[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3665 Introduced in House (IH)]
111th CONGRESS
1st Session
H. R. 3665
To amend title XIX of the Social Security Act to provide for payment
for Medicaid services furnished by Ryan White part C grantees under a
cost-based prospective payment system.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 29, 2009
Ms. Baldwin (for herself, Mrs. Capps, Ms. Matsui, and Ms. Moore of
Wisconsin) introduced the following bill; which was referred to the
Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to provide for payment
for Medicaid services furnished by Ryan White part C grantees under a
cost-based prospective payment system.
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 ``Ryan White Grantee Medicaid Payment
Equity Act of 2009''.
SEC. 2. MEDICAID PAYMENT FOR SERVICES FURNISHED BY RYAN WHITE PART C
GRANTEES ON A COST-BASED PROSPECTIVE PAYMENT SYSTEM.
(a) In General.--Section 1902 of the Social Security Act (42 U.S.C.
1396a) is amended--
(1) in subsection (a)(15), by inserting before the
semicolon at the end the following: ``and provide for payment
for services described in section 1905(a) provided by a
recipient of a grant under part C of title XXVI of the Public
Health Service Act in accordance with subsection (gg)''; and
(2) by adding at the end the following new subsection:
``(gg) Payment for Services Provided by Ryan White Part C
Grantees.--
``(1) In general.--Beginning with fiscal year 2010 with
respect to services furnished on or after January 1, 2010, and
each succeeding fiscal year, the State plan shall provide for
payment for services described in section 1905(a) (in this
subsection referred to as `Medicaid covered services')
furnished by a recipient of a grant under part C of title XXVI
of the Public Health Service Act (in the subsection referred to
as a `grantee') in accordance with the provisions of this
subsection.
``(2) Fiscal year 2010.--Subject to paragraph (4), for
services furnished on and after January 1, 2010, during fiscal
year 2010, the State plan shall provide for payment for such
services in an amount (calculated on a per visit or similar
basis as specified by the Secretary) that is equal to 100
percent of the average of the costs of the grantee of
furnishing such services during fiscal years 2008 and 2009
which are reasonable and related to the cost of furnishing such
services, or based on such other tests of reasonableness as the
Secretary prescribes in regulations under section 1833(a)(3),
or, in the case of services to which such regulations do not
apply, the same methodology used under section 1833(a)(3),
adjusted to take into account any increase or decrease in the
scope of such services furnished by the grantee during fiscal
year 2010.
``(3) Fiscal year 2011 and succeeding fiscal years.--
Subject to paragraph (4), for services furnished during fiscal
year 2011 or a succeeding fiscal year, the State plan shall
provide for payment for such services in an amount (calculated
on a per visit or similar basis) that is equal to the amount
calculated for such services under this subsection for the
preceding fiscal year--
``(A) increased by the percentage increase in the
MEI (as defined in section 1842(I)(3)) applicable to
primary care services (as defined in section
1842(I)(4)) for that fiscal year; and
``(B) adjusted to take into account any increase or
decrease in the scope of such services furnished by the
grantee during that fiscal year.
``(4) Establishment of initial year payment amount for new
grantees.--In any case in which an entity first becomes a
grantee after fiscal year 2009, the State plan shall provide
for payment for Medicaid covered services furnished by the
entity in the first fiscal year in which the entity so
qualifies in an amount (calculated on a per visit or similar
basis) that is equal to 100 percent of the costs of furnishing
such services during such fiscal year based on the rates
established under this subsection for the fiscal year for other
such grantees located in the same or adjacent area with a
similar case load or, in the absence of such a grantee, in
accordance with the regulations and methodology referred to in
paragraph (2) or based on such other tests of reasonableness as
the Secretary may specify. For each fiscal year following the
fiscal year in which the entity first qualifies, the State plan
shall provide for the payment amount to be calculated in
accordance with paragraph (3).
``(5) Administration in the case of managed care.--
``(A) In general.--In the case of services
furnished by a grantee pursuant to a contract between
the grantee and a managed care entity (as defined in
section 1932(a)(1)(B)), the State plan shall provide
for payment to the grantee by the State of a
supplemental payment equal to the amount (if any) by
which the amount determined under paragraphs (2), (3),
and (4) exceeds the amount of the payments provided
under the contract.
``(B) Payment schedule.--The supplemental payment
required under subparagraph (A) shall be made pursuant
to a payment schedule agreed to by the State and the
grantee, but in no case less frequently than every 4
months.
``(6) Alternative payment methodologies.--Notwithstanding
any other provision of this section, the State plan may provide
for payment in any fiscal year to a grantee for Medicaid
covered services in an amount which is determined under an
alternative payment methodology that--
``(A) is agreed to by the State and the grantee;
and
``(B) results in payment to the grantee of an
amount which is at least equal to the amount otherwise
required to be paid to the grantee under this
subsection.''.
(b) Effective Date.--
(1) Except as provided in paragraph (2), the amendments
made by subsection (a) shall apply to services furnished on or
after January 1, 2010, without regard to whether or not final
regulations to carry out such amendment shave been promulgated
by such date.
(2) In the case of a State plan for medical assistance
under title XIX of the Social Security Act which the Secretary
of Health and Human Services determines requires State
legislation (other than legislation appropriating funds) in
order for the plan to meet the additional requirement imposed
by the amendments made by subsection (a), the State plan shall
not be regarded as failing to comply with the requirements of
such title solely on the basis of its failure to meet this
additional requirement before the first day of the first
calendar quarter beginning after the close of the first regular
session of the State legislature that begins after the date of
the enactment of this Act. For purposes of the previous
sentence, in the case of a State that has a 2-year legislative
session, each year of such session shall be deemed to be a
separate regular session of the State legislature.
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