[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1860 Introduced in House (IH)]







106th CONGRESS
  1st Session
                                H. R. 1860

  To require managed care organizations to contract with providers in 
          medically underserved areas, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 19, 1999

Mrs. Christensen (for herself, Mrs. Jones of Ohio, Mr. Rush, Ms. Eddie 
   Bernice Johnson of Texas, Mr. Clyburn, Mr. Wynn, Mr. Thompson of 
 Mississippi, Ms. Kilpatrick, Mrs. Meek of Florida, Mr. Menendez, Mrs. 
    Clayton, Ms. Carson, Ms. Millender-McDonald, Mr. Watt of North 
Carolina, Mr. Jefferson, Ms. Lee, Mr. Bishop, Mr. Owens, Mr. Hilliard, 
 Mr. Payne, Mr. Davis of Illinois, Ms. Norton, Mr. Meeks of New York, 
  Ms. Brown of Florida, Mr. Scott, Mr. Fattah, Mr. Clay, Mr. Lewis of 
Georgia, Ms. Jackson-Lee of Texas, Mr. Towns, Mr. Cummings, Ms. Waters, 
  Ms. McKinney, Mr. Dixon, Mr. Conyers, Mr. Hastings of Florida, Mr. 
Jackson of Illinois, Mr. Ford, and Mr. Rangel) introduced the following 
bill; which was referred to the Committee on Commerce, and in addition 
 to the Committees on Education and the Workforce, and Ways and Means, 
for a period to be subsequently determined by the Speaker, in each case 
for consideration of such provisions as fall within the jurisdiction of 
                        the committee concerned

_______________________________________________________________________

                                 A BILL


 
  To require managed care organizations to contract with providers in 
          medically underserved areas, 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; FINDINGS.

    (a) Short Title.--This Act may be cited as the ``Medically 
Underserved Access to Care Act of 1999''.
    (b) Findings.--Congress finds the following:
            (1) Minority individuals living in medically underserved 
        areas are generally less well-off socioeconomically, and are 
        often sicker than the population that managed care 
        organizations traditionally serve.
            (2) Many managed care organizations are not equipped to 
        deal effectively with minorities in underserved areas and 
        consequently may offer lower quality health care in such areas.
            (3) Often managed care organizations do not contract with 
        physicians and other community-based service providers who 
        traditionally serve medically underserved areas.
            (4) There is a concern among minority physicians that 
        selective marketing practices and referral processes may keep 
        minority and community-based physicians out of some managed 
        care organizations.
            (5) Managed care organizations sometimes exclude physicians 
        and other community-based health care providers who 
        traditionally provide service to underserved areas; this is 
        particularly the case among minority physicians who may be well 
        established in their community based practices but are not 
        board certified.

SEC. 2. REQUIREMENT FOR SERVICE TO AREAS THAT INCLUDE A MEDICALLY 
              UNDERSERVED POPULATION.

