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HR 10331

Patient Navigation Assistance Act

119th Congress Introduced by Mark DeSaulnier

Authorizes Medicaid reimbursement for patient navigator services and sets standards for who can provide them and how they are trained.

Introduced in House
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WeVote Research Nonpartisan
Bill Summary · HR 10331

Overview

  • Bill: HR 10331, the Patient Navigation Assistance Act
  • Session: 119th Congress, 2nd Session
  • Introduced: September 10, 2026 by Rep. Mark DeSaulnier
  • Purpose: To authorize and fund Medicaid reimbursement for patient navigator services under Title XIX of the Social Security Act, and to define key terms and requirements for eligible entities and patient navigators.

The main purpose and intent

  • Establish Medicaid coverage and reimbursement for patient navigator services.
  • Ensure that patient navigators assist low-income individuals eligible for medical assistance by providing education, referrals, and help in obtaining health, social, and logistical resources.
  • Create a defined framework for who can provide these services, what constitutes a patient navigator, and how services are funded and delivered.

Key provisions and changes

  1. Medicaid coverage expansion (Section 2, general amendments to Section 1902(a))

    • Adds new paragraph (91) to require that states reimburse an eligible entity for patient navigator services provided to individuals eligible for medical assistance, when such services are delivered by a patient navigator through the eligible entity.
    • Establishes criteria for what counts as an eligible entity and ensures Medicaid payment aligns with those criteria.

  2. Definitions and requirements for patient navigator services (new subsection 1902(zz))

    • Eligible entity:
      • Must be an eligible entity under 340A(l)(1) of the Public Health Service Act and meet grant-related requirements (b, c, e, j(3)).
    • Patient navigator:
      • An individual employed by a health care or community-based organization.
      • Provides individualized education and resources to facilitate informed decision-making and timely access to quality health and psychosocial care.
      • Must have education, licensure, or certification, with at least one of the following:
      • A bachelor’s degree in nursing, a master’s in social work, or a bachelor’s in a health-related field; OR
      • Licensure/certification as a registered nurse, social worker, or clinical practitioner (as applicable) and relevant scope-of-practice requirements.
      • Completion of competency-based navigation training, or a Secretary-approved training program under 340A(l)(3) of the Public Health Service Act.
      • Transitional training exception: If the individual completes a Secretary-approved training program (subparagraph IV of (A)(ii)), that training will not count toward the education/licensure requirement for up to 3 years after provisions apply, creating a transition period.
    • Patient navigator services:
      • Broadly defined as services provided by a patient navigator, including:
      • Referrals and activities to help obtain needed services (medical, social, financial, logistical, etc.).
      • Services described in paragraphs (1)-(6) of subsection (b) of section 340A of the Public Health Service Act (which detail duties, standards, and activities for patient navigators and community knowledge).
      • Other services as determined by the Secretary.

  3. Medically-aligned treatment (FMAP) (Section 2(b))

    • Adds a new paragraph (32) to Section 1905(a) to treat patient navigator services as medical assistance for purposes of the Federal Medical Assistance Percentage (FMAP) when they meet the requirements in 1902(a)(91).
    • Aligns funding and eligibility under the standard rules for Medicaid medical assistance.

  4. Effective date and state implementation (Section 2(c))

    • Effective date applies to patient navigator services provided after the first day of the first calendar year beginning after enactment.
    • Provides a transitional relief: if a state plan under Title XIX requires state legislation to meet amendments, the state plan will not be deemed noncompliant solely due to not meeting the new requirement before the start of the first regular session after enactment.
    • States with 2-year legislative sessions: each year of the session counts as a separate regular session for the purposes of this transition.

Who would be affected

  • Medicaid beneficiaries eligible for medical assistance under state plans.
  • Eligible entities capable of employing or administering patient navigators (as defined, and meeting 340A-related eligibility).
  • Patient navigators themselves (professionally qualified, with specified education, licensure, or training).
  • State Medicaid programs (through FMAP and reimbursement changes).

Procedural and timeline aspects

  • Effective date: For patient navigator services, beginning the first calendar year after enactment (subject to the transition rules for state legislation).
  • State plan flexibility: States needing new legislation to comply have a transition window and are not penalized for delays to the first regular session after enactment.
  • Implementation relies on Secretary-approved training programs under Public Health Service Act provisions and alignment with 340A requirements for eligible entities and navigator duties.

Potential impact

  • Increases access to navigational support for Medicaid enrollees, potentially improving timely access to care and coordination of medical, social, and financial services.
  • Creates a standardized framework for who can provide navigator services and how they must be trained or credentialed.
  • Introduces funding pathways via Medicaid reimbursement, incentivizing entities to establish or expand navigator programs.
  • May require state legislative or regulatory adjustments to align plans with the new requirements during the transition period.

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

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