42 U.S.C. § 256a — Patient navigator grants

Page 432 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 256a and provisions set out as a note under section 1396a of this title] is to provide assistance to communities and consortia of health care providers and others, to de- velop or strengthen integrated community health care delivery systems that coordinate health care services for individuals who are uninsured or underinsured and to develop or strengthen activities related to providing coordinated care for individuals with chronic condi- tions who are uninsured or underinsured, through the— ‘‘(1) coordination of services to allow individuals to receive efficient and higher quality care and to gain entry into and receive services from a comprehensive system of care; ‘‘(2) development of the infrastructure for a health care delivery system characterized by effective col- laboration, information sharing, and clinical and fi- nancial coordination among all providers of care in the community; and ‘‘(3) provision of new Federal resources that do not supplant funding for existing Federal categorical pro- grams that support entities providing services to low- income populations.’’ § 256a. Patient navigator grants (a) Grants The Secretary, acting through the Adminis- trator of the Health Resources and Services Ad- ministration, may make grants to eligible enti- ties for the development and operation of dem- onstration programs to provide patient navi- gator services to improve health care outcomes. The Secretary shall coordinate with, and ensure the participation of, the Indian Health Service, the National Cancer Institute, the Office of Rural Health Policy, and such other offices and agencies as deemed appropriate by the Sec- retary, regarding the design and evaluation of the demonstration programs. (b) Use of funds The Secretary shall require each recipient of a grant under this section to use the grant to re- cruit, assign, train, and employ patient naviga- tors who have direct knowledge of the commu- nities they serve to facilitate the care of indi- viduals, including by performing each of the fol- lowing duties: (1) Acting as contacts, including by assisting in the coordination of health care services and provider referrals, for individuals who are seeking prevention or early detection services for, or who following a screening or early de- tection service are found to have a symptom, abnormal finding, or diagnosis of, cancer or other chronic disease. (2) Facilitating the involvement of commu- nity organizations in assisting individuals who are at risk for or who have cancer or other chronic diseases to receive better access to high-quality health care services (such as by creating partnerships with patient advocacy groups, charities, health care centers, commu- nity hospice centers, other health care pro- viders, or other organizations in the targeted community). (3) Notifying individuals of clinical trials and, on request, facilitating enrollment of eli- gible individuals in these trials. (4) Anticipating, identifying, and helping pa- tients to overcome barriers within the health care system to ensure prompt diagnostic and treatment resolution of an abnormal finding of cancer or other chronic disease. (5) Coordinating with the relevant health in- surance ombudsman programs to provide in- formation to individuals who are at risk for or who have cancer or other chronic diseases about health coverage, including private in- surance, health care savings accounts, and other publicly funded programs (such as Medi- care, Medicaid, health programs operated by the Department of Veterans Affairs or the De- partment of Defense, the State children’s health insurance program, and any private or governmental prescription assistance pro- grams). (6) Conducting ongoing outreach to health disparity populations, including the unin- sured, rural populations, and other medically underserved populations, in addition to assist- ing other individuals who are at risk for or who have cancer or other chronic diseases to seek preventative care. (c) Prohibitions (1) Referral fees The Secretary shall require each recipient of a grant under this section to prohibit any pa- tient navigator providing services under the grant from accepting any referral fee, kick- back, or other thing of value in return for re- ferring an individual to a particular health care provider. (2) Legal fees and costs The Secretary shall prohibit the use of any grant funds received under this section to pay any fees or costs resulting from any litigation, arbitration, mediation, or other proceeding to resolve a legal dispute. (d) Grant period (1) In general Subject to paragraphs (2) and (3), the Sec- retary may award grants under this section for periods of not more than 3 years. (2) Extensions Subject to paragraph (3), the Secretary may extend the period of a grant under this sec- tion. Each such extension shall be for a period of not more than 1 year. (3) Limitations on grant period In carrying out this section, the Secretary shall ensure that the total period of a grant does not exceed 4 years. (e) Application (1) In general To seek a grant under this section, an eligi- ble entity shall submit an application to the Secretary in such form, in such manner, and containing such information as the Secretary may require. (2) Contents At a minimum, the Secretary shall require each such application to outline how the eligi- ble entity will establish baseline measures and benchmarks that meet the Secretary’s re- quirements to evaluate program outcomes. (3) Minimum core proficiencies The Secretary