[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 941 Introduced in Senate (IS)]







110th CONGRESS
  1st Session
                                 S. 941

   To increase Federal support for Community Health Centers and the 
National Health Service Corps in order to ensure access to health care 
    for millions of Americans living in medically-underserved areas.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 20, 2007

 Mr. Sanders (for himself and Ms. Murkowski) introduced the following 
  bill; which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
   To increase Federal support for Community Health Centers and the 
National Health Service Corps in order to ensure access to health care 
    for millions of Americans living in medically-underserved areas.

    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 Health Centers Investment 
Act''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) An estimated 35,000,000 Americans have no regular 
        source of health care, and lack access to the most basic health 
        services.
            (2) Access to health care is especially difficult for those 
        Americans who live in medically underserved rural communities 
        or inner city neighborhoods, who lack public or private health 
        insurance coverage and the ability to pay directly for care, or 
        who are members of other vulnerable groups, including 
        individuals who are homeless or are migrant farm workers.
            (3) The consequences of poor access to health care is 
        evidenced in elevated infant and childhood mortality rates, 
        dangerously low childhood immunization rates, overutilization 
        of hospital emergency rooms or other inappropriate providers of 
        primary care services, and hospitalization rates for 
        preventable conditions that are significantly higher than the 
        national average.
            (4) Community health centers, which serve more than 
        16,000,000 needy Americans in more than 5,000 communities 
        across the country, provide an effective and proven model for 
        extending access to all medically underserved Americans.
            (5) Numerous independent studies confirm that these health 
        centers have compiled a remarkable record of achievement in 
        providing care of superior quality, with exceptional cost-
        effectiveness and efficiency, saving billions of dollars for 
        both taxpayers and private payers.
            (6) Over the past 5 years, with strong bipartisan support 
        from the Congress and encouragement by the Executive Branch, 
        nearly 900 underserved communities were funded to establish or 
        expand a health center, offering care to almost 5,000,000 more 
        needy individuals. Yet during that same period, another 800 
        communities were approved for a health center but were not 
        funded, because not enough funding was available for them, and 
        there are thousands more underserved communities across America 
        that need a health center but do not have one today.
            (7) Furthermore, the existing, currently funded health 
        centers have experienced reduced Federal grant support over the 
        past 2 years, jeopardizing their ability to be sustained and 
        meet the needs of the growing number of uninsured in their 
        service areas. Growing new health centers without supporting 
        existing ones is a failed policy that will ultimately weaken 
        this valuable resource for the most disadvantaged Americans.
            (8) Critical to the growth of new and existing health 
        centers is having a sufficient supply of primary care health 
        professionals to staff them. Currently, health centers rely on 
        the National Health Service Corps for over 20 percent of their 
        physician workforce. Yet, fewer than half of all Corps 
        placements are made to health centers, even though they are one 
        of the strongest cords in the health care safety net.
            (9) According to published research, health centers in the 
        last year experienced a 15 percent physician vacancy rate and a 
        19 percent dentist vacancy rate nationally. In rural areas, 
        vacancy rates were higher, 19 percent for physicians and 27 
        percent for dentists.
            (10) Adequate reimbursement for the services that health 
        centers provide is another pressing need if health centers are 
        to fulfill their mission. While health centers provide care to 
        more than 1,000,000 medically underserved Medicare 
        beneficiaries, their Medicare payments are subject to an 
        arbitrary payment cap that is now 15 years old and adversely 
        affects more than three-quarters of all health centers, causing 
        annual revenue losses in excess of $50,000,000 nationally.

SEC. 3. COMMUNITY HEALTH CENTERS.

