[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 504 Introduced in House (IH)]
107th CONGRESS
1st Session
H. R. 504
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
February 7, 2001
Mr. Green of Texas (for himself, Ms. Pelosi, Mr. Deutsch, Mr. Nadler,
Mr. Filner, Mr. Frost, Mr. Jefferson, Mr. Hinchey, Mr. Coyne, Mrs. Meek
of Florida, Mr. Stark, Mr. Rodriguez, Mr. Bass, Mr. Bentsen, Mr.
Capuano, Mr. Barrett, Mr. Reyes, Mrs. Christensen, Mr. Stenholm, Ms.
DeGette, Mr. Kleczka, Mrs. Jones of Ohio, Mrs. Morella, Mr.
Abercrombie, Mr. Ford, Ms. McCarthy of Missouri, Mr. Clyburn, Mr. Rush,
Ms. Baldwin, Mr. McDermott, Mr. Lantos, Mr. Wexler, Mr. Blagojevich,
Mr. Udall of New Mexico, Mr. Pastor, and Mr. Matsui) introduced the
following bill; which was referred to the Committee on Energy and
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 2001''.
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 $250,000,000
in fiscal year 2002 and such sums as may be necessary for each of
fiscal years 2003 through 2006.''.
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