[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4000 Introduced in House (IH)]







107th CONGRESS
  2d Session
                                H. R. 4000

 To amend title XVIII of the Social Security Act to enhance the access 
 of Medicare beneficiaries who live in medically underserved areas to 
 critical primary and preventive health care benefits, to improve the 
            Medicare+Choice program, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 19, 2002

   Mr. Weller (for himself, Mr. Lewis of Georgia, Mr. Bereuter, Mr. 
  Hinchey, Mr. Foley, Mr. McNulty, Mr. Deal of Georgia, Ms. Carson of 
  Indiana, Mr. Bonilla, Mrs. Christensen, Mr. Sessions, Mrs. Jones of 
    Ohio, Mr. LaTourette, and Mr. Davis of Illinois) introduced the 
following bill; which was referred to the Committee on Ways and Means, 
 and in addition to the Committee on Energy and Commerce, 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 amend title XVIII of the Social Security Act to enhance the access 
 of Medicare beneficiaries who live in medically underserved areas to 
 critical primary and preventive health care benefits, to improve the 
            Medicare+Choice program, 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; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Medicare Safety 
Net Access Act of 2002''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Supplemental reimbursement for Federally qualified health 
                            centers participating in medicare managed 
                            care.
Sec. 3. Revision of Federally qualified health center payment limits.
Sec. 4. Coverage of additional Federally qualified health center 
                            services.
Sec. 5. Providing safe harbor for certain collaborative efforts that 
                            benefit medically underserved populations.

SEC. 2. SUPPLEMENTAL REIMBURSEMENT FOR FEDERALLY QUALIFIED HEALTH 
              CENTERS PARTICIPATING IN MEDICARE MANAGED CARE.