    (a) Funding.--To carry out the program authorized under section 330 
of the Public Health Service Act (42 U.S.C. 254b), there are authorized 
to be appropriated, and there are appropriated--
            (1) for fiscal year 2008, $2,563,000,000;
            (2) for fiscal year 2009, $2,863,000,000;
            (3) for fiscal year 2010, $3,263,000,000;
            (4) for fiscal year 2011, $3,663,000,000;
            (5) for fiscal year 2012, $4,163,000,000;
            (6) for fiscal year 2013, $4,663,000,000;
            (7) for fiscal year 2014, $5,263,000,000; and
            (8) for fiscal year 2015, $5,863,000,000.
    (b) Use of Funds.--In each of the fiscal years described in 
subsection (a), amounts appropriated under such section shall be used 
in accordance with the following priorities:
            (1) Fiscal year 2008.--With respect to fiscal year 2008:
                    (A) First priority shall be given to providing 
                continuing operating grants to all health centers that 
                received operating grants under section 330 of the 
                Public Health Service Act (42 U.S.C. 254b) during the 
                previous fiscal year, and which continue to meet all 
                eligibility requirements for the receipt of funding 
                under such section.
                    (B) Second priority shall be given to providing an 
                adjustment (not to exceed $100,000,000 for all health 
                centers) in the amount of each operating grant awarded 
                to a health center pursuant to subparagraph (A) to 
                account for--
                            (i) the increased cost of providing 
                        services through each such health center based 
                        on the average increase in costs per encounter 
                        reported by all health centers during the most 
                        recent reporting period for which such 
                        information is available prior to the beginning 
                        of the fiscal year; and
                            (ii) the change in the number of users 
                        reported by each such health center during the 
                        most recent reporting period for which such 
                        information is available prior to the beginning 
                        of the fiscal year;
                    (C) Third priority shall be given to providing 
                initial operating grants (or expanded operating grants, 
                as the case may be) to all eligible applicants for New 
                Access Point or Expanded Medical Capacity grants during 
                fiscal years 2002 through 2007 (not to exceed 
                $225,000,000 for all such grantees), that--
                            (i) received a score of ``Fully 
                        Acceptable'' or better from an Objective Review 
                        Committee established by the Health Resources 
                        and Services Administration during that period; 
                        and
                            (ii) did not receive funding because of a 
                        lack of available appropriated funds during 
                        that period to permit the funding of such 
                        applications.
                    (D) Fourth priority shall be given to providing 
                initial operating grants (or expanded operating grants, 
                as the case may be) to all eligible applicants for New 
                Access Point or Expanded Medical Capacity grants during 
                fiscal year 2008, that received a score of ``Fully 
                Acceptable'' or better from an Objective Review 
                Committee established by the Health Resources and 
                Services Administration during that fiscal year, 
                subject to the availability of appropriations. 
                Notwithstanding any funding criteria that may otherwise 
                be utilized in the selection of grantees under the 
                programs described in this subparagraph, the criteria 
                to be used for the approval of applications under this 
                subparagraph shall ensure an equitable geographic 
                distribution with respect to the service areas of the 
                grantees that receive such assistance.
                    (E)(i) Fifth priority shall be given to supporting 
                the planning and development of new health centers (not 
                to exceed $25,000,000 for all such support) in 
                communities that demonstrate need for a health center 
                under section 330 of the Public Health Service Act (42 
                U.S.C. 254b), including counties, other eligible 
                geographic or governmental subdivisions such as cities, 
                towns, neighborhoods, or groups of such subdivisions in 
                contiguous areas.
                    (ii) Funds made available under clause (i) shall be 
                used to award grants in accordance with section 330(c) 
                of the Public Health Service Act (42 U.S.C. 254b(c)), 
                particularly to entities that will serve medically 
                underserved areas identified through the use of 
                criteria including the distance of the area from other 
                sources of primary medical or dental care, the lack of 
                access to existing primary health care practices among 
                the population of the community, the lack of acceptance 
                of Medicaid beneficiaries among existing primary health 
                care practices in the community, significant 
                disparities in health status, the percentage of 
                uninsured and underinsured, and other measures that 
                indicate barriers to appropriate primary health care.
                    (iii) Of the amount made available for grants under 
                clause (i), not more than $20,000,000 may be used to 
                provide support to health center networks (as defined 
                in section 330(e)(1)(C) of the Public Health Service 
                Act (42 U.S.C. 254b(e)(1)(C)), or to organizations that 
                represent all health centers in a State, and that have 
                established or have made a commitment to establishing 
                Statewide systems of health centers that will ensure 
                the presence of health centers in all underserved areas 
                in that State.
                    (iv) Notwithstanding any funding criteria that may 
                otherwise be utilized in awarding grants of the type 
                described in this subparagraph, the criteria used for 
                the approval of applications under this subparagraph 
                shall ensure an equitable geographic distribution with 
                respect to the service areas of the grantees that 
                receive such assistance.
            (2) Succeeding fiscal years.--For fiscal year 2009, and for 
        each succeeding fiscal year, funds shall be distributed under 
        this section in accordance with the priorities described in 
        subparagraphs (A), (B), (D), and (E) of paragraph (1).

