[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 654 Introduced in Senate (IS)]







108th CONGRESS
  1st Session
                                 S. 654

 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 SENATE OF THE UNITED STATES

                             March 18, 2003

   Ms. Snowe (for herself, Mr. Bingaman, Mr. Bond, and Mr. Hollings) 
introduced the following bill; which was read twice and referred to the 
                          Committee on Finance

_______________________________________________________________________

                                 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 2003''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

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

SEC. 2. DELIVERY OF MEDICARE-COVERED PRIMARY AND PREVENTIVE SERVICES AT 
              FEDERALLY QUALIFIED HEALTH CENTERS.

    (a) Coverage of Medicare-Covered Ambulatory Services by FQHCs.--
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 and such services when provided by a health care provider 
or health care professional employed by or under contract with a 
Federally qualified health center shall be treated as billable visits 
for purposes of payment to the Federally qualified health center.''.
    (b) Ensuring FQHC Reimbursement Under Hospital and Skilled Nursing 
Facility Prospective Payment Systems.--
            (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) Patients of skilled nursing facilities.--Section 
        1888(e)(2)(A) of the Social Security Act (42 U.S.C. 
        1395yy(e)(2)(A)) is amended--
                    (A) in clause (i)(II), by striking ``clauses (ii) 
                and (iii)'' and inserting ``clauses (ii) through 
                (iv)''; and
                    (B) by adding at the end 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.--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, 2004; and
            (2) by subsection (c) shall take effect on the date of 
        enactment of this Act.

SEC. 3. PROVIDING SAFE HARBOR FOR CERTAIN COLLABORATIVE EFFORTS THAT 
              BENEFIT MEDICALLY UNDERSERVED POPULATIONS.

    (a) In General.--Section 1128B(b)(3) (42 U.S.C. 1320a-7(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 public or 
                nonprofit private health center entity described under 
                clause (i) or (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 
contributes to the ability of the health center entity to maintain or 
increase the availability, 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 described in 
                section 1128B(b)(3)(G) of the Social Security Act, as 
                added by subsection (a), for health center entity 
                arrangements to the antikickback penalties.
                    (B) Factors to consider.--The Secretary shall 
                consider the following factors, among others, in 
                establishing standards relating to the exception for 
                health center entity arrangements under subparagraph 
                (A):
                            (i) Whether the arrangement between the 
                        health center entity and the other party 
                        results in savings of Federal grant funds or 
                        increased revenues to the health center entity.
                            (ii) Whether the arrangement between the 
                        health center entity and the other party 
                        restricts or limits a patient's freedom of 
                        choice.
                            (iii) Whether the arrangement between the 
                        health center entity and the other party 
                        protects a health care professional's 
                        independent medical judgment regarding 
                        medically appropriate treatment.
                The Secretary may also include other standards and 
                criteria that are consistent with the intent of 
                Congress in enacting the exception established under 
                this section.
            (2) Interim final effect.--No later than 180 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 such change and 
        revision, after public notice and opportunity (for a period of 
        not more than 60 days) for public comment, as is consistent 
        with this subsection.

SEC. 4. REIMBURSEMENT FOR FEDERALLY QUALIFIED HEALTH CENTERS 
              PARTICIPATING IN MEDICARE MANAGED CARE.

    (a) Reimbursement.--
            (1) In general.--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) 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) Payment levels and amounts.--A contract under 
                this part shall require the Medicare+Choice 
                organization to provide, in any contract between the 
                organization and a Federally qualified health center, 
                for a level and amount of payment to the Federally 
                qualified health center for services provided by such 
                health center 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.
                    ``(B) 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 provided for in section 
                1833(a)(3)(B) 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)), as amended by 
section 3(a), 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 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, 2004, and contract 
years beginning on or after such date.
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