[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3949 Introduced in House (IH)]







107th CONGRESS
  2d Session
                                H. R. 3949

    To amend title XIX of the Social Security Act to require health 
   maintenance organizations and other managed care plans providing 
   medical assistance to Medicaid beneficiaries to make payments for 
    assistance provided to such beneficiaries by health centers in 
  Federally-assisted housing for the elderly, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 12, 2002

Ms. Velazquez introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
    To amend title XIX of the Social Security Act to require health 
   maintenance organizations and other managed care plans providing 
   medical assistance to Medicaid beneficiaries to make payments for 
    assistance provided to such beneficiaries by health centers in 
  Federally-assisted housing for the elderly, 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.

    This Act may be cited as the ``Healthcare Accessibility for Seniors 
Act of 2002''.

SEC. 2. REQUIRING MEDICAID HEALTH MAINTENANCE ORGANIZATIONS TO MAKE 
              PAYMENTS FOR SERVICES PROVIDED BY HEALTH CENTERS IN 
              FEDERALLY-ASSISTED HOUSING FOR THE ELDERLY.

    (a) In General.--Section 1903(m)(2)(A) of the Social Security Act 
(42 U.S.C. 1396b(m)(2)(A)) is amended--
            (1) by striking ``and'' at the end of clause (xi);
            (2) by striking the period at the end of clause (xii) and 
        inserting ``; and''; and
            (3) by adding at the end the following new clause:
            ``(xiii) such contract provides that--
                    ``(I) the entity's network of participating 
                providers of such services shall include at least one 
                health center in Federally-assisted housing for the 
                elderly (as defined in section 1905(t)), or
                    ``(II) the entity shall enter into a contract for 
                the provision of such services to such individuals with 
                each such center (as so defined) located in the 
                entity's service area, under terms and conditions 
                (including terms and conditions relating to patient 
                referrals and the sharing of patient records) similar 
                to those applicable to a contract between the entity 
                and a similar provider of such services in the area (in 
                accordance with standards established by the 
                Secretary).''.
    (b) Health Center in Federally-Assisted Housing for the Elderly 
Described.--Section 1905 of such Act (42 U.S.C. 1396d) is amended by 
adding at the end the following new subsection:
    ``(t) The term `health center in Federally-assisted housing for the 
elderly' means a clinic which is located at an Federally-assisted 
housing project (which may be receiving assistance under section 202 of 
the Housing Act of 1959) in which elderly persons (as defined in 
section 3(b)(3)(D) of the United States Housing Act of 1937) constitute 
a minimum of 25 percent of its residents and which--
            ``(1) provides physical examinations, injury treatment, 
        primary health services, mental health services, and other 
        services (to the extent permitted under the laws or regulations 
        of the State in which it is located) on an on-site basis to 
        residents of the housing project (without regard to whether or 
        not the residents are enrolled in the State plan under this 
        title);
            ``(2) refers such residents to other providers of health 
        care services for services which the center does not provide 
        on-site;
            ``(3) has entered into arrangements with other providers of 
        health care services providing services on a 24-hour, emergency 
        basis;
            ``(4) has on its staff at least one physician (whether 
        employed on a part-time or full-time basis); at least one 
        physician assistant, nurse practitioner, or clinical nurse 
        specialist; and at least one mental health professional; and
            ``(5) is approved or certified as such a clinic by the 
        State in which it is located.''.
    (c) Prohibition Against Waiver of Requirement.--The Secretary of 
Health and Human Services may not waive (pursuant to section 1115 or 
section 1915 of the Social Security Act or otherwise) the application 
of section 1903(m)(2)(A)(xii) of the Social Security Act (as added by 
subsection (a)) with respect to any State.
    (d) Effective Date.--The amendments made by subsections (a) and (b) 
shall apply to contracts between a State and a medicaid managed care 
entity for contract  years or periods that begin on or after 180 days 
after the date of the enactment of this Act.

SEC. 3. ESTABLISHMENT OF CLEARINGHOUSE FOR INFORMATION AND TECHNICAL 
              ASSISTANCE ON HEALTH CENTERS IN FEDERALLY-ASSISTED 
              HOUSING FOR THE ELDERLY.

