Bill Details
S.721 - 119th Congress
Status
Latest action
2025-02-25 - Read twice and referred to the Committee on Finance.
Introduced Date
2025-02-25
Policy Area
Health
Committees
View committees (1)
Sponsors
Cosponsors
5
0
0
AI Summary This summary was generated by AI from the bill text. AI can get information wrong.
This bill would let state Medicaid programs create special “health home” care programs for people with sickle cell disease, starting in 2026. These programs are meant to give better outpatient care and help patients get more coordinated treatment. The bill also says that states using this option must include dental and vision care, and it requires states to report on how well the program works. The federal government would also have to share guidance on how states can set up these programs.
- Starting January 1, 2026, states could ask for approval to run a Medicaid health home program focused mainly on people with sickle cell disease.
- States with an approved program would have to provide dental and vision services to enrolled patients, even if those services are not normally covered for all Medicaid members in that state.
- After the first eight fiscal quarters of the program, states would need to report on patient care quality, access to care, and total health care costs for people in the program.
- By June 30, 2026, the Centers for Medicare & Medicaid Services would have to post best practices for building and running these programs, using medical guidelines and input from doctors, providers, and patient groups.
Official Summaries
Sickle Cell Disease Comprehensive Care Act
This bill allows state Medicaid programs to establish health homes to provide coordinated care for individuals with sickle-cell disease. (Under current law, state Medicaid programs may establish health homes to provide coordinated care for individuals with specified chronic conditions.) States must ensure that such care includes dental and vision services.
The Centers for Medicare & Medicaid Services must issue best practices for states on how to design and implement such health homes.
Current Full Text
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 721 Introduced in Senate (IS)]
<DOC>
119th CONGRESS
1st Session
S. 721
To amend title XIX of the Social Security Act to establish a
demonstration project to improve outpatient clinical care for
individuals with sickle cell disease.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
February 25, 2025
Mr. Booker (for himself and Mr. Scott of South Carolina) introduced the
following bill; which was read twice and referred to the Committee on
Finance
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to establish a
demonstration project to improve outpatient clinical care for
individuals with sickle cell disease.
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 ``Sickle Cell Disease Comprehensive
Care Act''.
SEC. 2. ENABLING STATE MEDICAID PROGRAMS TO PROVIDE CARE THROUGH HEALTH
HOMES TO INDIVIDUALS WITH SICKLE CELL DISEASE.
Section 1945 of the Social Security Act (42 U.S.C. 1396w-4) is
amended--
(1) in subsection (a), by inserting ``(and, beginning
January 1, 2026, to eligible individuals with sickle cell
disease (as defined in subsection (c)(5)))'' after ``chronic
conditions'';
(2) in subsection (c)--
(A) in paragraph (1), by inserting ``and each
eligible individual with sickle cell disease'' after
``chronic conditions''; and
(B) by adding at the end the following new
paragraph:
``(5) Special rule relating to sickle cell disease health
homes.--
``(A) In general.--Beginning January 1, 2026, the
Secretary may approve a State plan amendment under this
section that is designed to provide health home
services primarily to eligible individuals with sickle
cell disease (in this section referred to as a `sickle
cell disease-focused State plan amendment').
``(B) Requirement to provide dental and vision
services.--In the case of a sickle cell disease-focused
State plan amendment approved by the Secretary on or
after January 1, 2026, a State shall ensure the
provision of dental and vision services to eligible
individuals with sickle cell disease who are enrolled
in such health home. Such requirement shall apply
irrespective of existing requirements related to
comparability or whether or not the State provides
dental or vision services to other Medicaid
beneficiaries.
``(C) Report requirements.--
``(i) In general.--In the case of a State
with a sickle cell disease-focused State plan
amendment, such State shall, at the end of the
first 8 fiscal year quarters that such State
plan amendment is in effect, submit to the
Secretary a report on the following, with
respect to eligible individuals with sickle
cell disease provided health home services
under such State plan amendment:
``(I) The quality of health care
provided to such individuals, with a
focus on outcomes relevant to the
recovery of each such individual.
``(II) The access of such
individuals to health care.
``(III) The total expenditures of
such individuals for health care.
``(ii) Applicable measures.--For purposes
of the report required under this subparagraph,
the Secretary shall specify all applicable
measures for determining quality of health care
provided to eligible individuals with sickle
cell disease, access to health care by such
individuals, and expenditures on health care by
such individuals.
``(D) Best practices.--Not later than June 30,
2026, the Secretary shall make publicly available on
the website of the Centers for Medicare & Medicaid
Services best practices for designing and implementing
a sickle cell disease-focused State plan amendment,
based on clinical practice guidelines for sickle cell
disease developed by medical specialty societies and in
consultation with sickle cell disease providers and
patient advocacy organizations.
``(E) Definitions.--For purposes of this section:
``(i) Eligible individual with sickle cell
disease.--The term `eligible individual with
sickle cell disease' means, with respect to a
State, an individual who satisfies all of the
following:
``(I) The individual is eligible
for medical assistance under the State
plan or under a waiver of such plan.
``(II) The individual has sickle
cell disease.
``(III) The individual may or may
not have previously received health
home services under any other State
plan amendment approved for the State
under this section by the Secretary.
``(ii) Sickle cell disease.--The term
`sickle cell disease' means an inherited blood
disorder affecting red blood cells that occurs
when an individual has inherited a sickle cell
gene from each parent, as identified by a
newborn screening or other genetic test.''; and
(3) in subsection (h)(5), by inserting ``or a health home
for eligible individuals with sickle cell disease'' after
``chronic conditions''.
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