[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 486 Introduced in Senate (IS)]
111th CONGRESS
1st Session
S. 486
To achieve access to comprehensive primary health care services for all
Americans and to reform the organization of primary care delivery
through an expansion of the Community Health Center and National Health
Service Corps programs.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
February 26, 2009
Mr. Sanders (for himself, Mr. Begich, Mr. Bingaman, Mrs. Boxer, Mr.
Brown, Mr. Burris, Mr. Cardin, Mr. Casey, Mr. Durbin, Mr. Harkin, Mr.
Inouye, Mr. Kennedy, Mr. Kerry, Mr. Johnson, Mr. Leahy, Mr. Menendez,
Mr. Merkley, Ms. Mikulski, Mr. Schumer, Ms. Stabenow, Mr. Tester, and
Mr. Wyden) introduced the following bill; which was read twice and
referred to the Committee on Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To achieve access to comprehensive primary health care services for all
Americans and to reform the organization of primary care delivery
through an expansion of the Community Health Center and National Health
Service Corps programs.
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 ``Access for All America Act''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) Providing universal coverage for health care for all
Americans will be incomplete if access to medical and other
health services is not improved.
(2) Currently, 56,000,000 Americans, both insured and
uninsured, have inadequate access to primary care due to a
shortage of physicians and other like providers in their
community.
(3) Several demonstrations are underway at the Federal and
State level to link patients to a primary care ``medical home''
as a means of assuring access, controlling costs, and improving
quality.
(4) Yet, there already exists a proven medical home model
that accomplishes these goals and has done so over the past 40
years while serving over 18,000,000 Americans.
(5) Community health centers, also known as Federally
Qualified Health Centers (FQHCs), have been found to more than
pay for themselves by providing coordinated, comprehensive
medical, dental, behavioral health, and prescription drug
services that reduce unnecessary emergency room visits,
ambulatory-sensitive hospitalizations, and avoidable specialty
care.
(6) The result is that the American Academy of Family
Physicians' Robert Graham Center found that medical expenses
for health center patients are 41 percent lower compared to
patients seen elsewhere, an average savings of $1,810 per
person per year.
(7) The Lewin Group found that providing access to a
medical home for every American would produce health care
savings of $67,000,000,000 per year, more than 8 times the
subsidy needed to sustain the 1,100 current health centers and
to create 3,900 new or expanded health center sites to
accomplish full access.
(8) Hand in hand with the expansion of the community health
center program, a renewed investment in the National Health
Service Corps is essential to reverse the decline in the supply
of primary care physicians and dentists.
(9) Both the expansion of the community health center
program and the investment in the National Health Service Corps
can be accomplished for less than 1 percent of total health
care spending today.
(10) Finally, to encourage broader adoption of the cost-
effective community health center model of care beyond
underserved areas and populations and to encourage the pursuit
and practice of primary care as a career, all willing primary
care practitioners should be encouraged to collaborate with
community health centers.
SEC. 3. SPENDING FOR FEDERALLY QUALIFIED HEALTH CENTERS (FQHCS).
Section 330(r) of the Public Health Service Act (42 U.S.C. 254b(r))
is amended by striking paragraph (1) and inserting the following:
``(1) General amounts for grants.--For the purpose of
carrying out this section, in addition to the amounts
authorized to be appropriated under subsection (d), there is
authorized to be appropriated the following:
``(A) For fiscal year 2010, $2,988,821,592.
``(B) For fiscal year 2011, $3,862,107,440.
``(C) For fiscal year 2012, $4,990,553,440.
``(D) For fiscal year 2013, $6,448,713,307.
``(E) For fiscal year 2014, $7,332,924,155.
``(F) For fiscal year 2015, $8,332,924,155.
``(G) For fiscal year 2016, and each subsequent
fiscal year, the amount appropriated for the preceding
fiscal year adjusted by the product of--
``(i) one plus the average percentage
increase in costs incurred per patient served;
and
``(ii) one plus the average percentage
increase in the total number of patients
served.''.
SEC. 4. OTHER PROVISIONS.
(a) Settings for Service Delivery.--Section 330(a)(1) of the Public
Health Service Act (42 U.S.C. 254b(a)(1)) is amended by adding at the
end the following: ``Required primary health services and additional
health services may be provided either at facilities directly operated
by the center or at any other inpatient or outpatient settings
determined appropriate by the center to meet the needs of its
patents.''.
(b) Location of Service Delivery Sites.--Section 330(a) of the
Public Health Service Act (42 U.S.C. 254b(a)) is amended by adding at
the end the following:
``(3) Considerations.--
``(A) Location of sites.--Subject to subparagraph
(B), a center shall not be required to locate its
service facility or facilities within a designated
medically underserved area in order to serve either the
residents of its catchment area or a special medically
underserved population comprised of migratory and
seasonal agricultural workers, the homeless, or
residents of public housing, if that location is
determined by the center to be reasonably accessible to
and appropriate to meet the needs of the medically
underserved residents of the center's catchment area or
the special medically underserved population, in
accordance with subparagraphs (A) and (J) of subsection
(k)(3).
