[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 648 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                 S. 648

    To amend title XVIII of the Social Security Act to establish a 
    prospective payment system instead of the reasonable cost-based 
    reimbursement method for Medicare-covered services provided by 
  Federally qualified health centers and to expand the scope of such 
  covered services to account for expansions in the scope of services 
 provided by Federally qualified health centers since the inclusion of 
         such services for coverage under the Medicare program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 19, 2009

 Mr. Bingaman (for himself, Ms. Snowe, and Mr. Sanders) introduced the 
 following bill; which was read twice and referred to the Committee on 
                                Finance

_______________________________________________________________________

                                 A BILL


 
    To amend title XVIII of the Social Security Act to establish a 
    prospective payment system instead of the reasonable cost-based 
    reimbursement method for Medicare-covered services provided by 
  Federally qualified health centers and to expand the scope of such 
  covered services to account for expansions in the scope of services 
 provided by Federally qualified health centers since the inclusion of 
         such services for coverage under the Medicare program.

    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 ``Medicare Access to Community Health 
Centers (MATCH) Act of 2009''.

SEC. 2. FINDINGS.

    Congress finds that:
            (1) National importance.--Community health centers serve as 
        the medical home and family physician to over 16,000,000 people 
        nationally. Patients of community health centers represent 1 in 
        7 low-income persons, 1 in 8 uninsured Americans, 1 in 9 
        Medicaid beneficiaries, 1 in 10 minorities, and 1 in 10 rural 
        residents.
            (2) Health care safety net.--Because Federally qualified 
        health centers (FQHCs) are generally located in medically 
        underserved areas, the patients of Federally qualified health 
        centers are disproportionately low income, uninsured or 
        publicly insured, and minorities, and they frequently have 
        poorer health and more complicated, costly medical needs than 
        patients nationally. As a chief component of the health care 
        safety net, Federally qualified health centers are required by 
        regulation to serve all patients, regardless of insurance 
        status or ability to pay.
            (3) Medicare beneficiaries.--Medicare beneficiaries are 
        typically less healthy and, therefore, costlier to treat than 
        other patients of Federally qualified health centers. Medicare 
        beneficiaries tend to have more complex health care needs as--
                    (A) more than half of Medicare patients have at 
                least 2 chronic conditions;
                    (B) 45 percent take 5 or more medications; and
                    (C) over half of Medicare beneficiaries have more 
                than 1 prescribing physician.
            (4) Need to improve fqhc payment.--While the Centers for 
        Medicare & Medicaid Services have nearly 15 years' worth of 
        cost report data from Federally qualified health centers, which 
        would equip the agency to develop a new Medicare reimbursement 
        system, the agency has failed to update and improve the 
        Medicare FQHC payment system.

SEC. 3. EXPANSION OF MEDICARE-COVERED PRIMARY AND PREVENTIVE SERVICES 
              AT FEDERALLY QUALIFIED HEALTH CENTERS.

    (a) In General.--Section 1861(aa)(3) of the Social Security Act (42 

U.S.C. 1395x(aa)(3)) is amended to read as follows:
    ``(3) The term `Federally qualified health center services' means--
            ``(A) services of the type described in subparagraphs (A) 
        through (C) of paragraph (1), and such other ambulatory 
        services furnished by a Federally qualified health center for 
        which payment may otherwise be made under this title if such 
        services were furnished by a health care provider or health 
        care professional other than a Federally qualified health 
        center; and
            ``(B) preventive primary health services that a center is 
        required to provide under section 330 of the Public Health 
        Service Act,
when furnished to an individual as a patient of a Federally qualified 
health center and such services when provided by a health care provider 
or health care professional employed by or under contract with a 
Federally qualified health center and for this purpose, any reference 
to a rural health clinic or a physician described in paragraph (2)(B) 
is deemed a reference to a Federally qualified health center or a 
physician at the center, respectively. Services described in the 
previous sentence shall be treated as billable visits for purposes of 
payment to the Federally qualified health center.''.
    (b) Conforming Amendment To Permit Payment for Hospital-Based 
Services.--Section 1862(a)(14) of such Act (42 U.S.C. 1395y(a)(14)) is 
amended by inserting ``Federally qualified health center services,'' 
after ``qualified psychologist services,''.
    (c) Effective Dates.--The amendments made by subsections (a) and 
(b) shall apply to services furnished on or after January 1, 2010.

SEC. 4. ESTABLISHMENT OF A MEDICARE PROSPECTIVE PAYMENT SYSTEM FOR 
              FEDERALLY QUALIFIED HEALTH CENTER SERVICES.