SEC. 4. NATIONAL HEALTH SERVICE CORPS.

    (a) Funding.--To carry out the programs authorized under sections 
331 through 338G of the Public Health Service Act (42 U.S.C. 254d-
254p), there are authorized to be appropriated, and there are 
appropriated--
            (1) for fiscal year 2008, $150,000,000;
            (2) for fiscal year 2009, $175,000,000;
            (3) for fiscal year 2010, $200,000,000;
            (4) for fiscal year 2011, $225,000,000;
            (5) for fiscal year 2012, $250,000,000;
            (6) for fiscal year 2013, $275,000,000;
            (7) for fiscal year 2014, $300,000,000; and
            (8) for fiscal year 2015, $325,000,000.
    (b) Assignment of Personnel.--
            (1) In general.--Section 333(a)(3) of the Public Health 
        Service Corps (42 U.S.C. 254f(a)(3)) is amended to read as 
        follows:
    ``(3)(A) In approving applications for assignment of members of the 
Corps, the Secretary shall not discriminate against application from 
entities that are not receiving Federal financial assistance under this 
Act.
    ``(B) In approving such applications, the Secretary shall--
            ``(i) give preference to applications in which a nonprofit 
        entity or public entity shall provide a site to which Corps 
        members may be assigned; and
            ``(ii) give the highest preference to applications--
                    ``(I) from entities described in clause (i) that 
                are federally qualified health centers as defined in 
                section 1905(l)(2)(B) of the Social Security Act; and
                    ``(II) from entities described in clause (i) that 
                primarily serve racial and ethnic minority and other 
                health disparity populations with annual incomes at or 
                below twice those set forth in the most recent poverty 
                guidelines issued by the Secretary pursuant to section 
                673(2) of the Community Services Block Grant Act (42 
                U.S.C. 9902(2)).''.
            (2) Priorities in assignment of corps personnel.--Section 
        333A of the Public Health Service Act (42 U.S.C. 254f-1) is 
        amended--
                    (A) in subsection (a)--
                            (i) by redesignating paragraphs (1), (2), 
                        and (3) as paragraphs (2), (3), and (4), 
                        respectively; and
                            (ii) by inserting before paragraph (2) (as 
                        so redesignated) the following:
            ``(1) give preference to applications as set forth in 
        subsection (a)(3) of section 333;''; and
                    (B) by striking ``subsection (a)(1)'' each place 
                such appears and inserting ``subsection (a)(2)''.
            (3) Conforming amendment.--Section 338I(c)(3)(B)(ii) of the 
        Public Health Service Act (42 U.S.C. 254q-1(c)(3)(B)(ii)) is 
        amended by striking ``section 333A(a)(1)'' and inserting 
        ``section 333A(a)(2)''.
    (c) Revision of Scholarship Limitation.--Section 338H(b) of the 
Public Health Service Act (42 U.S.C. 254q(b)) is amended to read as 
follows:
    ``(b) Scholarships.--Of the amount appropriated under subsection 
(a) for a fiscal year, the Secretary shall obligate not less than 40 
percent for the purpose of awarding contracts for scholarships under 
this subpart (including scholarships to individuals from disadvantaged 
backgrounds).''.

SEC. 5. MEDICARE.

    (a) Coverage for FQHC Ambulatory Services.--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.''.
    (b) Per Visit Payment Requirements for FQHCs.--Section 
1833(a)(3)(A) of the Social Security Act (42 U.S.C. 1395l(a)(3)(A)), is 
amended by adding ``(which regulations may not limit the per visit 
payment amount, or a component of such amount, for services described 
in section 1832(a)(2)(D)(ii))'' after ``the Secretary may prescribe in 
regulations''.
    (c) Effective Date.--The amendments made by this section shall 
apply to services provided on or after January 1, 2007.
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