[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5171 Introduced in House (IH)]







109th CONGRESS
  2d Session
                                H. R. 5171

    To amend the Public Health Service Act to provide for community 
 projects that will reduce the number of individuals who are uninsured 
          with respect to health care, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 25, 2006

  Mr. Hoekstra (for himself, Mr. Gillmor, Mr. McCotter, Mr. Rogers of 
   Michigan, Mr. Ehlers, Mr. Boozman, Mr. Shadegg, Mr. Camp, and Mr. 
 LaTourette) introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
    To amend the Public Health Service Act to provide for community 
 projects that will reduce the number of individuals who are uninsured 
          with respect to health care, 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 ``Communities Building Access Act''.

SEC. 2. FINDINGS.

    The Congress finds as follows:
            (1) Two models of community programs for the uninsured have 
        emerged as effective in generating community support and 
        funding in urban and rural areas; in providing effective care 
        and coverage for the uninsured; in avoiding displacement of 
        private coverage; and in avoiding duplication of other federal 
        programs for the uninsured.
            (2) These community models have demonstrated community-wide 
        economic benefit. Employers in the community experience less 
        health care cost-shifting, in addition to increased 
        productivity and employee retention. With greater emphasis on 
        preventive and chronic care, a community's uninsured population 
        becomes less of a financial burden on state and local budgets.
            (3) These community models have demonstrated potential 
        national solutions for certain uninsured populations, including 
        the working uninsured. Such lessons learned from these models 
        include, for example, the level of subsidy necessary to get 
        small employers to purchase coverage for their employees, how 
        to effectively market access programs to the uninsured, and how 
        to effectively manage chronic care among lower-income 
        populations.
            (4) These community models have succeeded in raising much 
        of the funding necessary to function, but have lacked financial 
        stability and would enjoy greater success with a stable partial 
        funding stream from the Federal Government.
            (5) These community models, if involved in a Federal 
        partnership, have the ability and willingness to be accountable 
        for a return on investment for Federal funding, and to 
        disseminate expertise to like-minded communities.

SEC. 3. GRANTS FOR MULTI-SHARE HEALTH CARE COVERAGE PROJECTS FOR 
              UNINSURED WORKING INDIVIDUALS.

    Subpart I of 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:

``SEC. 330M. MULTI-SHARE HEALTH CARE COVERAGE PROJECTS FOR UNINSURED 
              WORKING INDIVIDUALS.

