[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 2065 Introduced in Senate (IS)]







110th CONGRESS
  1st Session
                                S. 2065

To provide assistance to community health coalitions to increase access 
          to and improve the quality of health care services.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           September 18, 2007

  Mrs. Murray introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
To provide assistance to community health coalitions to increase access 
          to and improve the quality of health care services.

    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 Coalitions for Access and 
Quality Improvement Act of 2007''.

SEC. 2. PURPOSE.

    Is it the purpose of this Act to provide assistance to community 
health coalitions (as defined in section (c)(1)) that have a clearly 
defined local need to increase access to and improve the quality of 
health care services through activities that--
            (1) develop or strengthen the coordination of services to 
        allow all individuals, including uninsured and low-income 
        individuals, to receive efficient and higher quality care and 
        to gain entry into and receive services from a comprehensive 
        system of medical, dental, pharmaceutical, and behavioral 
        health care;
            (2) develop efficient and sustainable infrastructure for a 
        healthcare delivery system characterized by effective 
        collaboration, information sharing, and clinical and financial 
        coordination among all types of providers of care in the 
        community; and
            (3) develop or strengthen activities related to providing 
        coordinated care for individuals with chronic conditions.

SEC. 3. COMMUNITY COALITIONS FOR ACCESS AND QUALITY IMPROVEMENT.

