1.This Act may be cited as
the Nurse-Managed Health Clinic
Investment Act of 2009
.
2.
(a)Congress
makes the following findings:
(1)Nurse-managed
health clinics (referred to in this section as NMHCs
) offer
their patients primary care and wellness services based on the nursing model,
which emphasizes the protection, promotion, and optimization of health along
with the prevention of illness, and the alleviation of suffering in conjunction
with diagnosis and treatment. Nurses are advocates and educators providing care
for individuals, families, communities, and populations.
(2)More than 200
NMHCs are currently in operation across the United States. Such clinics record
over 2,000,000 client encounters annually.
(3)NMHCs offering
primary care services meet the Institute of Medicine’s definition of safety-net
provider by providing care regardless of their patients' ability to pay. A
substantial share of the patient mix is made up of uninsured individuals,
Medicaid recipients, State Children's Health Insurance Program recipients, and
other vulnerable populations. A recent study funded by the Centers for Medicare
& Medicaid Services reported that more than 45 percent of the payor mix for
NMHCs is uninsured, and 37 percent are Medicaid recipients.
(4)NMHC patients are
very diverse. According to recent data, 46 percent of NMHC patients are
Caucasian, 29 percent are African-American, and another 20 percent are
Latino.
(5)Approximately
133,000,000 people in the United States (45 percent of the population) have at
least 1 chronic disease. These diseases account for 81 percent of hospital
admissions, 91 percent of all prescriptions filled, and 76 percent of all
physician visits. About 75 percent of health care spending in the United States
is related to chronic care. Chronic disease management programs have the
potential to reduce costs and improve outcomes for chronically ill patients.
NMHCs providing wellness services strengthen the health care safety-net by
expanding access to chronic disease management services for geriatric and
medically underserved populations.
(6)NMHCs offering
primary care provide a medical home for medically underserved individuals, and
are viable partners with the Federal Government to reduce health disparities.
They provide a full range of health care services, including primary care,
wellness services, and behavioral health care to the residents of rural and
urban underserved communities. Because NMHCs are often located in public
housing developments, senior living arrangements, schools, and community
centers, they help remove barriers preventing access to care and are
instrumental in addressing and eliminating the factors contributing to health
disparities.
(7)NMHCs offering
wellness services reinforce the medical home concept by providing a critical
first level of care for populations living in rural areas with limited access
to physicians and other primary care providers. NMHC patients participating in
wellness services are connected to a medical home through established referral
networks.
(8)As new strategies
for increasing health coverage are implemented, utilization of nurse-managed
health clinics offering both primary care and wellness services will help meet
the increased demand arising from newly covered individuals while alleviating
current primary care physician shortages.
(9)In spite of their
numerous benefits, NMHCs of all types have limited access to both Federal and
State funding. Initially, many NMHCs were established through grants from the
Division of Nursing of the Health Resources and Services Administration
(referred to in this paragraph as the Division of Nursing
). Soon
after their inception, NMHC directors recognized their patients had a desperate
need for primary care and wellness services, a need that continues. To meet
that need, NHMCs across the country have expanded their mission to focus on
increasing access to primary care and wellness services the medically
underserved populations, while still maintaining their role as clinical sites
for nursing education. Available sources of Division of Nursing grant funding
cannot accommodate the increased cost associated with caring for the uninsured
and medically underserved populations that has accompanied the expanding focus
of nurse-managed care. As a result, 50 percent of the NMHCs established between
1993 and 2007 have had to close. Such clinics frequently are the only source of
health care for their patients, and such closures have left thousands without
health care.
(10)In recognition
of the growing needs of NMHCs, in Senate Report 109–103, Congress called on the
Bureau of Primary Health Care (BPHC) to “consider establishing a grant program
… that would support the establishment or expansion of nurse practice
arrangements commonly referred to as nurse-managed health centers …”. The goal
of this Act is to comply with the language of such Senate Report by
establishing a grant program within BPHC that is a better fit for the changing
role of NMHCs. The program will give NMHCs access to a stable source of
funding, further enabling them to expand primary care and wellness services in
underserved communities, while reducing the level of health disparities that
vulnerable populations throughout the Nation face.
(b)It
is the purpose of this Act to fund the development and operation of
nurse-managed health clinics to—
(1)provide
comprehensive and accessible primary health care and wellness services to
vulnerable populations living in the Nation's medically underserved
communities; and
(2)reduce the level
of health disparities experienced by vulnerable populations.
3.Nurse-managed
health clinicsTitle III of
the Public Health Service Act (42 U.S.C. 241 et seq.) is amended by adding at
the end the following:
SNurse-managed
health clinic program
399JJ.Grants to
nurse–managed health clinics
(a)Definition;
establishment of criteriaIn this section:
(1)Nurse-managed
health clinic or NMHC
The term nurse-managed
health clinic or NMHC means a nurse-practice arrangement,
managed by advanced practice nurses, that provides primary care or wellness
services to underserved or vulnerable populations and is associated with a
school, college, university, or department of nursing, federally qualified
health center, or an independent nonprofit health or social services
agency.
(2)Medically
underserved populationsThe term medically underserved
population has the meaning given such term in section 330(b)(3).
(3)The term vulnerable population means a
population that lacks access to adequate primary care or suffers from increased
health disparities due to factors such as health, age, race, ethnicity, sex,
insurance status, income level, or ability to communicate effectively.
