[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4970 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 4970

   To amend part D of title III of the Public Health Service Act to 
    provide grants to strengthen the effectiveness, efficiency, and 
      coordination of services for the uninsured and underinsured.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 26, 2000

Mr. Green of Texas introduced the following bill; which was referred to 
                       the Committee on Commerce

_______________________________________________________________________

                                 A BILL


 
   To amend part D of title III of the Public Health Service Act to 
    provide grants to strengthen the effectiveness, efficiency, and 
      coordination of services for the uninsured and underinsured.

    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 ``Community Access to Health Care Act 
of 2000''.

SEC. 2. PURPOSE.

    The purpose of this Act is to provide assistance to communities and 
to consortia of health care providers and others, including those in 
rural areas and including American Indian and Alaska Native entities, 
in order to develop or strengthen integrated health care delivery 
systems that coordinate health services for individuals who are 
uninsured and individuals who are underinsured, through--
            (1) coordination of services to allow such individuals to 
        receive efficient and higher quality care and to gain entry 
        into a comprehensive system of care;
            (2) development of the infrastructure for a health care 
        delivery system characterized by effective collaboration, 
        information sharing, and clinical and financial coordination 
        among all providers of care in the community; and
            (3) provision of new Federal resources that do not supplant 
        funding for existing Federal categorical programs that support 
        entities providing services to low-income populations.

SEC. 3. CREATION OF COMMUNITY ACCESS PROGRAM.

    Part D of title III of the Public Health Service Act (42 U.S.C. 
254b et seq.) is amended by inserting after subpart IV the following 
new subpart:

                 ``Subpart V--Community Access Program

``SEC. 340. GRANTS TO STRENGTHEN THE EFFECTIVENESS, EFFICIENCY, AND 
              COORDINATION OF SERVICES FOR THE UNINSURED AND 
              UNDERINSURED.