    (a) Supplemental Reimbursement.--Section 1833(a)(3) of the Social 
Security Act (42 U.S.C. 1395l(a)(3)) is amended to read as follows:
            ``(3) in the case of services described in section 
        1832(a)(2)(D)--
                    ``(A) except as provided in subparagraph (B), the 
                costs which are reasonable and related to the cost of 
                furnishing such services or which are based on such 
                other tests of reasonableness as the Secretary may 
                prescribe in regulations, including those authorized 
                under section 1861(v)(1)(A), less the amount a provider 
                may charge as described in clause (ii) of section 
                1866(a)(2)(A), but in no case may the payment for such 
                services (other than for items and services described 
                in section 1861(s)(10)(A)) exceed 80 percent of such 
                costs; or
                    ``(B) with respect to the services described in 
                clause (ii) of section 1832(a)(2)(D) that are furnished 
                to an individual enrolled with a Medicare+Choice 
                organization under part C pursuant to a written 
                agreement described in section 1853(j), the amount by 
                which--
                            ``(i) the amount of payment that would have 
                        otherwise been provided under subparagraph (A) 
                        (calculated as if `100 percent' were 
                        substituted for `80 percent' in such 
                        subparagraph) for such services if the 
                        individual had not been so enrolled; exceeds
                            ``(ii) the amount of the payments received 
                        under such written agreement for such services 
                        (not including any financial incentives 
                        provided for in such agreement such as risk 
                        pool payments, bonuses, or withholds),
                less the amount the Federally qualified health center 
                may charge as described in section 1857(e)(3)(C);''.
    (b) Continuation of Medicare+Choice Monthly Payments.--
            (1) In general.--Section 1853 of the Social Security Act 
        (42 U.S.C. 1395w-23) is amended by adding at the end the 
        following new subsection:
    ``(j) Special Payment Rule for Federally Qualified Health Center 
Services.--If an individual who is enrolled with a Medicare+Choice 
organization under this part receives a service from a Federally 
qualified health center that has a written agreement with such 
organization for providing such a service (including any agreement 
required under section 1857(e)(3))--
            ``(1) the Secretary shall pay the amount determined under 
        section 1833(a)(3)(B) directly to the Federally qualified 
        health center not less frequently than quarterly; and
            ``(2) the Secretary shall not reduce the amount of the 
        monthly payments to the Medicare+Choice organization made under 
        section 1853(a) as a result of the application of paragraph 
        (1).''.
            (2) Conforming amendments.--
                    (A) Paragraphs (1) and (2) of section 1851(i) of 
                the Social Security Act (42 U.S.C. 1395w-21(i)(1)) are 
                each amended by inserting ``1853(j),'' after 
                ``1853(h),''.
                    (B) Section 1853(c)(5) is amended by striking 
                ``subsections (a)(3)(C)(iii) and (i)'' and  inserting 
``subsections (a)(3)(C)(iii), (i), and (j)(1)''.
    (c) Additional Medicare+Choice Contract Requirements.--Section 
1857(e) of the Social Security Act (42 U.S.C. 1395w-27(e)) is amended 
by adding at the end the following new paragraph:
            ``(3) Agreements with federally qualified health centers.--
                    ``(A) Ensuring equal access to services of fqhcs.--
                A contract under this part shall require the 
                Medicare+Choice organization to enter into (and to 
                demonstrate to the Secretary that it has entered into) 
                a sufficient number of written agreements with 
                Federally qualified health centers providing Federally 
                qualified health center services for which payment may 
                be made under this title in the service area of each 
                Medicare+Choice plan offered by such organization so 
                that such services are reasonably available to 
                individuals enrolled in the plan.
                    ``(B) Ensuring equal payment levels and amounts.--A 
                contract under this part shall require the 
                Medicare+Choice organization to provide a level and 
                amount of payment to each Federally qualified health 
                center for services provided by such health center that 
                are covered under the written agreement described in 
                subparagraph (A) that is not less than the level and 
                amount of payment that the organization would make for 
                such services if the services had been furnished by a 
                provider of services that was not a Federally qualified 
                health center.
                    ``(C) Cost-sharing.--Under the written agreement 
                described in subparagraph (A), a Federally qualified 
                health center must accept the Medicare+Choice contract 
                price plus the Federal payment as payment in full for 
                services covered by the contract, except that such a 
                health center may collect any amount of cost-sharing 
                permitted under the contract under this part, so long 
                as the amounts of any deductible, coinsurance, or 
                copayment comply with the requirements under section 
                1854(e) and do not result in a total payment to the 
                center in excess of the amount determined under section 
                1833(a)(3)(A) (calculated as if `100 percent' were 
                substituted for `80 percent' in such section).''.
    (d) Safe Harbor From Antikickback Prohibition.--Section 1128B(b)(3) 
of the Social Security Act (42 U.S.C. 1320a-7b(b)(3)) is amended--
            (1) in subparagraph (E), by striking ``and'' after the 
        semicolon at the end;
            (2) in subparagraph (F), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following new subparagraph:
                    ``(G) any remuneration between a Federally 
                qualified health center (or an entity controlled by 
                such a health center) and a Medicare+Choice 
                organization pursuant to the written agreement 
                described in section 1853(j).''.
    (e) Effective Date.--The amendments made by this section shall 
apply to services provided on or after January 1, 2003, and contract 
years beginning on or after such date.

SEC. 3. REVISION OF FEDERALLY QUALIFIED HEALTH CENTER PAYMENT LIMITS.

    (a) Per Visit Payment Requirements for FQHCs.--Section 
1833(a)(3)(A) of the Social Security Act (42 U.S.C. 1395l(a)(3)(A)), as 
amended by section 2(a), is amended by adding ``(which regulations may 
not limit the per visit payment amount, or a component of such amount, 
for services described in section 1832(a)(2)(D)(ii))'' after ``the 
Secretary may prescribe in regulations''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to services provided on or after January 1, 2003.

SEC. 4. COVERAGE OF ADDITIONAL FEDERALLY QUALIFIED HEALTH CENTER 
              SERVICES.

