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Bill H.1173
SECTION 2. Chapter 118E of the General Laws is hereby amended by inserting after section 10N, the following section:-
Section 10R. (a) As used in this section, the following words shall have the following meanings:
“Community health worker” means a frontline health worker who Serves as a liaison between patients, health-care providers, social service providers and community members to facilitate access to health-related services in the community the health worker serves, including access to physical, behavioral, and preventive health services or access to services to address social determinants of health.
“Patient navigation services” means the following services furnished by a community health worker to patients in their communities:
1. Services to prevent or screen for chronic diseases (such as cancer) and services designed to slow the progression of chronic diseases.
2. Screenings for nonclinical and social needs and referrals to appropriate services and agencies to meet those needs.
3. Group and individual education to prevent illness or disease, including the promotion of healthy behaviors to increase awareness and prevent the development of illness or disease.
4. Health coaching, health navigation, health advocacy, and individual supports, including transitions of care supports.
5. Overcoming cultural factors, such as language, socioeconomic status, or health literacy, to properly understand treatment options or treatment plans.
6. Diagnosis-related patient education with respect to treatment and self-management of a health condition or illness, including helping patients learn to effectively comply with medical care instructions.
7. Any other service approved by the division.
(b) The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization or primary care clinician plan shall provide coverage for patient navigation service as defined in this section to improve access to care for individuals who are eligible for screening, follow-up or treatment services.
(c) Reimbursement shall be provided to individuals who are trained and have completed a national patient navigation certification or credentialing program, or other certification or training program approved by the Executive Office of Health and Human Services.
(d) The executive office of health and human services shall obtain any federal authorization necessary to implement this section and maximize federal financial participation for the coverage and benefits provided under this section.
(e) The office of Medicaid shall promulgate regulations or other guidance necessary to effectuate this section.
(f) This act shall apply to all contracts entered into, renewed or amended on or after January 1, 2026.
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