    (a) In General.--Paragraph (3) section 1833(a) of the Social 
Security Act (42 U.S.C. 1395l(a)) is amended to read as follows:
            ``(3)(A) in the case of services described in section 
        1832(a)(2)(D)(i) the costs which are reasonable and related to 
        the furnishing of such services or which are based on such 
        other tests of reasonableness as the Secretary may prescribe in 
        regulations including those authorized under section 
        1861(v)(1)(A), less the amount a provider may charge as 
        described in clause (ii) of section 1866(a)(2)(A) but in no 
        case may the payment for such services (other than for items 
        and services described in section 1861(s)(10)(A)) exceed 80 
        percent of such costs; and
            ``(B) in the case of services described in section 
        1832(a)(2)(D)(ii) furnished by a Federally qualified health 
        center--
                    ``(i) subject to clauses (iii) and (iv), for 
                services furnished on and after January 1, 2010, during 
                the center's fiscal year that ends in 2010, an amount 
                (calculated on a per visit basis) that is equal to 100 
                percent of the average of the costs of the center of 
                furnishing such services during such center's fiscal 
                years ending during 2008 and 2009 which are reasonable 
                and related to the cost of furnishing such services, or 
                which are based on such other tests of reasonableness 
                as the Secretary prescribes in regulations including 
                those authorized under section 1861(v)(1)(A) (except 
                that in calculating such cost in a center's fiscal 
                years ending during 2008 and 2009 and applying the 
                average of such cost for a center's fiscal year ending 
                during fiscal year 2010, the Secretary shall not apply 
                a per visit payment limit or productivity screen), less 
                the amount a provider may charge as described in clause 
                (ii) of section 1866(a)(2)(A), but in no case may the 
                payment for such services (other than for items or 
                services described in section 1861(s)(10)(A)) exceed 80 
                percent of such average of such costs;
                    ``(ii) subject to clauses (iii) and (iv), for 
                services furnished during the center's fiscal year 
                ending during 2011 or a succeeding fiscal year, an 
                amount (calculated on a per visit basis and without the 
                application of a per visit limit or productivity 
                screen) that is equal to the amount determined under 
                this subparagraph for the center's preceding fiscal 
                year (without regard to any copayment)--
                            ``(I) increased for a center's fiscal year 
                        ending during 2011 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 2011 and increased 
                        for a center's fiscal year ending during 2012 
                        or any succeeding fiscal year by the percentage 
                        increase for such year of a market basket of 
                        Federally qualified health center costs as 
                        developed and promulgated through regulations 
                        by the Secretary; and
                            ``(II) adjusted to take into account any 
                        increase or decrease in the scope of services, 
                        including a change in the type, intensity, 
                        duration, or amount of services, furnished by 
                        the center during the center's fiscal year,
                less the amount a provider may charge as described in 
                clause (ii) of section 1866(a)(2)(A), but in no case 
                may the payment for such services (other than for items 
                or services described in section 1861(s)(10)(A)) exceed 
                80 percent of the amount determined under this clause 
                (without regard to any copayment);
                    ``(iii) subject to clause (iv), in the case of an 
                entity that first qualifies as a Federally qualified 
                health center in a center's fiscal year ending after 
                2009--
                            ``(I) for the first such center's fiscal 
                        year, an amount (calculated on a per visit 
                        basis and without the application of a per 
                        visit payment limit or productivity screen) 
                        that is equal to 100 percent of the costs of 
                        furnishing such services during such center's 
                        fiscal year based on the per visit payment 
                        rates established under clause (i) or (ii) for 
                        a comparable period for other such centers 
                        located in the same or adjacent areas with a 
                        similar caseload or, in the absence of such a 
                        center, in accordance with the regulations and 
                        methodology referred to in clause (i) or based 
                        on such other tests of reasonableness (without 
                        the application of a per visit payment limit or 
                        productivity screen) as the Secretary may 
                        specify, less the amount a provider may charge 
                        as described in clause (ii) of section 1866 
                        (a)(2)(A), but in no case may the payment for 
                        such services (other than for items and 
                        services described in section 1861(s)(10)(A)) 
                        exceed 80 percent of such costs; and
                            ``(II) for each succeeding center's fiscal 
                        year, the amount calculated in accordance with 
                        clause (ii); and
                    ``(iv) with respect to Federally qualified health 
                center services that are furnished to an individual 
                enrolled with a MA plan under part C pursuant to a 
                written agreement described in section 1853(a)(4) (or, 
                in the case of a MA private fee for service plan, 
                without such written agreement) the amount (if any) by 
                which--
                            ``(I) the amount of payment that would have 
                        otherwise been provided under clause (i), (ii), 
                        or (iii) (calculated as if `100 percent' were 
                        substituted for `80 percent' in such clauses) 
                        for such services if the individual had not 
                        been enrolled; exceeds
                            ``(II) the amount of the payments received 
                        under such written agreement (or, in the case 
                        of MA private fee for service plans, without 
                        such written agreement) for such services (not 
                        including any financial incentives provided for 
                        in such agreement such as risk pool payments, 
                        bonuses, or withholds) less the amount the 
                        Federally qualified health center may charge as 
                        described in section 1857(e)(3)(B);''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to services furnished on or after January 1, 2010.
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