    (a) Grants To Strengthen the Effectiveness, Efficiency, and 
Coordination of Services.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'') shall award grants 
to eligible entities assist in the development of integrated health 
care delivery systems to serve defined communities of individuals to--
            (1) improve the efficiency of and coordination among the 
        providers providing services through such systems;
            (2) assist local communities in developing programs 
        targeted toward preventing and managing chronic diseases; and
            (3) expand and enhance the services provided through such 
        systems.
    (b) Eligible Entities.--To be eligible to receive a grant under 
this section, an entity shall--
            (1) represent a balanced consortium--
                    (A) whose principal purpose is to assure the 
                sustainable capacity for the provision of a broad range 
                of coordinated services for all residents within a 
                community defined in the entity's grant application as 
                described in paragraph (2); and
                    (B) that includes at least one of each of the 
                following providers that serve the community (unless 
                such provider does not exist within the community, 
                declines or refuses to participate, or places 
                unreasonable conditions on their participation)--
                            (i) a federally qualified health center (as 
                        defined in section 1861(aa) of the Social 
                        Security Act (42 U.S.C. 1395x(aa)));
                            (ii) rural health clinics and rural health 
                        networks (as defined in section 1861(aa) of the 
                        Social Security Act (42 U.S.C. 1395x(aa)));
                            (iii) a hospital with a low-income 
                        utilization rate that is greater than 25 
                        percent (as defined in section 1923(b)(3) of 
                        the Social Security Act (42 U.S.C. 1396r-
                        4(b)(3))), or a Critical Access Hospital (as 
                        defined in section 19(c)(2) of such Act (42 
                        U.S.C. 1395i-4(c)(2)));
                            (iv) a public health department; and
                            (v) an interested public or private sector 
                        health care provider or an organization that 
                        has traditionally served the medically 
                        uninsured and low-income individuals; and
            (2) submit to the Secretary an application, at such time, 
        in such manner, and containing such information and the 
        Secretary may require, including--
                    (A) a clear description of the community to be 
                served and access, quality, and efficiency outcomes to 
                be achieved under the grant;
                    (B) a description of the providers who will 
                participate in the community coalition under the grant 
                and each provider's contribution to the care of 
                individuals in the community;
                    (C) a description of the activities that the 
                applicant and the community coalition propose to 
                perform under the grant to further the objectives of 
                this section;
                    (D) evidence demonstrating that the applicant is an 
                established coalition with an ability to build on the 
                current system for serving the community by involving 
                providers who have traditionally provided a significant 
                volume of care for uninsured and low-income individuals 
                for that community;
                    (E) evidence demonstrating the coalition'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 pharmacy, substance abuse, 
                behavioral health and oral health services, in a manner 
                that assures continuity of care in the community;
                    (F) evidence of community involvement, including 
                the business community, in the development, 
                implementation, and direction of the system of care 
                that the coalition proposes to assure;
                    (G) evidence demonstrating the coalition's ability 
                to ensure that participating individuals are enrolled 
                in health care coverage programs, both public and 
                private, for which the individuals are eligible;
                    (H) 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 manner to assure long-term 
                sustainability of the system of care;
                    (I) a plan for the evaluation of the activities 
                carried out under the grant, including measurement of 
                progress toward the goals and objectives of the program 
                and the use of evaluation findings to improve system 
                performance;
                    (J) evidence demonstrating fiscal responsibility 
                through the use of appropriate accounting procedures 
                and management systems;
                    (K) evidence demonstrating commitment to serve the 
                community without regard to the ability of an 
                individual or family to pay by arranging for or 
                providing free or reduced charge care for the poor; and
                    (L) such other information as the Secretary may 
                require.
    (c) Limitations.--The term of an initial grant to an eligible 
entity under this section shall be 3 fiscal years. An entity may 
receive an extension for 2 additional years if--
            (1) the eligible entity submits to the Secretary a request 
        for a grant for such additional period;
            (2) the Secretary determines that current performance 
        justifies the granting of such an extension; and
            (3) the Secretary determines that granting such extension 
        is necessary to further the objectives described in subsection 
        (a).
    (d) Priorities.--In awarding grants under this section, the 
Secretary--
            (1) may provide priority to applicants that demonstrate the 
        greatest extent of unmet need in the community to be served for 
        a more coordinated system of care; and
            (2) shall provide priority to applicants that best promote 
        the objectives of this section, taking into consideration the 
        extent to which the applicant--
                    (A) identifies a community whose geographical area 
                has a high or increasing percentage of individuals who 
                are uninsured or low-income;
                    (B) demonstrates that the applicant has included in 
                its community coalition providers, support systems, and 
                programs that have a tradition of serving individuals 
                and families in the community who are uninsured or earn 
                below 200 of the Federal poverty level;
                    (C) demonstrates that the proposed coalition 
                activities would expand the utilization of preventive 
                and primary care services for uninsured and 
                underinsured individuals and families in the community, 
                including pharmaceuticals, behavioral and mental health 
                services, oral health services, or substance abuse 
                services;
                    (D) proposes approaches that would improve 
                coordination between health care providers and 
                appropriate social service providers;
                    (E) demonstrates collaboration with State and local 
                governments;
                    (F) demonstrates that the applicant makes use of 
                non-Federal contributions to the greatest extent 
                possible; or
                    (G) demonstrates the likelihood that the proposed 
                activities will lead to sustainable integrated delivery 
                systems as additional efforts of health systems 
                development evolve.
