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H 1173

An Act to facilitate timely access to quality health care by expanding access to patient navigation

194th Legislature (2025-2026) Introduced by Jim Arciero and 20 co-sponsors

Expands coverage and reimbursement for patient navigation by trained community health workers to speed screening, follow-up, and treatment, boosting access and reducing barriers.

Accompanied a new draft, see H4939
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Bill Summary · H 1173

Summary of H 1173: An Act to facilitate timely access to quality health care by expanding access to patient navigation

Purpose and intent

  • The bill aims to improve timely access to quality health care by expanding the use of patient navigation services, delivered through trained community health workers, to assist individuals in navigating screening, follow-up, and treatment services.
  • It seeks to establish a formal coverage and reimbursement framework for patient navigation within the Commonwealth’s health care system, with an emphasis on addressing barriers to care and social determinants of health.

Key provisions

Creation and definition (Section 10R added to Chapter 118E)

  • Defines “community health worker” as a frontline health worker who acts as a liaison among patients, health-care providers, social service providers, and community members to facilitate access to health-related services, including physical, behavioral, preventive health services, and services addressing social determinants of health.
  • Defines “patient navigation services” as services provided by community health workers, including:
    1. Prevention/screening for chronic diseases and interventions to slow disease progression.
    2. Screening for nonclinical and social needs with referrals to appropriate services.
    3. Education to prevent illness, including promotion of healthy behaviors.
    4. Health coaching, navigation, advocacy, and individual supports (including transitions of care).
    5. Addressing cultural barriers (language, socioeconomic status, health literacy) to understand treatment options/plans.
    6. Diagnosis-related patient education for treatment/self-management.
    7. Any other service approved by the division.

Coverage and access (broad coverage mandate)

  • The Division of Medical Security/related agencies and their contracted insurers, health plans, health maintenance organizations, behavioral health management firms, and third-party administrators under Medicaid/primary care plans must provide coverage for patient navigation services as defined to improve access for individuals eligible for screening, follow-up, or treatment.

Reimbursement

  • Reimburses individuals who are trained and have completed a national patient navigation certification or credentialing program (or other approved certification/training program).

Federal and regulatory implementation

  • The Executive Office of Health and Human Services must seek any necessary federal authorization to implement the section and maximize federal financial participation (FFP) for the coverage and benefits.
  • The Office of Medicaid shall promulgate regulations or other guidance to effectuate the section.

Effective date

  • The measure applies to all contracts entered into, renewed, or amended on or after January 1, 2026.

Who is affected

  • Patients eligible for screening, follow-up, or treatment services who would access patient navigation.
  • Community health workers and individuals seeking certification in patient navigation.
  • State agencies and contractors involved in Medicaid managed care, primary care clinician plans, HMOs, health insurers, and related managed care/behavioral health organizations.
  • Providers and health systems partnering with Medicaid and contracted plans to deliver navigation services.

Procedural and timeline aspects

  • Introduced: February 27, 2025.
  • Referred to: House Committee on Financial Services (February 27, 2025).
  • Senate concurrence noted; related action ongoing.
  • Hearing scheduled: October 8, 2025, from 10:30 AM to 2:30 PM in Gardner Auditorium.
  • Related bill: HD 1895 (replaces the measure).

Potential impact (summary)

  • Expands access to care by covering comprehensive patient navigation services, potentially reducing delays in screening, follow-up, and treatment.
  • Promotes use of trained community health workers to address medical and social needs, health literacy, language barriers, and cultural factors.
  • Requires regulatory alignment and federal participation to optimize funding opportunities.
  • Creates a defined path for reimbursement, encouraging workforce development in patient navigation.

Note: Details beyond the bill text (e.g., precise cost estimates or anticipated savings) are not provided in the summary.

Compiled from official sources — confirm details with the bill’s official record.

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