(4)Behavioral
health care servicesThe term behavioral health care
services means health care related to adult, family, and pediatric
emotional health and well-being and consists of identifying, assessing, and
defining mental health problems and developing a plan of care, which may
include psychopharmacological management, education about specific mental
illnesses, or basic counseling services that are furnished by qualified health
care professionals.
(5)Comprehensive
primary health care servicesThe term comprehensive primary
health care services means health care related to adult, family, and
pediatric health and consisting of adult health, pediatrics, obstetrics, or
gynecology services that are furnished by nurse practitioners, physician
assistants, physicians, nurse midwives, clinical nurse specialists, other
advanced practice nurses, or other qualified health care professionals. In
addition to primary care services, specific services may include—
(A)preventive health
services;
(B)prenatal and
perinatal services;
(C)appropriate
cancer screening;
(D)well-child
services;
(E)immunizations
against vaccine-preventable diseases;
(F)screenings for
elevated blood lead levels;
(G)screening for
communicable diseases;
(H)cholesterol
screenings;
(I)pediatric eye and
ear screenings to determine the need for vision and hearing correction;
(J)emergency medical
services;
(K)diagnostic
laboratory and radiologic services;
(L)care navigation
services;
(M)pharmaceutical
services, as may be appropriate for each clinic; and
(N)voluntary family
planning.
(6)The term wellness services means any
health-related service or intervention, not including primary care, which is
designed to reduce identifiable health risks and increase healthy behaviors
intended to prevent the onset of disease or lessen the impact of existing
chronic conditions by teaching more effective management techniques that focus
on individual self-care and patient-driven decisionmaking. Specific services
may include—
(A)chronic disease
self-management training;
(B)health screenings
relating to hypertension, diabetes, cancer, HIV, lead exposure, and other
chronic conditions;
(C)health and
patient education;
(D)immunizations
against vaccine-preventable diseases;
(E)outreach and home
visiting services;
(F)environmental
health risk reduction services;
(G)case management
services;
(H)interpretation
and translation services;
(I)weight control
programs;
(J)smoking cessation
programs;
(K)physical activity
and fitness programs involving geriatric, youth, and other vulnerable
populations;
(L)occupational
safety and health; and
(M)cognitive
behavioral services.
(b)Authority To
award grantsThe Secretary shall award grants for the cost of the
operation of NMHCs that meet the requirements of this section.
(c)To
be eligible to receive a grant under this section, an entity shall—
(1)be a NMHC;
and
(2)submit to the
Secretary an application at such time, in such manner, and containing—
(A)an assurance that
the NMHC provides direct access to client-centered nursing services with access
to other health care services and that nurses are the major service providers
at the NMHC;
(B)evidence that an
advanced practice nurse (APN
) holds an executive management
position within the organizational structure of the NMHC and that an APN has
direct responsibility for overseeing the daily operations of the NMHC;
(C)an assurance that
the NMHC will continue to provide comprehensive primary care services or
wellness services for the duration of the grant period;
(D)an assurance that
the nurse-managed health clinic will establish, not later than 90 days after
receiving a grant under this section, a community advisory committee composed
of individuals, a majority of whom are being served by the clinic, the purpose
of which is to provide input into the nurse-managed health clinic
decisionmaking process;
(E)an assurance that
the NMHC will demonstrate the receipt of non-Federal matching funds equaling at
least 20 percent of the Federal portion of any grant awarded under this
section, and evidence that the necessary matching funds will be acquired not
later than 180 days after receiving the grant; and
(F)an assurance that
the NMHC will provide care regardless of the insurance status or income of a
patient.
(d)The Secretary may, upon a showing of good cause,
waive any aspect of the matching funds requirement described in subsection
(c)(2)(E).
(e)
(1)Funds awarded under a grant under this section may be
used for the provision of primary care services and wellness services, for the
management of NMHC programs, for the payment of salaries for NMHC personnel,
and for providing training for the provision of required health services. Funds
may also be used for acquiring and leasing buildings and equipment (including
the cost of amortizing the principle of, and paying interest on, loans for such
buildings and equipment).
(2)The
amount of any grant made in any fiscal year to a NMHC shall be determined by
the Secretary, taking into account—
(A)the financial
need of the NMHC;
(B)State, local, and
other operational funding provided to the NMHC; and
(C)other factors as
determined appropriate by the Secretary.
(f)
(1)The Secretary shall establish a program through which the
Secretary shall provide (either through the Department of Health and Human
Services or by grant or contract) technical and other assistance to NMHCs to
assist such clinics in meeting the requirements of this section. In determining
appropriate providers to assist in offering technical assistance, the Secretary
shall consider whether the provider has demonstrated the capacity to
effectively address the unique needs of NMHCs.
(2)Services provided under this section may include
necessary technical and nonfinancial assistance, including fiscal and program
management assistance, training in fiscal and program management, operational
and administrative support, and the provision of information to NMHC regarding
the various resources available under this section and how those resources can
best be used to meet the health needs of the communities served by
NMHCs.
(g)The
Secretary shall develop and implement a plan for evaluating NMHCs funded under
this section. Such evaluations shall monitor and track the performance of the
grantee as well as the quality of the services that are provided under the
grant.
(h)Authorization
of appropriationsFor the purposes of carrying out this section,
there are authorized to be appropriated $50,000,000 for fiscal year 2010, and
such sums as may be necessary for each of fiscal years 2011 through
2014.
.