[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.''.
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