Coverage of community health services under part B of the Medicare program

(a) Coverage of Services (1) In general Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)) is amended— (A) in subparagraph (II), by striking subsection (lll)(3)) and all that follows and inserting subsection (lll)(3));; (B) in subparagraph (JJ), by inserting and after the semicolon at the end; and (C) by adding at the end the following new subparagraph: (KK) community health services (as defined in subsection (nnn)(1)) furnished on or after January 1, 2027;. (2) Definitions Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended by adding at the end the following new subsection: (nnn) Community health services; community health agency (1) Community health services (A) In general The term community health services means the services described in subparagraph (B) that are furnished— (i) by a community health agency (as defined in paragraph (2)); and (ii) in accordance with an individual needs assessment that meets requirements established by the Secretary and is conducted under the supervision of an applicable provider; and (B) Services described The services described in this subparagraph are the following: (i) Preventive services Diagnostic, screening, and preventive services to prevent illness, disease, injury, or any other physical or mental health condition, reduce physical or mental disability, and restore an individual to the best possible functional level, including the following: (I) Services described in section 1905(a)(13). (II) Containment of infectious disease outbreaks, including providing in-language, culturally specific, and trusted support services, such as public health outreach. (III) Direct provision of screenings and basic health services, as recommended by an applicable provider. (IV) Provision of coaching and social support, such as support for individuals to obtain health care, support to reduce stress and social isolation, support for self-management of disease, and other support necessary for the prevention and management of health conditions. (V) Care coordination and connection to preventive care services, including for chronic conditions, such as diabetes, asthma, chronic obstructive pulmonary disease, congestive heart disease, autoimmune disease, or behavioral health conditions. (VI) Facilitation of transportation to needed services. (VII) Promotion of healthy behaviors, such as physical activity and smoking cessation. (VIII) Case management and linkage to resources that connect people with disabilities to assistive technology, home modifications, and other adaptations to increase their ability to live independently in the community. (IX) Provision of support for health literacy and cross-cultural communication. (X) Provision of culturally and linguistically appropriate health education. (XI) Other services, as the Secretary determines appropriate to preserve and improve individual and public health. (ii) Services to address social determinants of health Services to address social determinants of health, including the following: (I) Assessment of individual and community needs and communicating identified needs to public health, health care, and social service agencies. (II) Provision of outreach and education regarding health insurance, and other health and social service systems. (III) Provision of education, assessment of needs, and social support through home visiting. (IV) Provision of case management (as defined in section 1915(g)(2)) and linkage to resources to alleviate financial strain, including food, housing, child services, technology, educational services, employment services, and other services. (V) Identification of underserved populations and referring them to appropriate health care agencies and community-based programs and organizations in order to increase access to quality health and social services and to streamline care, including serving as a liaison between individuals and communities and health and social service organizations. (C) Applicable provider For purposes of subparagraphs (A)(ii) and (B)(i)(III), the term applicable provider means— (i) a physician (as defined in section 1861(r)); (ii) a physician assistant, a nurse practitioner; and a clinical nurse specialist (as such terms are defined in section 1861(aa)(5)); and (iii) any other practitioner described in section 1842(b)(18)(C) that the Secretary determines appropriate. (2) Community health agency The term community health agency means an entity, including a community-based organization, a nonprofit organization, an urban Indian organization, a community health worker network, a Federally qualified health center, a rural health clinic, a local or State public health department, an academic institution, a health care provider, and any other organization deemed appropriate by the Secretary, that meets requirements established by the Secretary, which may include the following requirements: (A) The entity provides for the employment of health workers who share lived experiences with the community served and minimize barriers to employment, including formal educational requirements. (B) The entity provides for market wage compensation and professional development and career advancement opportunities for health workers, as well as training on core competencies. (C) The entity has established work practices and manageable caseloads that allow health workers to provide tailored, holistic, person-centered support. (D) The entity ensures— (i) the safety of health workers, in accordance with applicable fair labor laws; (ii) the supervision, coaching, and evaluation of health workers, through the use of evidence-informed process and outcome indicators developed in consultation with community health workers, promotoras, and community health representatives (as such terms are defined in section 1903(cc)(4)); and (iii) leadership and engagement of health workers in organization- and program-level decision making, including decision making related to the improvement of processes and outcomes.. (3) Amount of payment Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395 l (a)(1)) is amended— (A) by striking and before (HH); and (B) by inserting before the semicolon:, and (II) with respect to community health services under section 1861(s)(2)(KK), the amounts paid shall be 100 percent of the lesser of the actual charge for the services or the amount determined under a fee schedule established by the Secretary for such services. (4) Waiver of application of deductible The first sentence of section 1833(b) of the Social Security Act (42 U.S.C. 1395l(b)) is amended— (A) by striking, and (13) and inserting (13); and (B) by striking 1861(n).. and inserting 1861(n), and (14) such deductible shall not apply with respect to community health services (as defined in section 1861(nnn)(1))..