    Not later than 180 days after the date of the enactment of this 
Act, the Secretary of Health and Human Services shall establish a 
clearinghouse through which interested parties may receive information 
and technical assistance on the establishment and operation of health 
centers in Federally-assisted housing for the elderly.

SEC. 4. GRANTS FOR HEALTH CENTERS IN FEDERALLY-ASSISTED HOUSING FOR THE 
              ELDERLY.

    (a) In General.--Part D of title III of the Public Health Service 
Act (42 U.S.C. 254b et seq.) is amended by adding at the end the 
following subpart:

   ``Subpart X--Health Centers in Federally-Assisted Housing for the 
                                Elderly

     ``health centers in federally-assisted housing for the elderly

    ``Sec. 340F. (a) In General.--
            ``(1) In general.--The Secretary may make grants to public 
        and nonprofit private entities for the purpose of making 
        available to elderly persons health services specified in 
        subsection (d) at sites that are on or in close proximity to 
        Federally-assisted housing projects for the elderly (or at such 
        other sites as the Secretary determines to be appropriate to 
        provide residents of such housing projects with access to the 
        services).
            ``(2) Elderly person.--For purposes of this section, the 
        term `elderly person' has the meaning given such term in 
        section 3(b)(3)(D) of the United States Housing Act of 1937 (42 
        U.S.C. 1437(b)(3)(D)).
            ``(3) Federally-assisted housing projects for the 
        elderly.--The term `Federally-assisted housing projects for the 
        elderly' is a Federally-assistance housing project in which the 
        elderly person constitute at least 25 percent of the residents 
        of the project.
    ``(b) Minimum Qualifications for Grantees.--
            ``(1) Status as medicaid provider.--
                    ``(A) Except as provided in subparagraph (B), the 
                Secretary may make a grant under subsection (a) only if 
                the applicant for the grant is a provider of services 
                under the State plan approved for the State involved 
                under title XIX of the Social Security Act.
                    ``(B) The requirements established in subparagraph 
                (A) do not apply to an applicant that provides health 
                services without charge and does not receive 
                reimbursement for the services from any third-party 
                payors.
            ``(2) Required consultations.--The Secretary may make a 
        grant under subsection (a) only if the applicant involved, in 
        preparing the application under subsection (j), has consulted 
        with elderly persons in the community in which services under 
        the grant are to be provided, with administrators at Federally-
        assisted housing projects for the elderly in the community, and 
        with the area agencies on aging in the community.
    ``(c) Preferences in Making Grants.--In making grants under 
subsection (a), the Secretary shall give preference to qualified 
applicants that are experienced in delivering health care services to 
medically underserved populations or in areas in which a significant 
number of elderly persons are at risk for health problems.
    ``(d) Authorized Services.--
            ``(1) In general.--The Secretary may make a grant under 
        subsection (a) only if the applicant involved agrees as 
        follows:
                    ``(A) Each of the following services will be made 
                available under the grant (as medically appropriate for 
                the child involved):
                            ``(i) Comprehensive health examinations.
                            ``(ii) Health education and prevention 
                        services.
                            ``(iii) Follow-up care and referrals 
                        regarding routine health problems.
                    ``(B) Services under subparagraph (A) will include 
                screenings, follow-up care, and referrals (including 
                referrals for specialty care) regarding dental, vision, 
                and hearing services, and regarding sexually-
                transmitted diseases and other communicable diseases.
            ``(2) Other services.--In addition to services specified in 
        paragraph (1), the Secretary may authorize a grantee under 
        subsection (a) to expend the grant for such additional health 
        or health-related services for elderly persons as the Secretary 
        determines to be appropriate.
    ``(e) Cultural Context of Services.--The Secretary may make a grant 
under subsection (a) only if the applicant involved agrees that 
services under the grant will be provided in the language and cultural 
context most appropriate for the individuals to whom the services are 
provided.