    ``(a) In General.--The Secretary may make grants for the purpose of 
assisting the development of integrated health care delivery systems--
            ``(1) to serve communities of individuals who are uninsured 
        and individuals who are underinsured;
            ``(2) to expand the scope of services provided; and
            ``(3) to improve the efficiency and coordination among the 
        providers of such services.
    ``(b) Eligible Entities.--To be eligible to receive a grant under 
this section, an entity must--
            ``(1) be a public or nonprofit private entity such as--
                    ``(A) a Federally qualified health center (as 
                defined under section 1861(aa)(4) of the Social 
                Security Act);
                    ``(B) a hospital that meets the requirements of 
                section 340B(a)(4)(L) (or, if none are available in the 
                area, a hospital that is a provider of a substantial 
                volume of non-emergency health services to uninsured 
                individuals and families without regard to their 
                ability to pay) without regard to 340B(a)(4)(L)(iii); 
                or
                    ``(C) a public health department; and
            ``(2) represent a consortium of providers and, as 
        appropriate, related agencies or entities--
                    ``(A) whose principal purpose is to provide a broad 
                range of coordinated health care services for a 
                community defined in the entity's grant application 
                (which may be a special population group such as 
                migrant and seasonal farm workers, homeless persons or 
                individuals with disabilities);
                    ``(B) that includes all health care providers that 
                serve the community and that have traditionally 
                provided care (beyond emergency services) to uninsured 
                and underinsured individuals without regard to the 
                individuals' ability to pay (if there are any such 
                providers) unless any such provider or providers 
                declines to participate; and
                    ``(C) that may include other health care providers 
                and related agencies and organizations;
except that preference shall be given to applicants that are health 
care providers identified in paragraph (1).
    ``(c) Applications.--To be eligible to receive a grant under this 
section, an eligible entity shall submit to the Secretary an 
application, in such form and manner as the Secretary shall prescribe, 
that shall--
            ``(1) define a community of uninsured and underinsured 
        individuals that consists of all such individuals--
                    ``(A) in a specified geographical area; or
                    ``(B) in a specified population within such an 
                area;
            ``(2) identify the providers who will participate in the 
        consortium's program under the grant, and specify each one's 
        contribution to the care of uninsured and underinsured 
        individuals in the community, including the volume of care it 
        provides to medicare and medicaid beneficiaries and to 
        privately paid patients;
            ``(3) describe the activities that the applicant and the 
        consortium propose to perform under the grant to further the 
        purposes of this section;
            ``(4) demonstrate the consortium's ability to build on the 
        current system for serving uninsured and underinsured 
        individuals by involving providers who have traditionally 
provided a significant volume of care for that community;
            ``(5) demonstrate the consortium's ability to develop 
        coordinated systems of care that either directly provide or 
        ensure the prompt provision of a broad range of high-quality, 
        accessible services, including, as appropriate, primary, 
        secondary, and tertiary services, as well as substance abuse 
        treatment and mental health services in a manner which assures 
        continuity of care in the community;
            ``(6) provide evidence of community involvement in the 
        development, implementation, and direction of the program that 
        it proposes to operate;
            ``(7) demonstrate the consortium's ability to ensure that 
        individuals participating in the program are enrolled in public 
        insurance programs for which they are eligible;
            ``(8) present a plan for leveraging other sources of 
        revenue, which may include State and local sources and private 
        grant funds, and integrating current and proposed new funding 
        sources in a way to assure long-term sustainability;
            ``(9) describe a plan for evaluation of the activities 
        carried out under the grant, including measurement of progress 
        toward the goals and objectives of the program;
            ``(10) demonstrate fiscal responsibility through the use of 
        appropriate accounting procedures and appropriate management 
        systems;
            ``(11) include such other information as the Secretary may 
        prescribe; and
            ``(12) demonstrate the commitment to serve the community 
        without regard to the ability of the individual or family to 
        pay by arranging for or providing free or reduced charge care 
        for the poor.
    ``(d) Priorities.--In awarding grants under this section, the 
Secretary may accord priority to applicants--
            ``(1) whose consortium includes public hospitals, Federally 
        qualified health centers (as defined in section 1905(l)(2)(B) 
        of the Social Security Act), and other providers that are 
        covered entities as defined by section 340B(a)(4) of this Act 
        (or that would be covered entities as so defined but for 
        subparagraph (L)(iii) of such section);
            ``(2) that identify a community whose geographical area has 
        a high or increasing percentage of individuals who are 
        uninsured;
            ``(3) whose consortium includes other health care providers 
        that have a tradition of serving uninsured individuals and 
        underinsured individuals in the community;
            ``(4) who show evidence that the program would expand 
        utilization of preventive and primary care services for 
        uninsured and underinsured individuals and families in the 
        community, including mental health services or substance abuse 
        services;
            ``(5) whose proposed program would improve coordination 
        between health care providers and appropriate social service 
        providers, including local and regional human services 
        agencies, school systems, and agencies on aging;
            ``(6) that demonstrate collaboration with State and local 
        governments;
            ``(7) that make use of non-Federal contributions to the 
        greatest extent possible; or
            ``(8) that demonstrate a likelihood that the proposed 
        program will continue after support under this section ceases.
    ``(e) Use of Funds.--
            ``(1) Use by grantees.--
                    ``(A) In general.--Except as provided in paragraphs 
                (2) and (3), a grantee may use amounts provided under 
                this section only for--
                            ``(i) direct expenses associated with 
                        planning, developing, and operating the greater 
                        integration of a health care delivery system so 
                        that it either directly provides or ensures the 
                        provision of a broad range of services, as 
                        appropriate, including primary, secondary, and 
                        tertiary services, as well as substance abuse 
                        treatment and mental health services; and
                            ``(ii) direct patient care and service 
                        expansions to fill identified or documented 
                        gaps within an integrated delivery system.
                    ``(B) Specific uses.--The following are examples of 
                purposes for which a grantee may use grant funds, when 
                such use meets the conditions stated in subparagraph 
                (A):
                            ``(i) Increase in outreach activities.
                            ``(ii) Improvements to case management.
                            ``(iii) Improvements to coordination of 
                        transportation to health care facilities.
                            ``(iv) Development of provider networks.
                            ``(v) Recruitment, training, and 
                        compensation of necessary personnel.
                            ``(vi) Acquisition of technology.
                            ``(vii) Identifying and closing gaps in 
                        services being provided.
                            ``(viii) Improvements to provider 
                        communication, including implementation of 
                        shared information systems or shared clinical 
                        systems.
                            ``(ix) Other activities that may be 
                        appropriate to a community that would increase 
                        access to the uninsured.
            ``(2) Direct patient care limitation.--No more than 15 
        percent of the funds provided under a grant may be used for 
        providing direct patient care and services.
            ``(3) Reservation of funds for national program purposes.--
        The Secretary may use not more than 3 percent of funds 
        appropriated to carry out this section for technical assistance 
        to grantees, obtaining assistance of experts and consultants, 
        meetings, dissemination of information, evaluation, and 
        activities that will extend the benefits of funded programs to 
        communities other than the one funded.
    ``(f) Maintenance of Effort.--With respect to activities for which 
a grant under this section is authorized, the Secretary may award such 
a grant only if the recipient of the grant and each of the 
participating providers agree that each one will maintain its 
expenditures of non-Federal funds for such activities at a level that 
is not less than the level of such expenditures during the year 
immediately preceding the fiscal year for which the applicant is 
applying to receive such grant.
    ``(g) Reports to the Secretary.--The recipient of a grant under 
this section shall report to the Secretary annually regarding--
            ``(1) progress in meeting the goals stated in its grant 
        application; and
            ``(2) such additional information as the Secretary may 
        require.
The Secretary may not renew an annual grant under this section unless 
the Secretary is satisfied that the consortium has made reasonable and 
demonstrable progress in meeting the goals set forth in its grant 
application for the preceding year.
    ``(h) Audits.--Each entity which receives a grant under this 
section shall provide for an independent annual financial audit of all 
records that relate to the disposition of funds received through this 
grant.
    ``(i) Technical Assistance.--The Secretary may, either directly or 
by grant or contract, provide any funded entity with technical and 
other non-financial assistance necessary to meet the requirements of 
this section.
    ``(j) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated $125,000,000 
in fiscal year 2001 and such sums as may be necessary for each of 
fiscal years 2002 through 2005.''.
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