Attachment D - Patient Navigator Act of 2005

H. R. 1812

One Hundred Ninth Congress
of the
United States of America
AT THE FIRST SESSION
Begun and held at the City of Washington on Tuesday,
the fourth day of January, two thousand and five

An Act
To amend the Public Health Service Act to authorize a demonstration grant program
to provide patient navigator services to reduce barriers and improve health care
outcomes, 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 ‘‘Patient Navigator Outreach
and Chronic Disease Prevention Act of 2005’’.
SEC. 2. PATIENT NAVIGATOR GRANTS.

Subpart V of part D of title III of the Public Health Service
Act (42 U.S.C. 256) is amended by adding at the end the following:

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‘‘SEC. 340A. PATIENT NAVIGATOR GRANTS.

‘‘(a) GRANTS.—The Secretary, acting through the Administrator
of the Health Resources and Services Administration, may make
grants to eligible entities for the development and operation of
demonstration programs to provide patient navigator 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 Secretary, 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 recruit, assign,
train, and employ patient navigators who have direct knowledge
of the communities they serve to facilitate the care of individuals,
including by performing each of the following 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 detection service
are found to have a symptom, abnormal finding, or diagnosis
of, cancer or other chronic disease.
‘‘(2) Facilitating the involvement of community 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, community hospice centers, other health care providers,
or other organizations in the targeted community).
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H. R. 1812—2
‘‘(3) Notifying individuals of clinical trials and, on request,
facilitating enrollment of eligible individuals in these trials.
‘‘(4) Anticipating, identifying, and helping patients 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 insurance
ombudsman programs to provide information to individuals
who are at risk for or who have cancer or other chronic diseases
about health coverage, including private insurance, health care
savings accounts, and other publicly funded programs (such
as Medicare, Medicaid, health programs operated by the
Department of Veterans Affairs or the Department of Defense,
the State children’s health insurance program, and any private
or governmental prescription assistance programs).
‘‘(6) Conducting ongoing outreach to health disparity populations, including the uninsured, rural populations, and other
medically underserved populations, in addition to assisting
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 patient
navigator providing services under the grant from accepting
any referral fee, kickback, or other thing of value in return
for referring 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
Secretary 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 section. 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—
‘‘(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.
‘‘(e) APPLICATION.—
‘‘(1) IN GENERAL.—To seek a grant under this section, an
eligible 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 eligible entity will
establish baseline measures and benchmarks that meet the
Secretary’s requirements to evaluate program outcomes.
‘‘(f) UNIFORM BASELINE MEASURES.—The Secretary shall establish uniform baseline measures in order to properly evaluate the
impact of the demonstration projects under this section.
‘‘(g) PREFERENCE.—In making grants under this section, the
Secretary shall give preference to eligible entities that demonstrate
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H. R. 1812—3
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 application 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 provide 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 completion of the demonstration grant program under
this section, the Secretary shall conduct a study of the results
of the program and submit to the Congress a report on such
results that includes the following:
‘‘(A) An evaluation of the program outcomes,
including—
‘‘(i) quantitative analysis of baseline and benchmark measures; and
‘‘(ii) aggregate information about the patients
served and program activities.
‘‘(B) Recommendations on whether patient navigator
programs could be used to improve 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 authorize funding for the delivery of health care services
(other than the patient navigator duties listed in subsection (b)).
‘‘(l) DEFINITIONS.—In this section:
‘‘(1) The term ‘eligible entity’ means a public or nonprofit
private health center (including a Federally qualified health
center (as that term is defined in section 1861(aa)(4) of the
Social Security Act)), 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 program approved by the Secretary
to perform the duties listed in subsection (b).
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‘‘(m) AUTHORIZATION OF APPROPRIATIONS.—
‘‘(1) IN GENERAL.—To carry out this section, there are
authorized 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, and $3,500,000 for fiscal year
2010.
‘‘(2) AVAILABILITY.—The amounts appropriated pursuant to
paragraph (1) shall remain available for obligation through
the end of fiscal year 2010.’’.

Speaker of the House of Representatives.

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Vice President of the United States and
President of the Senate.

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