    ``(a) In General.--The Secretary shall make grants to public or 
nonprofit private entities to carry out demonstration projects for the 
purpose of--
            ``(1) making available, on a cost-sharing basis as 
        described in subsection (c)(2)(C), health care coverage to 
        qualifying employees through employers that have not 
        contributed to health care benefits for employees during the 
        12-month period prior to participating in such a project; and
            ``(2) making available, on such basis, health care coverage 
        to qualifying self-employed individuals who have been without 
        such coverage during the 12-month period prior to participating 
        in such a project.
    ``(b) Qualifying Employees and Self-Employed Individuals.--For 
purposes of this section, the term `qualifying', with respect to an 
employee or self-employed individual, means that the employee or self-
employed individual is not eligible for health services under the 
program under title XVIII, XIX, or XXI of the Social Security Act 
(relating to the Medicare program, the Medicaid program, and the State 
children's health insurance program, respectively).
    ``(c) Requirements for Grant.--
            ``(1) In general.--A grant may be made under subsection (a) 
        for a project only if the applicant involved--
                    ``(A) has defined a service area for the project;
                    ``(B) has formed a consortium of entities in such 
                service area, which consortium is composed of employers 
                whose employees may or may not be served by the 
                project, health care providers who will provide 
                services through the project, and other appropriate 
                entities;
                    ``(C) has ensured that the consortium has 
                established a set of unified goals for the project;
                    ``(D) has conducted a basic level of demographic 
                research to obtain data on the uninsured businesses, 
                working uninsured, and provider community within the 
                service area in order to determine the potential value 
                and effectiveness of operating such a project, which 
                data includes--
                            ``(i) the rate of uncompensated care;
                            ``(ii) the number of women lacking prenatal 
                        services;
                            ``(iii) immunization rates; and
                            ``(iv) the number of employers that do not 
                        provide health insurance to their employees; 
                        and
                    ``(E) has conducted a basic evaluation of State 
                health insurance and local laws that might impact the 
                implementation of the project.
            ``(2) Agreements.--A grant may be made under subsection (a) 
        for a project only if the applicant involved agrees as follows:
                    ``(A) Eligibility criteria will be established for 
                employers to participate in the project, including the 
                requirement that the employers be located within the 
                service area defined under paragraph (1)(A) for the 
                project, which may include--
                            ``(i) a maximum average income earned by 
                        the employees of the business;
                            ``(ii) criteria, in addition to the 12-
                        month periods under subsection (a), to avoid 
                        creating any incentive for an employer or self-
                        employed individual to discontinue health plans 
                        or health insurance policies; and
                            ``(iii) such other criteria as the 
                        consortium under paragraph (1)(B) considers to 
                        be appropriate.
                    ``(B) A network of health care providers will be 
                formed to provide services to qualifying employees and 
                self-employed individuals who participate in the 
                project, which services will be provided according to a 
                schedule of fees and copayments negotiated by the 
                project.
                    ``(C) Of the cost of providing health care coverage 
                through the project--
                            ``(i) not more than 30 percent will be paid 
                        by the project with funds from the grant; and
                            ``(ii) not less than 70 percent will be 
                        paid by the employer, the employee, and any 
                        additional sources of funds (such as the 
                        community in which the project is located) that 
                        may be available pursuant to arrangements with 
                        the project.
                    ``(D) A minimum benefit package will be selected 
                that includes--
                            ``(i) physicians services;
                            ``(ii) prescription drug benefits;
                            ``(iii) in-patient hospital services;
                            ``(iv) out-patient services;
                            ``(v) emergency room visits;
                            ``(vi) emergency ambulance services; and
                            ``(vii) diagnostic laboratory tests and x-
                        rays.
                With respect to compliance with the agreement under 
                this subparagraph, the project is not required to 
                provide coverage for any service performed outside the 
                service area of the project, except to the extent that 
                a service specified in any of clauses (i) through (vii) 
                is not reasonably available within the service area.
                    ``(E) The minimum benefit package will not exclude 
                coverage of a medical condition on the basis that it is 
                a pre-existing condition.
                    ``(F) An entity will be selected by the consortium 
                under paragraph (1)(B) to carry out administrative and 
                accounting functions with respect to the health care 
                coverage to be offered by the project, including 
                monthly billings, verification and enrollment of 
                eligible employers and employees, maintenance of 
                membership rosters, operation of the utilization 
                management program under subparagraph (G), and 
                development of a marketing plan.
                    ``(G) A utilization management program will be 
                selected that ensures delivery of care in the 
                appropriate setting, using appropriate resources and 
                clinical practice guidelines.
                    ``(H) A plan will be implemented for measuring 
                quality and efficiency of care provided through the 
                project within two years after the project begins 
                operation.
                    ``(I) A plan will be implemented for managing care 
                for enrollees with chronic illness, as well as 
                additional cost-control initiatives that will be 
                employed by the project within 2 years after the 
                project begins operation.
                    ``(J) A plan will be implemented for protecting the 
                project from high risks, which may include affiliation 
                with State high-risk pool or local safety net program, 
                and purchase of reinsurance.
                    ``(K) A plan will be implemented for evaluating the 
                project on an interim basis, not less frequently than 
                annually.
    ``(d) Application for Grant.--A grant may be made under subsection 
(a) only if an application for the grant is submitted to the Secretary 
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.
    ``(e) Authorization of Appropriations.--For the purpose of making 
grants under subsection (a), there is authorized to be appropriated 
$36,000,000 in the aggregate for the fiscal years 2007 through 2013, of 
which there are authorized to be appropriated amounts as follows:
            ``(1) For fiscal year 2007, $2,000,000.
            ``(2) For each of the fiscal years 2008 and 2009, 
        $5,000,000.
            ``(3) For each of the fiscal years 2010 through 2013, 
        $6,000,000.

``SEC. 330N. GRANTS FOR VOLUNTEER SPECIALTY PROVIDER NETWORKS.

