1.This Act may be cited as the
Ryan White Grantee Medicaid Payment Equity Act of
2009
.
2.Medicaid payment
for services furnished by Ryan White part C grantees on a cost-based
prospective payment system
(a)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)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)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 yearsSubject 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 granteesIn 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 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)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 methodologiesNotwithstanding 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)
(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.