    (a) Requirement.--
            (1) In general.--A managed care organization offering a 
        managed care plan shall establish and maintain adequate 
        arrangements, as defined under regulations of the Secretary, 
        with a sufficient number, mix, and distribution of health care 
        professionals and providers to assure that covered items and 
        services are available and accessible to each enrollee under 
        the plan--
                    (A) in the service area of the organization;
                    (B) in a variety of sites of service;
                    (C) with reasonable promptness (including 
                reasonable hours of operation and after-hours 
                services);
                    (D) with reasonable proximity to the residences and 
                workplaces of enrollees; and
                    (E) in a manner that--
                            (i) takes into account the diverse needs of 
                        enrollees; and
                            (ii) reasonably assures continuity of care.
            (2) Treatment of organizations serving certain areas.--For 
        a managed care organization that serves a medically underserved 
        area, the organization shall be treated as meeting the 
        requirement of paragraph (1) if the organization has 
        arrangements with a sufficient number, mix, and distribution of 
        health care professionals and providers having a history of 
        serving such areas.
    (b) Enforcement of Requirements.--
            (1) Application to group health plans.--
                    (A) Public health service act.--For purposes of 
                applying title XXVII of the Public Health Service Act, 
                the requirements of subsection (a) shall be treated as 
                though they were included in subpart 2 of part A of 
                such title (42 U.S.C. 300gg-4 et seq.).
                    (B) Employee retirement income security act of 
                1974.--For purposes of applying part 7 of subtitle B of 
                title I of the Employee Retirement Income Security Act 
                of 1974, the requirements of subsection (a) shall be 
                treated as though they were included in subpart B of 
                such part (29 U.S.C. 1185 et seq.).
                    (C) Internal revenue code of 1986.--For purposes of 
                applying chapter 100 of the Internal Revenue Code of 
                1986, the requirements of subsection (a) shall be 
                treated as though they were included in subchapter B of 
                such chapter.
            (2) Application to individual health insurance coverage.--
        For purposes of applying title XXVII of the Public Health 
        Service Act, the requirements of subsection (a) also shall be 
        treated as though they were part of subpart 2 of part B of such 
        title (42 U.S.C. 300gg-51 et seq.).
            (3) Medicare.--The Secretary may not enter into a contract 
        under section 1857 of the Social Security Act (42 U.S.C. 1395w-
        27) with a Medicare+Choice organization that is a managed care 
        organization unless the contract contains assurances 
        satisfactory to the Secretary that the organization will comply 
        with the applicable requirements of subsection (a) of this Act.
            (4) Medicaid.--Notwithstanding any other provision of law, 
        no funds shall be paid to a State under section 1903(a)(1) of 
        the Social Security Act (42 U.S.C. 1396b(a)(1)) with respect to 
        medical assistance provided through payment to a medicaid 
        managed care organization (as defined in section 1903(m)(1)(A) 
        of such Act, 42 U.S.C. 1396b(m)(1)(A)) unless the contract with 
        such organization contains assurances satisfactory to the 
        Secretary that the organization will comply with the applicable 
        requirements of subsection (a) of this Act.

SEC. 3. ESTABLISHMENT OF GRANT PROGRAM.

    (a) In General.--The Secretary shall establish a program in the 
Office of Minority Health of the Department of Health and Human 
Services to award competitive grants to eligible nongovernmental 
agencies to enable such agencies to develop outreach programs to--
            (1) inform individuals in medically underserved areas how 
        to access managed care organizations in their communities; and
            (2) assist physicians and other health care professionals 
        who serve in medically underserved areas to enroll as providers 
        in managed care organizations in their communities.
    (b) Eligibility and Amount.--
            (1) Eligibility.--The criteria necessary to receive a grant 
        under this section shall be determined by the Secretary.
            (2) Amount.--The amount of a grant awarded to an agency 
        under this section shall be determined by the Secretary.

SEC. 4. DEFINITIONS.

    For purposes of this Act:
            (1) Enrollee.--The term ``enrollee'' means, with respect to 
        a managed care plan offered by a managed care organization, an 
        individual enrolled with the organization for coverage under 
        such a plan.
            (2) Health care professional.--The term ``health care 
        professional'' means a physician or other health care 
        practitioner who is licensed under State law with respect to 
        the health care services the practitioner furnishes.
            (3) Health plan.--The term ``health plan'' means a group 
        health plan or health insurance coverage offered by a health 
        insurance issuer.
            (4) Managed care organization.--The term ``managed care 
        organization'' means any entity, including a group health plan, 
        health maintenance organization, or provider-sponsored 
        organization, in relation to its offering of a managed care 
        plan, and includes any other entity that provides or manages 
        the coverage under such a plan under a contract or arrangement 
        with the entity.
            (5) Managed care plan.--The term ``managed care plan'' 
        means a health plan offered by an entity if the entity--
                    (A) provides or arranges for the provision of 
                health care items and services to enrollees in the plan 
                through participating health care professionals and 
                providers; or
                    (B) provides financial incentives (such as variable 
                copayments and deductibles) to induce enrollees to 
                obtain benefits through participating health care 
                professionals and providers,
        or both.
            (6) Medically underserved area.--The term ``medically 
        underserved area'' means an area that is designated as a health 
        professional shortage area under section 332 of the Public 
        Health Service Act (42 U.S.C. 254e) or as a medically 
        underserved area for purposes of section 330 or 1302(7) of such 
        Act (42 U.S.C. 254c, 300e-1(7)).
            (7) Participating.--The term ``participating'' means, with 
        respect to a health care professional or provider in relation 
        to a health plan offered by an entity, a physician or provider 
        that furnishes health care items and services to enrollees of 
        the entity under an agreement with the entity.
            (8) Primary care provider.--The term ``primary care 
        provider'' means a health care professional who acts as a 
        gatekeeper for the overall care of an enrollee.
            (9) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services .
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