    (e) Use of Funds.--
            (1) Use by grantees.--
                    (A) In general.--Except as provided in paragraphs 
                (2) and (3), a grantee shall use amounts provided under 
                this section only for--
                            (i) direct expenses associated with 
                        achieving the greater integration of a health 
                        care delivery system so that the system either 
                        directly provides or ensures the provision of a 
                        broad range of culturally competent services, 
                        including, as appropriate, primary, secondary, 
                        and tertiary care as well as oral health, 
                        substance abuse, behavioral and mental health, 
                        and pharmaceutical services; and
                            (ii) direct patient care and service 
                        expansions to fill identified or documented 
                        gaps within an integrated delivery system.
                    (B) Specific uses.--Upon compliance with 
                subparagraph (A) a grantees may use amounts provided 
                under this section for the following:
                            (i) To provide increases in outreach 
                        activities and to close gaps in health care 
                        service, including referrals to specialty 
                        services and prescription drugs and conducting 
                        ongoing outreach to health disparity 
                        populations.
                            (ii) To make improvements to care 
                        management and delivery of patient-centered 
                        care, including patient navigation services.
                            (iii) To make improvements to coordinate 
                        transportation to health care facilities.
                            (iv) The development of provider networks 
                        and other innovative models to engage 
                        physicians in voluntary efforts to serve the 
                        medically underserved within a community.
                            (v) Recruitment, training, and compensation 
                        of necessary personnel.
                            (vi) The acquisition of technology for the 
                        purpose of coordinating care and improving 
                        provider communication, including the 
                        implementation of shared information systems or 
                        shared clinical systems.
                            (vii) The development of common processes 
                        such as mechanisms for determining eligibility 
                        for the programs provided through the system, 
                        common identification cards, sliding scale 
                        discounts, and the monitoring and tracking of 
                        outcomes.
                            (viii) The development of specific 
                        prevention and disease management tools and 
                        processes.
                            (ix) Language access services.
                            (x) The facilitation of the involvement of 
                        community organizations to provide better 
                        access to high quality health care services to 
                        individuals at risk for, or who have, chronic 
                        diseases or cancer.
                            (xi) Helping patients overcome barriers 
                        within the health care system to ensure prompt 
                        diagnostic and treatment resolution of an 
                        abnormal finding of cancer or chronic disease.
            (2) Direct patient care limitation.--Not to exceed 20 
        percent of the amounts received under a grant under this 
        section may be used for providing direct patient care and 
        services.
            (3) Reservation of funds for national program purposes.--
        The Secretary may use not to exceed 7 percent of the amount 
        appropriated to carry out this section each fiscal year to 
        enter into contracts with an organization that has expertise in 
        facilitating peer to peer technical assistance among grantees, 
        to obtain assistance of experts and consultants, to hold 
        meetings, to develop tools, to disseminate information, to 
        demonstrate access, quality and efficiency outcomes for 
        sustainability, and for evaluations.
    (f) Requirements.--
            (1) Evaluation of effectiveness.--An entity that receive a 
        grant under this section shall annually submit to the Secretary 
        a report concerning--
                    (A) the progress made in meeting the goals and 
                measurable objectives set forth in the grant 
                application submitted by the entity under subsection 
                (b);
                    (B) the extent to which activities carried out by 
                the entity under the grant have--
                            (i) improved the effectiveness, efficiency, 
                        and coordination of services for uninsured and 
                        low-income individuals in the community served 
                        by such entity, using commonly accepted outcome 
                        measures;
                            (ii) resulted in the provision of better 
                        quality health care for individuals and 
                        families in the community served; and
                            (iii) resulted in the provision of health 
                        care to such individuals at lower cost than 
                        would have been possible in the absence of the 
                        activities conducted by such entity; and
                    (C) the findings of an independent financial audit 
                conducted on all records that relate to the disposition 
                of funds received under the grant.
            (2) Progress.--The Secretary may not renew a grant under 
        this section unless the Secretary determines that the coalition 
        has made reasonable and demonstrable progress in meeting the 
        goals and objectives set forth in the grant application for the 
        preceding fiscal year.
    (g) 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 applicant and each of the participating providers 
agree that the grantee and each such provider will maintain its 
expenditures of non-Federal funds for such activities at a level that 
is not less then the level of such expenditures during the fiscal year 
immediately preceding the fiscal year for which the applicant is 
applying to receive such grant.
    (h) Technical Assistance.--The Secretary may, either directly or by 
grant or contract, provide any entity that receives a grant under this 
section with technical and other nonfinancial assistance necessary to 
enable the entity to comply with the requirements of this section. The 
purposes of this section may be achieved by grant or contract with 
State and national not-for-profit organizations with expertise in 
building successful community coalitions.
    (i) Evaluation of Program.--Not later than September 30, 2012, the 
Secretary shall prepare and submit to the appropriate committees of 
Congress a report that describes the extent to which projects funded 
under this section have been successful in improving the effectiveness, 
efficiency, and coordination of services in the communities served by 
such projects, including whether the projects resulted in the provision 
of better quality health care for such individuals, and whether such 
care was provided at lower costs than would have been provided in the 
absence of such projects.
    (j) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section--
            (1) $75,000,000 for fiscal year 2008;
            (2) $100,000,000 for fiscal year 2009;
            (3) $125,000,000 for fiscal year 2010;
            (4) $150,000,000 for fiscal year 2011; and
            (5) $175,000,000 for fiscal year 2012.
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