 days after enactment of this Act, the
Secretary of Education must promulgate rules to provide a clear
and accessible process for community service officers to apply
for loan forgiveness. These rules must ensure that community
service officers employed by local law enforcement agencies
receive Public Service Loan Forgiveness benefits no later than
one year after applying for and being determined eligible for
this program.
(2) No later than 120 days after enactment of this Act, the
Secretary of Education must create and maintain a clear and
accessible appeals process for all borrowers who are denied
participation in the PSLF Program. The appeals process must
meet, but is not limited to, the following requirements:
(A) petition for appeal must be submitted through
an online program which is clearly displayed on the
department website and is accessible to non-English
speakers;
(B) the Department must provide notice of the
appeals process when a borrower initially applies for
the PSLF Program;
(C) the Department must provide for accessible
communication with borowers;
(D) the Department must provide the borrower
detailed information about which loans did not qualify,
which payments did not qualify, and what information is
necessary for a successful appeal;
(E) borrowers who were denied loan forgiveness
prior to enactment of this Act have 180 days to request
reconsideration; and
(F) for any months in which a borrower postponed
monthly payments under a deferment or forbearance and
was employed full-time or part-time at a qualifying
employer as defined in 34 CFR 685.219 but was in a
deferment or forbearance status, the borrower may
obtain credit towards forgiveness for those months.
TITLE III--LOAN AND INTEREST PAUSE
SEC. 301. STUDENT LOAN AND INTEREST PAUSE.
(a) Section 455(f) of the Higher Education Act of 1965 (20 U.S.C.
1087e(f)) is amended--
(1) in paragraph (1), in the matter preceding subparagraph
(A), by striking ``A borrower'' and inserting ``Except as
provided in paragraph (6), a borrower'';
(2) in paragraph (2)(A)--
(A) in clause (i), by striking ``or'' after the
semicolon;
(B) by striking the matter following clause (ii);
(C) in clause (ii), by striking the comma at the
end and inserting ``; or''; and
(D) by adding at the end the following:
``(iii) is serving in a medical or
residency program which, in part, focuses on
the provision of street medicine;''; and
(3) by adding at the end the following:
``(6) Special rule for certain in school deferment.--
Notwithstanding any other provision of this Act, a borrower
described in paragraph (2)(A)(ii) shall be eligible for a
deferment, during which periodic installments of principal need
not be paid and interest shall not accrue on any loan made to
the borrower under this part.''.
TITLE IV--IMPROVED STANDARDS FOR SHELTERS
SEC. 401. SAFE SHELTERS.
Whereas homeless shelters should always be safe for residents;
Whereas a significant number of homeless women report feeling safer
spending the night in a car as opposed to a shelter;
Whereas approximately thirty-two percent of homeless women report
being sexually or physically assaulted each year;
Whereas homeless individuals accrue citations for sleeping in their
car or parking their car in a certain spot for too long, resulting in
criminal records which might prevent an employer from providing them
employment;
Whereas a significant number of homeless women are unable to afford
menstrual products; and
Whereas transgender men frequently experience discrimination by
being denied necessary menstrual products.
SEC. 402. IMPROVED STANDARDS.
(a) Section 415 of the McKinney-Vento Homeless Assistance Act (42
U.S.C. 1137) is amended by adding at the end the following:
``(c) Emergency Shelter Requirements.--No amount provided under
this subtitle may be allocated to an emergency shelter unless such
emergency shelter--
``(1) provides menstrual products for each menstruating
resident; and
``(2) maintains a security camera system with no less than
two functional security cameras and consideration for
residents' personal privacy.''.
(b) There shall be no restrictions on the kind of security cameras
a shelter may install and maintain to be in compliance with this Act.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and the Workforce, and Financial Services, 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 Committees on Education and the Workforce, and Financial Services, 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 Committees on Education and the Workforce, and Financial Services, 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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