1.This Act may be cited as the
Community Health Centers Investment
Act
.
2.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.
3.
(a)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)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)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)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).
4.National Health Service Corps
(a)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)
(1)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
personnelSection 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)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
limitationSection 338H(b) of
the Public Health Service Act (42 U.S.C. 254q(b)) is amended to read as
follows:
(b)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).
.
5.
(a)Coverage for FQHC ambulatory
servicesSection 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
FQHCsSection 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)The amendments made by
this section shall apply to services provided on or after January 1,
2007.