``(B) Location within another center's area.--The
Secretary may permit applicants for grants under this
section to propose the location of a service delivery
site within another center's catchment area if the
applicant demonstrates sufficient unmet need in such
area and can otherwise justify the need for additional
Federal resources in the catchment area. In determining
whether to approve such a proposal, the Secretary shall
take into consideration whether collaboration between
the two centers exists, or whether the applicant has
made reasonable attempts to establish such
collaboration, and shall consider any comments timely
submitted by the affected center concerning the
potential impact of the proposal on the availability or
accessibility of services the affected center currently
provides or the financial viability of the affected
center.''.
(c) Affiliation Agreements.--Section 330(k)(3)(B) of the Public
Health Service Act (42 U.S.C. 254b(k)(3)(B)) is amended by inserting
before the semicolon the following: ``, including contractual
arrangements as appropriate, while maintaining full compliance with the
requirements of this section, including the requirements of
subparagraph (H) concerning the composition and authorities of the
center's governing board, and, except as otherwise provided in clause
(ii) of such subparagraph, ensuring full autonomy of the center over
policies, direction, and operations related to health care delivery,
personnel, finances, and quality assurance''.
(d) Governance Requirements.--Section 330(k)(3) of the Public
Health Service Act (42 U.S.C. 254b(k)(3)) is amended--
(1) in subparagraph (H)--
(A) in clause (ii), strike ``; and'' and inserting
``, except that in the case of a public center (as
defined in the second sentence of this paragraph), the
public entity may retain authority to establish
financial and personnel policies for the center; and'';
(B) in clause (iii), by adding ``and'' at the end;
and
(C) by inserting after clause (iii) the following:
``(iv) in the case of a co-applicant with a
public entity, meets the requirements of
clauses (i) and (ii);''; and
(2) in the second sentence, by inserting before the period
the following: ``that is governed by a board that satisfies the
requirements of subparagraph (H) or that jointly applies (or
has applied) for funding with a co-applicant board that meets
such requirements''.
(e) Adjustment in Center's Operating Plan and Budget.--Section
330(k)(3)(I)(i) of the Public Health Service Act (42 U.S.C.
254b(k)(3)(I)(i)) is amended by adding before the semicolon the
following: ``, which may be modified by the center at any time during
the fiscal year involved if such modifications do not require
additional grant funds, do not compromise the availability or
accessibility of services currently provided by the center, and
otherwise meet the conditions of subsection (a)(3)(B), except that any
such modifications that do not comply with this clause, as determined
by the health center, shall be submitted to the Secretary for
approval''.
(f) Joint Purchasing Arrangements for Reduced Cost.--Section 330(l)
of the Public Health Service Act (42 U.S.C. 254b(l)) is amended--
(1) by striking ``The Secretary'' and inserting the
following:
``(1) In general.--The Secretary''; and
(2) by adding at the end the following:
``(2) Assistance with supplies and services costs.--The
Secretary, directly or through grants or contracts, may carry
out projects to establish and administer arrangements under
which the costs of providing the supplies and services needed
for the operation of federally qualified health centers are
reduced through collaborative efforts of the centers, through
making purchases that apply to multiple centers, or through
such other methods as the Secretary determines to be
appropriate.''.
(g) Opportunity To Correct Material Failure Regarding Grant
Conditions.--Section 330(e) of the Public Health Service Act (42 U.S.C.
254b(e)) is amended by adding at the end the following:
``(6) Opportunity to correct material failure regarding
grant conditions.--If the Secretary finds that a center
materially fails to meet any requirement (except for any
requirements waived by the Secretary) necessary to qualify for
its grant under this subsection, the Secretary shall provide
the center with an opportunity to achieve compliance (over a
period of up to 1 year from making such finding) before
terminating the center's grant. A center may appeal and obtain
an impartial review of any Secretarial determination made with
respect to a grant under this subsection, or may appeal and
receive a fair hearing on any Secretarial determination
involving termination of the center's grant entitlement,
modification of the center's service area, termination of a
medically underserved population designation within the
center's service area, disallowance of any grant expenditures,
or a significant reduction in a center's grant amount.''.
SEC. 5. FUNDING FOR NATIONAL HEALTH SERVICE CORPS.
Section 338H(a) of the Public Health Service Act (42 U.S.C.
254q(a)) is amended to read as follows:
``(a) Authorization of Appropriations.--For the purpose of carrying
out this section, there is authorized to be appropriated, out of any
funds in the Treasury not otherwise appropriated, the following:
``(1) For fiscal year 2010, $320,461,632.
``(2) For fiscal year 2011, $414,095,394.
``(3) For fiscal year 2012, $535,087,442.
``(4) For fiscal year 2013, $691,431,432.
``(5) For fiscal year 2014, $893,456,433.
``(6) For fiscal year 2015, $1,154,510,336.
``(7) For fiscal year 2016, and each subsequent fiscal
year, the amount appropriated for the preceding fiscal year
adjusted by the product of--
``(A) one plus the average percentage increase in
the costs of health professions education during the
prior fiscal year; and
``(B) one plus the average percentage change in the
number of individuals residing in health professions
shortage areas designated under section 333 during the
prior fiscal year, relative to the number of
individuals residing in such areas during the previous
fiscal year.''.
<all>