shall not award a grant to an entity under this section unless such entity Page 433 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 256a provides assurances that patient navigators recruited, assigned, trained, or employed using grant funds meet minimum core proficiencies, as defined by the entity that submits the ap- plication, that are tailored for the main focus or intervention of the navigator involved. (f) Uniform baseline measures The Secretary shall establish uniform baseline measures in order to properly evaluate the im- pact of the demonstration projects under this section. (g) Preference In making grants under this section, the Sec- retary shall give preference to eligible entities that demonstrate in their applications plans to utilize patient navigator services to overcome significant barriers in order to improve health care outcomes in their respective communities. (h) Duplication of services An eligible entity that is receiving Federal funds for activities described in subsection (b) on the date on which the entity submits an ap- plication under subsection (e) may not receive a grant under this section unless the entity can demonstrate that amounts received under the grant will be utilized to expand services or pro- vide new services to individuals who would not otherwise be served. (i) Coordination with other programs The Secretary shall ensure coordination of the demonstration grant program under this section with existing authorized programs in order to facilitate access to high-quality health care services. (j) Study; reports (1) Final report by Secretary Not later than 6 months after the comple- tion of the demonstration grant program under this section, the Secretary shall con- duct a study of the results of the program and submit to the Congress a report on such re- sults that includes the following: (A) An evaluation of the program out- comes, including— (i) quantitative analysis of baseline and benchmark measures; and (ii) aggregate information about the pa- tients served and program activities. (B) Recommendations on whether patient navigator programs could be used to im- prove patient outcomes in other public health areas. (2) Interim reports by Secretary The Secretary may provide interim reports to the Congress on the demonstration grant program under this section at such intervals as the Secretary determines to be appropriate. (3) Reports by grantees The Secretary may require grant recipients under this section to submit interim and final reports on grant program outcomes. (k) Rule of construction This section shall not be construed to author- ize funding for the delivery of health care serv- ices (other than the patient navigator duties listed in subsection (b)). (l) Definitions In this section: (1) The term ‘‘eligible entity’’ means a pub- lic or nonprofit private health center (includ- ing a Federally qualified health center (as that term is defined in section 1395x(aa)(4) of this title)), a health facility operated by or pursuant to a contract with the Indian Health Service, a hospital, a cancer center, a rural health clinic, an academic health center, or a nonprofit entity that enters into a partnership or coordinates referrals with such a center, clinic, facility, or hospital to provide patient navigator services. (2) The term ‘‘health disparity population’’ means a population that, as determined by the Secretary, has a significant disparity in the overall rate of disease incidence, prevalence, morbidity, mortality, or survival rates as compared to the health status of the general population. (3) The term ‘‘patient navigator’’ means an individual who has completed a training pro- gram approved by the Secretary to perform the duties listed in subsection (b). (m) Authorization of appropriations (1) In general To carry out this section, there are author- ized to be appropriated $2,000,000 for fiscal year 2006, $5,000,000 for fiscal year 2007, $8,000,000 for fiscal year 2008, $6,500,000 for fiscal year 2009, $3,500,000 for fiscal year 2010, and such sums as may be necessary for each of fiscal years 2011 through 2015. (2) Availability The amounts appropriated pursuant to para- graph (1) shall remain available for obligation through the end of fiscal year 2015. (July 1, 1944, ch. 373, title III, § 340A, as added Pub. L. 109–18, § 2, June 29, 2005, 119 Stat. 340; amended Pub. L. 111–148, title III, § 3510, Mar. 23, 2010, 124 Stat. 537.) Editorial Notes PRIOR PROVISIONS A prior section 256a, act July 1, 1944, ch. 373, title III, § 340A, as added Nov. 6, 1990, Pub. L. 101–527, § 3, 104 Stat. 2314; amended Oct. 27, 1992, Pub. L. 102–531, title III, § 309(d), 106 Stat. 3502, related to health services for residents of public housing, prior to repeal by Pub. L. 104–299, §§ 4(a)(3), 5, Oct. 11, 1996, 110 Stat. 3645, effective Oct. 1, 1996. Another prior section 256a, act July 1, 1944, ch. 373, title III, § 340A, as added Nov. 10, 1978, Pub. L. 95–626, title I, § 106(a), 92 Stat. 3560, related to technical assist- ance demonstration grants and contracts, prior to re- peal by Pub. L. 100–77, title VI, § 601, July 22, 1987, 101 Stat. 511. AMENDMENTS 2010—Subsec. (d)(3). Pub. L. 111–148, § 3510(1), added par. (3) and struck out former par. (3). Prior to amend- ment, text read as follows: ‘‘In carrying out this sec- tion, the Secretary— ‘‘(A) shall ensure that the total period of a grant does not exceed 4 years; and ‘‘(B) may not authorize any grant period ending after September 30, 2010.’’ Subsec. (e)(3). Pub. L. 111–148, § 3510(2), added par. (3). Subsec. (m)(1). Pub. L. 111–148, § 3510(3)(A), sub- stituted ‘‘$3,500,000 for fiscal year 2010, and such sums Page 434 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 256a–1 as may be necessary for each of fiscal years 2011 through 2015’’ for ‘‘and $3,500,000 for fiscal year 2010’’. Subsec. (m)(2). Pub. L. 111–148, § 3510(3)(B), substituted ‘‘2015’’ for ‘‘2010’’. § 256a–1. Establishing community health teams to support the patient-centered medical home (a) In general The Secretary of Health and Human Services (referred to in this section as the ‘‘Secretary’’) shall establish a program to provide grants to or enter into contracts with eligible entities to es- tablish community-based interdisciplinary, interprofessional teams (referred to in this sec- tion as ‘‘health teams’’) to support primary care practices, including obstetrics and gynecology practices, within the hospital service areas served by the eligible entities. Grants or con- tracts shall be used to— (1) establish health teams to provide support services to primary care providers; and (2) provide capitated payments to primary care providers as determined by the Secretary. (b) Eligible entities To be eligible to receive a grant or contract under subsection (a), an entity shall— (1)(A) be a State or State-designated entity; or (B) be an Indian tribe or tribal organization, as defined in section 1603 of title 25; (2) submit a plan for achieving long-term fi- nancial sustainability within 3 years; (3) submit a plan for incorporating preven- tion initiatives and patient education and care management resources into the delivery of health care that is integrated with commu- nity-based prevention and treatment re- sources, where available; (4) ensure that the health team established by the entity includes an interdisciplinary, interprofessional team of health care pro- viders, as determined by the Secretary; such team may include medical specialists, nurses, pharmacists, nutritionists, dieticians, social workers, behavioral and mental health pro- viders (including substance use disorder pre- vention and treatment providers), doctors of chiropractic, licensed complementary and al- ternative medicine practitioners, and physi- cians’ assistants; (5) agree to provide services to eligible indi- viduals with chronic conditions, as described in section 1396w–4 of this title (as added by section 2703), in accordance with the payment methodology established under subsection (c) of such section; and (6) submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may re- quire. (c) Requirements for health teams A health team established pursuant to a grant or contract under subsection (a) shall— (1) establish contractual agreements with primary care providers to provide support services; (2) support patient-centered medical homes, defined as a mode of care that includes— (A) personal physicians or other primary care providers; (B) whole person orientation; (C) coordinated and integrated care; (D) safe and high-quality care through evi- dence-informed medicine, appropriate use of health information technology, and contin- uous quality improvements; (E) expanded access to care; and (F) payment that recognizes added value from additional components of patient-cen- tered care; (3) collaborate with local primary care pro- viders and existing State and community based resources to coordinate disease preven- tion, chronic disease management, transitioning between health care providers and settings and case management for pa- tients, including children, with priority given to those amenable to prevention and with chronic diseases or conditions identified by the Secretary; (4) in collaboration with local health care providers, develop and implement inter- disciplinary, interprofessional care plans that integrate clinical and community preventive and health promotion services for patients, in- cluding children, with a priority given to those amenable to prevention and with chron- ic diseases or conditions identified by the Sec- retary; (5) incorporate health care providers, pa- tients, caregivers, and authorized representa- tives in program design and oversight; (6) provide support necessary for local pri- mary care providers to— (A) coordinate and provide access to high- quality health care services; (B) coordinate and provide access to pre- ventive and health promotion services; (C) provide access to appropriate specialty care and inpatient services; (D) provide quality-driven, cost-effective, culturally appropriate, and patient- and family-centered health care; (E) provide access to pharmacist-delivered medication management services, including medication reconciliation; (F) provide coordination of the appropriate use of complementary and alternative (CAM) services to those who request such services; (G) promote effective strategies for treat- ment planning, monitoring health outcomes and resource use, sharing information, treat- ment decision support, and organizing care to avoid duplication of service and other medical management approaches intended to improve quality and value of health care services; (H) provide local access to the continuum of health care services in the most appro- priate setting, including access to individ- uals that implement the care plans of pa- tients and coordinate care, such as integra- tive health care practitioners; (I) collect and report data that permits evaluation of the success of the collabo- rative effort on patient outcomes, including collection of data on patient experience of care, and identification of areas for improve- ment; and (J) establish a coordinated system of early identification and referral for children at