Demonstration project for integrated health systems to expand access to primary and preventive services for the medically underserved

Part D of title III of the Public Health Service Act (42 U.S.C. 259b et seq.) is amended by adding at the end the following new subpart:

Demonstration Project for Integrated Health Systems to Expand Access to Primary and Preventive Services for the Medically Underserved

340H.

Demonstration project for integrated health systems to expand access to primary and preventive care for the medically underserved

(a)

Establishment of demonstration

(1)

In general

Not later than January 1, 2009, the Secretary shall establish a demonstration project (hereafter in this section referred to as the demonstration) under which up to 30 qualifying integrated health systems receive grants for the costs of their operations to expand access to primary and preventive services for the medically underserved. (2)

Rule of construction

Nothing in this section shall be construed as authorizing grants to be made or used for the costs of specialty care or hospital care furnished by an integrated health system. (b)

Application

Any integrated health system desiring to participate in the demonstration shall submit an application in such manner, at such time, and containing such information as the Secretary may require. (c)

Criteria for selection

In selecting integrated health systems to participate in the demonstration (hereafter referred to as participating integrated health systems), the Secretary shall ensure representation of integrated health systems that are located in a variety of States (including the District of Columbia and the territories and possessions of the United States) and locations within States, including rural areas, inner-city areas, and frontier areas. (d)

Duration

Subject to the availability of appropriations, the demonstration shall be conducted (and operating grants be made to each participating integrated health system) for a period of 3 years. (e)

Reports

(1)

In general

The Secretary shall submit to the appropriate committees of the Congress interim and final reports with respect to the demonstration, with an interim report being submitted not later than 3 months after the demonstration has been in operation for 24 months and a final report being submitted not later than 3 months after the close of the demonstration. (2)

Content

Such reports shall evaluate the effectiveness of the demonstration in providing greater access to primary and preventive care for medically underserved populations, and how the coordinated approach offered by integrated health systems contributes to improved patient outcomes. (f)

Authorization of appropriations

(1)

In general

There is authorized to be appropriated $25,000,000 for each of the fiscal years 2009, 2010, and 2011 to carry out this section. (2)

Construction

Nothing in this section shall be construed as requiring or authorizing a reduction in the amounts appropriated for grants to health centers under section 330 for the fiscal years referred to in paragraph (1). (g)

Definitions

For purposes of this section: (1)

Frontier area

The term frontier area has the meaning given to such term in regulations promulgated pursuant to section 330I(r). (2)

Integrated health system

The term integrated health system means a health system that— (A)has a demonstrated capacity and commitment to provide a full range of primary care, specialty care, and hospital care in both inpatient and outpatient settings; and (B)is organized to provide such care in a coordinated fashion. (3)

Qualifying integrated health system

(A)

In general

The term qualifying integrated health system means a public or private nonprofit entity that is an integrated health system that meets the requirements of subparagraph (B) and serves a medically underserved population (either through the staff and supporting resources of the integrated health system or through contracts or cooperative arrangements) by providing— (i)required primary and preventive health and related services (as defined in paragraph (4)); and (ii)as may be appropriate for a population served by a particular integrated health system, integrative health services (as defined in paragraph (5)) that are necessary for the adequate support of the required primary and preventive health and related services and that improve care coordination. (B)

Other requirements

The requirements of this subparagraph are that the integrated health system— (i)will make the required primary and preventive health and related services of the integrated health system available and accessible in the service area of the integrated health system promptly, as appropriate, and in a manner which assures continuity; (ii)will demonstrate financial responsibility by the use of such accounting procedures and other requirements as may be prescribed by the Secretary; (iii)provides or will provide services to individuals who are eligible for medical assistance under title XIX of the Social Security Act or for assistance under title XXI of such Act; (iv)has prepared a schedule of fees or payments for the provision of its services consistent with locally prevailing rates or charges and designed to cover its reasonable costs of operation and has prepared a corresponding schedule of discounts to be applied to the payment of such fees or payments, which discounts are adjusted on the basis of the patient’s ability to pay; (v)will assure that no patient will be denied health care services due to an individual’s inability to pay for such services; (vi)will assure that any fees or payments required by the system for such services will be reduced or waived to enable the system to fulfill the assurance described in clause (v); (vii)provides assurances that any grant funds will be expended to supplement, and not supplant, the expenditures of the integrated health system for primary and preventive health services for the medically underserved; and (viii)submits to the Secretary such reports as the Secretary may require to determine compliance with this subparagraph. (C)

Treatment of certain entities

The term qualifying integrated health system may include a nurse-managed health clinic if such clinic meets the requirements of subparagraphs (A) and (B) (except those requirements that have been waived under paragraph (4)(B)). (4)

Required primary and preventive health and related services

(A)

In general

Except as provided in subparagraph (B), the term required primary and preventive health and related services means basic health services consisting of— (i)health services related to family medicine, internal medicine, pediatrics, obstetrics, or gynecology that are furnished by physicians where appropriate, physician assistants, nurse practitioners, and nurse midwives; (ii)diagnostic laboratory services and radiologic services; (iii)preventive health services, including prenatal and perinatal care; appropriate cancer screening; well-child services; immunizations against vaccine-preventable diseases; screenings for elevated blood lead levels, communicable diseases, and cholesterol; pediatric eye, ear, and dental screenings to determine the need for vision and hearing correction and dental care; and voluntary family planning services; (iv)emergency medical services; and (v)pharmaceutical services, behavioral, mental health, and substance abuse services, preventive dental services, and recuperative care, as may be appropriate. (B)

Exception

In the case of an integrated health system serving a targeted population, the Secretary shall, upon a showing of good cause, waive the requirement that the integrated health system provide each required primary and preventive health and related service under this paragraph if the Secretary determines one or more such services are inappropriate or unnecessary for such population. (5)

Integrative health services

The term integrative health services means services that are not included as required primary and preventive health and related services and are associated with achieving the greater integration of a health care delivery system to improve patient care coordination so that the system either directly provides or ensures the provision of a broad range of culturally competent services. Integrative health services include but are not limited to the following: (A)Outreach activities. (B)Case management and patient navigation services. (C)Chronic care management. (D)Transportation to health care facilities. (E)Development of provider networks and other innovative models to engage local physicians and other providers to serve the medically underserved within a community. (F)Recruitment, training, and compensation of necessary personnel. (G)Acquisition of technology for the purpose of coordinating care. (H)Improvements to provider communication, including implementation of shared information systems or shared clinical systems. (I)Determination of eligibility for Federal, State, and local programs that provide, or financially support the provision of, medical, social, housing, educational, or other related services. (J)Development of prevention and disease management tools and processes. (K)Translation services. (L)Development and implementation of evaluation measures and processes to assess patient outcomes. (M)Integration of primary care and mental health services. (N)Carrying out other activities that may be appropriate to a community and that would increase access by the uninsured to health care, such as access initiatives for which private entities provide non-Federal contributions to supplement the Federal funds provided through the grants for the initiatives. (6)

Specialty care

The term specialty care means care that is provided through a referral and by a physician or nonphysician practitioner, such as surgical consultative services, radiology services requiring the immediate presence of a physician, audiology, optometric services, cardiology services, magnetic resonance imagery (MRI) services, computerized axial tomography (CAT) scans, nuclear medicine studies, and ambulatory surgical services. (7)

Nurse-managed health clinic

The term nurse-managed health clinic means a nurse-practice arrangement, managed by advanced practice nurses, that provides care for underserved and vulnerable populations and is associated with a school, college, or department of nursing or an independent nonprofit health or social services agency.