    ``(a) In General.--The Secretary shall make grants to public or 
nonprofit private entities to carry out demonstration projects for the 
purpose of forming and maintaining networks composed of health care 
specialists who volunteer health services to eligible individuals.
    ``(b) Eligible Individuals.--For purposes of this section, the term 
`eligible individual' means an individual who has been enrolled by a 
project under subsection (a) and--
            ``(1) whose employer does not provide health care coverage;
            ``(2) is unable to obtain health care coverage through a 
        family member or common law partner;
            ``(3) is at or below a poverty level specified by the 
        Secretary; and
            ``(4) is not eligible for health services under the program 
        under title XVIII, XIX, or XXI of the Social Security Act 
        (relating to the Medicare program, the Medicaid program, and 
        the State children's health insurance program, respectively).
    ``(c) Qualified Grant Expenditures.--A grant may be made under 
subsection (a) for a project only if the applicant involved agrees that 
the grant will be expended to assist specialists that are participants 
in the network involved through any or all of the following means:
            ``(1) Paying nominal administrative or fees to the 
        participants for the costs of providing services to eligible 
        individuals.
            ``(2) Assisting with the cost of training primary care 
        practitioners to manage the chronic conditions that are most 
        often treated by the network specialists.
            ``(3) Assisting participants with the costs of providing 
        fees to recruit specialists to practice in the service area of 
        the project.
            ``(4) Assisting with the costs of operating a community 
        clinic staffed by volunteer network specialists.
            ``(5) Assisting participants with the costs of installing 
        or operating information technology that is of benefit to 
        patients, such as technology to avoid medical errors or to 
        facilitate the authorized electronic transfer of the health 
        records of eligible individuals.
            ``(6) Paying for necessary prescription drug costs for 
        necessary treatment prescribed by network specialists.
            ``(7) Such additional means as the Secretary may authorize.
    ``(d) Certain Requirements for Grant.--A grant may be made under 
subsection (a) for a project only if the applicant involved--
            ``(1) has defined a service area for the project;
            ``(2) has formed a consortium of various community members, 
        leaders, and organizations in such area;
            ``(3) has ensured that the consortium has established a set 
        of unified goals for the project;
            ``(4) has conducted the basic level of demographic research 
        described in section 330M(c)(1)(D);
            ``(5) has a plan for managing the care of eligible 
        individuals with chronic illness; and
            ``(6) has a plan for evaluating the project on an interim 
        basis, not less frequently than once each year.
    ``(e) Matching Funds.--
            ``(1) In general.--With respect to the costs of the project 
        to be carried out under subsection (a) by an applicant, a grant 
        under such subsection may be made 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 not less than \1/3\ of such costs ($1 for 
        each $2 provided in the grant).
            ``(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.
    ``(f) Application for Grant.--A grant may be made under subsection 
(a) only if an application for the grant is submitted to the Secretary 
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.
    ``(g) Authorization of Appropriations.--For the purpose of making 
grants under subsection (a), there is authorized to be appropriated 
$9,000,000 in the aggregate for the fiscal years 2007 through 2013, of 
which there are authorized to be appropriated amounts as follows:
            ``(1) For each of the fiscal years 2007 and 2008, $500,000.
            ``(2) For each of the fiscal years 2009 and 2010, 
        $1,000,000.
            ``(3) For each of the fiscal years 2011 through 2013, 
        $2,000,000.

``SEC. 330O. CLEARINGHOUSE FOR INFORMATION ON COMMUNITY-INITIATED 
              PROJECTS TO PROVIDE HEALTH CARE COVERAGE TO UNINSURED 
              INDIVIDUALS.

    ``(a) In General.--The Secretary shall make an award of a grant or 
contract for the establishment and operation of a clearinghouse to 
collect and make available, on a national basis, information on 
projects under sections 330M and 330N and similar projects that are 
community-initiated (referred to in this section as `access projects').
    ``(b) Certain Requirements.--The Secretary shall ensure that the 
information collected and made available under subsection (a) by the 
Clearinghouse includes the following:
            ``(1) A database identifying technical-assistance experts 
        who are or have been involved in the planning or operation of 
        access projects.
            ``(2) Information regarding the success and progress of 
        access projects, including--
                    ``(A) information on best-practices identified for 
                such projects;
                    ``(B) the number of individuals who lacked health 
                care coverage prior to receiving such coverage through 
                the projects;
                    ``(C) the number of individuals served by the 
                projects who have chronic conditions that are managed 
                by the projects;
                    ``(D) the economic impact of the projects for 
                businesses in the communities in which the projects 
                operated; and
                    ``(E) the savings of hospitals and other health 
                care providers in such communities that resulted from 
                the operation of the projects.
    ``(c) Application.--An award may be made under subsection (a) only 
if an application for the award is submitted to the Secretary 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.
    ``(d) Solicitation of Reports.--The Secretary may carry out a 
program to encourage public and private entities that plan or operate 
access projects to submit to the Clearinghouse reports that provide 
information on the projects.
    ``(e) Definition.--For purposes of this section, the term 
`Clearinghouse' means the clearinghouse under subsection (a).
    ``(f) Authorization of Appropriation.--For the purpose of making 
awards under subsection (a), there are authorized to be appropriated 
such sums as may be necessary for each of the fiscal years 2007 through 
2013.''.
                                 <all>