Grants for qualified commercial fishing industry health care coverage demonstration programs

Part B of title III of the Public Health Service Act (42 U.S.C. 243 et seq.) is amended by adding at the end the following new section:

320B.

Grants for qualified commercial fishing industry health care coverage demonstration programs

(a)

Establishment of program

(1)

In general

The Secretary, through the Health Resources and Services Administration, shall establish a grant program (in this section referred to as the grant program) for the purpose of assisting commercial fishing States to establish, or strengthen existing, programs to expand health care coverage and access for uninsured or underinsured workers and their families in the commercial fishing industry. (2)

Types of grants

Under the grant program, the Secretary shall provide— (A)program planning grants under subsection (b) for commercial fishing States and organizations within such States; and (B)implementation and administration grants under subsection (c) for no more than 15 commercial fishing States. (3)

Application required

No grant may be awarded under this section except pursuant to an application that is made in such form and manner, and containing such information, as the Secretary may require. (b)

Program planning grants

(1)

In general

Under the grant program the Secretary may award grants to one or more commercial fishing States (or to organizations with a history of active involvement in the commercial fishing industry in such a State, including knowledge of economic and social aspects of such industry), not to exceed $200,000 for each year and for no more than two years, to conduct initial research and planning for the development of a qualified health care coverage program in the State. Any grantee under this subsection shall— (A)conduct a demographic survey of the State’s commercial fishing industry and such industry’s health care needs; and (B)develop a strategic plan, including a detailed financial plan, for implementation of a qualified health care coverage program within the State. (2)

Consultation with States

Before awarding a grant under this subsection to an organization, the Secretary shall consult with States where the organization is located in order to assist in a determination as to whether the organization— (A)has the necessary familiarity with and knowledge of the commercial fishing industry in the State to fulfill the purposes of the grant; and (B)has a history of fraudulent or abusive practices that would disqualify the organization from carrying out the grant. (3)

Actions following completion of planning grants

Based on the research findings, financial plan, and other recommendations developed by the State or organization under paragraph (1), a State may submit an application for program implementation and administration grants under subsection (c). (c)

Implementation and program administration grants

(1)

In general

Under the grant program, subject to the succeeding provisions of this subsection, the Secretary may award the following grants to commercial fishing States: (A)

Initial implementation grants

A grant, not to exceed $2,000,000 for each year and for no more than two years, for initial implementation of a qualified health care coverage program. (B)

Program administration grants

A grant, not to exceed $3,000,000 for each year and for no more than five years, for administration of a qualified health care coverage program. (C)

Continued administration grants

A grant, not to exceed $3,000,000 for each year, for continued administration of a qualified health care coverage program in a State that has been awarded administration grants for 5 years under subparagraph (B) and that has satisfactorily administered such program using the funds provided by such grants for at least 5 years, if the economic conditions of the fishing industry in the program’s service area (or the condition of fish stocks that are important to the fishing industry in such area) jeopardize the ability of the program to continue providing affordable health care coverage.

A grant may be made for a qualified health care coverage program under subparagraph (A) or (B) regardless of whether or not the program was developed with a program planning grant under subsection (b) or was implemented under a grant under subparagraph (A), respectively, and regardless of whether the program was developed or initially implemented before the date of the enactment of this section.

(2)

Eligibility requirements

The Secretary may not award a grant under this subsection to a commercial fishing State for implementation or administration of a health care coverage program unless— (A)the State demonstrates that the program— (i)is a qualified health care coverage program and enrolls fishing industry members and their families if they were uninsured or underinsured; and (ii)requires Federal funding for its operation; and (B)the State provides assurances satisfactory to the Secretary that— (i)if the program is an expansion of an existing health care coverage program, the State will use the grant funding to expand the enrolled population of uninsured or underinsured commercial fishing industry members and their families, or modify coverage to comply with qualified health care coverage, under the program and to supplement, and not supplant, State provided funding for such program; or (ii)if the program is a new qualified health care coverage program, the State will ensure the program’s continued success through the implementation of appropriate financial and consumer protection regulations, controls, licensing, or oversight policies, including (as determined by the State) any of the following: (I)Protection against insolvency, fraud and abuse. (II)State-based stop-loss protection. (III)Reinsurance. (IV)Receivership/liquidation protection against insolvency for individuals. (V)Another demonstration of State financial commitment. (3)

