Sec. 101. Street medicine pilot program
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/bill/118/hr/5387/ih/section-101A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
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. 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.
In order to participate in the Program, a provider must— be an eligible provider (as defined in subsection (e)(3)); be enrolled— under section 1886(j) of the Social Security Act ( 42 U.S.C. 1395cc(j) ); or 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. ); be affiliated with a hospital, university, non-profit organization, city government, county government, state government, or private health care practice; use a qualified electronic health record to document interactions with, and medical services furnished to, covered individuals under the Program; maintain medical malpractice insurance in the State in which such provider is furnishing medical services under the Program; and in the case of a provider prescribing opioid medication, meet the requirement described in subparagraph (B).
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. 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. 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— the name and date of birth of such individual; whether the covered individual has, or has history of, a substance use disorder; the length of time such individual has been homeless, and factors contributing to such individual’s lack of permanent housing; whether an individual is under the care of a medical provider other than a street medicine team or provider; the contact information, and billing information for such provider; the credentials of such provider; and any other information as determined by the Secretary.
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. Nothing in this section shall be construed as requiring a provider to document, with respect to a covered individual— the permanent address of such individual; the address of the facility where medical services were furnished to such individual; or the name of contact information of a provider referring such individual to the program.
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. 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. 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. 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. ).
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. Unsheltered homeless individuals may obtain services from any qualified street medicine provider, as defined in this Act, for purposes of the Program. 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. Prior authorization shall not be required for purposes of an individual receiving care from a street medicine provider. 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. 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 rules to guarantee a clear and accessible process for making such referrals. 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. If a patient is a Medicaid or Medicare beneficiary, MCPs must ensure that, they meet the following requirements: 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; provides female patients with direct access to women’s routine and preventive health care services; arranges for patients to receive a second opinion, should the patient elect, at no cost to the patient; and 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. The Secretary has the authority to allocate existing funds for the Program. In this Act: The term covered individual means an unsheltered homeless individual over the age of zero who resides in an eligible city or county. 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. 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. The term eligible provider includes— a physician (as defined in section 1861(r) of the Social Security Act ( 42 U.S.C. 1395(aa)(5)(A) ); 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) ); a behavioral health therapist; a supplier (as defined in section 1861(d) of the Social Security Act ( 42 U.S.C. 1395(d) ); a psychologist (as defined in section 799B(11) of the Public Health Service Act ( 42 U.S.C. 295p(11) ); a physical therapist; occupational therapist; an emergency medical technician responding to a call or case in which health care is administered to an unhoused homeless individual; or any provider as determined by the Secretary. 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) ). 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) ). 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) ). 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. The consumption of schedule I drugs, fentanyl, cocaine, and methamphetamine under the supervision of health care professionals.
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Sec. 101
Street medicine pilot program
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