    ``(f) Limitation on Imposition of Fees for Services.--The Secretary 
may make a grant under subsection (a) only if the applicant involved 
agrees that, if a fee is imposed for the provision of services under 
the grant, such fee--
            ``(1) will be made according to a schedule of fees that is 
        made available to the public;
            ``(2) will be adjusted to reflect the income and resources 
        of the elderly persons involved; and
            ``(3) will not be imposed on any elderly person with an 
        income of less than 150 percent of the applicable official 
        poverty line (established by the Director of the Office of 
        Management and Budget and revised by the Secretary in 
        accordance with section 673(2) of the Omnibus Budget 
        Reconciliation Act of 1981).
    ``(g) Matching Funds.--
            ``(1) In general.--With respect to the costs of the program 
        to be carried out under subsection (a) by an applicant, the 
        Secretary, subject to paragraph (3), may make a grant under 
        such subsection only if the applicant agrees to make available 
        (directly or through donations from public or private entities) 
        non-Federal contributions toward such costs in an amount that 
        is--
                    ``(A) for the first fiscal year for which the 
                applicant receives such a grant, 10 percent of such 
                costs;
                    ``(B) for any second such fiscal year, 25 percent 
                of such costs; and
                    ``(C) for any subsequent such fiscal year, 50 
                percent of such costs.
            ``(2) Determination of amount contributed.--Non-Federal 
        contributions required in paragraph (1) may be in cash or in 
        kind, fairly evaluated, including plant, equipment, or 
        services. Amounts provided by the Federal Government, or 
        services assisted or subsidized to any significant extent by 
        the Federal Government, may not be included in determining the 
        amount of such non-Federal contributions.
            ``(3) Waiver.--The Secretary may for an applicant waive the 
        requirement of paragraph (1) for a fiscal year if the Secretary 
        determines that the applicant will be unable to carry out a 
        program under subsection (a) otherwise. If the Secretary 
        provides a waiver under the preceding sentence for a grantee 
        under subsection (a) for a fiscal year, the Secretary may make 
        a grant to the applicant for the following fiscal year only if 
        the Secretary reviews the waiver to determine whether the 
        waiver should remain in effect.
    ``(h) Additional Agreements.--The Secretary may make a grant under 
subsection (a) only if the applicant involved agrees as follows:
            ``(1) The applicant will maintain the confidentiality of 
        patient records.
            ``(2) The applicant will establish an ongoing quality 
        assurance program regarding services provided under the grant.
            ``(3) The applicant will not expend more than 10 percent of 
        the grant for administrative expenses regarding the grant.
    ``(i) Reports to Secretary.--The Secretary may make a grant under 
subsection (a) only if the applicant agrees that, not later than 
February 1 of the fiscal year following the fiscal year for which the 
grant is to be made, the applicant will submit to the Secretary a 
report describing the program carried out by the applicant under the 
grant, including provisions on the utilization, cost, and outcome of 
services provided under the grant.
    ``(j) Application for Grant; Plan.--The Secretary may make a grant 
under subsection (a) only if an application for the grant is submitted 
to the Secretary; the application contains a plan describing the 
proposal of the applicant for a program under subsection (a); and the 
application is in such form, is made in such manner, and contains such 
agreements, assurances, and information as the Secretary determines to 
be necessary to carry out this section.
    ``(k) Evaluation of Programs.--The Secretary, directly or through 
grants or contracts, shall provide for evaluations of programs carried 
out under subsection (a), including the cost-effectiveness and health-
effectiveness of the programs.
    ``(l) Reports to Congress.--Not later than May 31 of each fiscal 
year, the Secretary shall submit to the Congress a report on the 
programs carried out under subsection (a). The report shall include a 
summary of the evaluations carried out under subsection (k) for the 
preceding fiscal year.
    ``(m) Authorization of Appropriations.--For the purpose of carrying 
out this section, there is authorized to be appropriated $500,000,000 
for fiscal year 2003, $550,000,000 for fiscal year 2004, $600,000,000 
for fiscal year 2005, $650,000,000 for fiscal year 2006, and 
$700,000,000 for fiscal year 2007.''.
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