Requirement of matching funds

(A)

In general

A grant may be made under this subsection only if the State 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 for each $2 of Federal funds provided in the grant. (B)

Determination of amount contributed

Non-Federal contributions required in subparagraph (A) 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. (4)

Contracting authority

(A)

In general

A commercial fishing State may enter into a contract with one or more eligible non-profit organizations or companies for the purpose of conducting activities under an implementation or administration grant under this subsection and may not enter into such a contract with an organization or company which is not eligible under subparagraph (C). (B)

Subcontracting arrangements

A contractor described in subparagraph (A) may subcontract with one or more eligible non-profit organizations or companies for the purpose of conducting activities under such an implementation or administration grant, if the State approves such subcontracting arrangements. (C)

Eligibility standards

The Secretary shall issue regulations establishing eligibility standards for organizations and companies under this paragraph. Such standards shall include requirements that States review whether prospective contractors or subcontractors under this paragraph— (i)have a history of fraudulent or abusive practices that would disqualify them from participating in a contract or subcontract; (ii)have the capability and experience to assist in the management of a qualified health care coverage program; and (iii)in the case of commercial fishing organizations, have an appropriate level of familiarity with, and knowledge of, the commercial fishing industry. (d)

Definitions

For purposes of this section: (1)

Commercial fishing State

The term commercial fishing State means a State (as defined in section 2(f)) with a significant commercial fishing population or a significant commercial fishing industry. The Secretary shall accept a State’s self-certification that it is a commercial fishing State if the State demonstrates to the Secretary that— (A)such self-certification is based on consultation by the State with local organizations familiar with the commercial fishing industry in the State; and (B)the State has a significant commercial fishing population or a significant commercial fishing industry. (2)

Commercial fishing industry member

The term commercial fishing industry member means a fisherman, crewmember, boat owner, captain, shore side business owner, employee of a company that provides shore side support, harvester, or other individual performing commercial fishing industry-related work, if more than half of such individual’s income derives from such work at the time the individual enrolls in a qualified health care coverage program. (3)

Qualified health care coverage program

The term qualified health care coverage program means a program that provides qualified health care coverage to commercial fishing industry members and their families consistent with the following: (A)Eligibility for enrollment of such members and families is only restricted by capacity, based on a first come, first served basis when space is limited, and health status related factors (as defined in section 2702), age, and gender may not be used as a basis for determining eligibility. (B)The program does not include any preexisting condition exclusion (as defined in section 2701) or any coverage elimination rider that permanently excludes from coverage an existing medical condition. (C)Premium rates under the program are computed based on a community rate, and may be adjusted only for income and family size. (4)

Qualified health care coverage

The term qualified health care coverage means coverage that meets any of the following conditions: (A)

FEHBP coverage

The coverage is actuarially equivalent to the coverage provided under the health benefits plan, under chapter 89 of title 5, United States Code, which has the largest enrollment, either in the United States or in the State involved. (B)

State employees coverage

The coverage is actuarially equivalent to the coverage provided under the health benefits plan, that is offered by the State to State government employees, which has the largest enrollment of such plans in the State. (e)

Authorization of appropriations

There are authorized to be appropriated to the Secretary for the purpose of carrying out this section— (1)$5,000,000 for fiscal year 2009; (2)$5,000,000 for fiscal year 2010; (3)$10,000,000 for fiscal year 2011; (4)$10,000,000 for fiscal year 2012; and (5)$20,000,000 for fiscal year 2013.