    (a) Coverage for FQHC Ambulatory Services.--Section 1861(aa)(3) of 
the Social Security Act (42 U.S.C. 1395x(aa)(3)) is amended to read as 
follows:
    ``(3) The term `Federally qualified health center services' means--
            ``(A) services of the type described in subparagraphs (A) 
        through (C) of paragraph (1), and such other services furnished 
        by a Federally qualified health center for which payment may 
        otherwise be made under this title if such services were 
        furnished by a health care provider or health care professional 
        other than a Federally qualified health center; and
            ``(B) preventive primary health services that a center is 
        required to provide under section 330 of the Public Health 
        Service Act,
when furnished to an individual as a patient of a Federally qualified 
health center.''.
    (b) Offsite FQHC Services.--
            (1) Patients of hospitals and critical access hospitals.--
        Section 1862(a)(14) of the Social Security Act (42 U.S.C. 
        1395y(a)) is amended by inserting ``Federally qualified health 
        center services,'' after ``qualified psychologist services,''.
            (2) Exclusion of federally qualified health center services 
        from the pps for skilled nursing facilities.--Section 1888(e) 
        of the Social Security Act (42 U.S.C. 1395yy(e)) is amended--
                    (A) in paragraph (2)(A)(i)(II), by striking 
                ``clauses (ii) and (iii)'' and inserting ``clauses (ii) 
                through (iv)''; and
                    (B) by adding at the end of paragraph (2)(A) the 
                following new clause:
                            ``(iv) Exclusion of federally qualified 
                        health center services.--Services described in 
                        this clause are Federally qualified health 
                        center services (as defined in section 
                        1861(aa)(3)).''.
    (c) Technical Corrections.--
            (1) Section 1861(aa)(1)(B) of the Social Security Act (42 
        U.S.C. 1395x(aa)(1)(B)) is amended by striking ``subsection 
        (hh)(1)),,'' and inserting ``subsection (hh)(1)),''.
            (2) Clauses (i) and (ii)(II) of section 1861(aa)(4)(A) of 
        the Social Security Act (42 U.S.C. 1395x(aa)(4)(A)) are each 
        amended by striking ``(other than subsection (h))''.
    (d) Effective Dates.--The amendments made--
            (1) by subsections (a) and (b) shall apply to services 
        furnished on or after January 1, 2003; and
            (2) by subsection (c) shall take effect on the date of 
        enactment of this Act.

SEC. 5. PROVIDING SAFE HARBOR FOR CERTAIN COLLABORATIVE EFFORTS THAT 
              BENEFIT MEDICALLY UNDERSERVED POPULATIONS.

    (a) In General.--Section 1128B(b)(3) of the Social Security Act (42 
U.S.C. 1320a-7(b)(3)), as amended by section 2(d), is amended--
            (1) in subparagraph (F), by striking ``and'' after the 
        semicolon at the end;
            (2) in subparagraph (G), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following new subparagraph:
                    ``(H) any remuneration between a public or 
                nonprofit private health center entity described under 
                clauses (i) and (ii) of section 1905(l)(2)(B) and any 
                individual or entity providing goods, items, services, 
                donations or loans, or a combination thereof, to such 
                health center entity pursuant to a contract, lease, 
                grant, loan, or other agreement, if such agreement 
                produces a community benefit that will be used by the 
                health center entity to maintain or increase the 
                availability or accessibility, or enhance the quality, 
                of services provided to a medically underserved 
                population served by the health center entity.''.
    (b) Rulemaking for Exception for Health Center Entity 
Arrangements.--
            (1) Establishment.--
                    (A) In general.--The Secretary of Health and Human 
                Services (in this subsection referred to as the 
                ``Secretary'') shall establish, on an expedited basis, 
                standards relating to the exception for health center 
                entity arrangements to the antikickback penalties 
                described in section 1128B(b)(3)(F) of the Social 
                Security Act, as added by subsection (a).
                    (B) Factors to consider.--In establishing standards 
                relating to the exception for health center entity 
                arrangements under subparagraph (A), the Secretary--
                            (i) shall extend the exception where the 
                        arrangement between the health center entity 
                        and the other party--
                                    (I) results in savings of Federal 
                                grant funds or increased revenues to 
                                the health center entity;
                                    (II) does not limit or restrict a 
                                patient's freedom of choice; and
                                    (III) does not interfere with a 
                                health care professional's independent 
                                medical judgment regarding medically 
                                appropriate treatment; and
                            (ii) may include other standards and 
                        criteria that are consistent with the intent of 
                        Congress in enacting the exception established 
                        under this subsection.
            (2) Interim final effect.--No later than 60 days after the 
        date of enactment of this Act, the Secretary shall publish a 
        rule in the Federal Register consistent with the factors under 
        paragraph (1)(B). Such rule shall be effective and final 
        immediately on an interim basis, subject to change and revision 
        after public notice and opportunity (for a period of not more 
        than 60 days) for public comment, provided that any change or 
        revision shall be consistent with this subsection.
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