[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 652 Introduced in Senate (IS)]
111th CONGRESS
1st Session
S. 652
To authorize the Secretary of Health and Human Services to make grants
to community health coalitions to assist in the development of
integrated health care delivery, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 19, 2009
Mrs. Murray introduced the following bill; which was read twice and
referred to the Committee on Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To authorize the Secretary of Health and Human Services to make grants
to community health coalitions to assist in the development of
integrated health care delivery, and for other purposes.
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 ``Community Coalitions for Access and
Quality Improvement Act of 2009''.
SEC. 2. PURPOSE.
The purpose of this Act is to provide assistance to community
health coalitions as described in section 3(b) with a clearly defined
local need to increase access to and improve the quality of health care
services through activities which--
(1) develop or strengthen coordination of services to allow
all individuals, including the uninsured and low-income, to
receive efficient and higher quality care and to gain entry
into and receive services from a comprehensive system of
medical, dental, pharmaceutical, and behavioral health care;
(2) develop efficient and sustainable infrastructure for a
health care delivery system characterized by effective
collaboration, information sharing, and clinical and financial
coordination among all types of providers of care in the
community; and
(3) develop or strengthen activities related to providing
coordinated care for individuals with chronic conditions.
SEC. 3. GRANTS TO STRENGTHEN THE EFFECTIVENESS, EFFICIENCY, AND
COORDINATION OF SERVICES.
(a) In General.--The Secretary of Health and Human Services (in
this Act referred to as the ``Secretary'') shall award grants to assist
in the development of integrated health care delivery systems to serve
defined communities of individuals--
(1) to improve the efficiency of and coordination among the
providers providing services through such systems;
(2) to assist local communities in developing programs
targeted toward preventing and managing chronic diseases; and
(3) to expand and enhance the services provided through
such systems.
(b) Eligible Entities.--To be eligible to receive a grant under
this section, an entity shall be an entity that--
(1) represents a balanced consortium--
(A) whose principal purpose is to ensure the
sustainable capacity for the provision of a broad range
of coordinated services for all residents within a
community defined in the entity's grant application as
described in paragraph (2); and
(B) that includes at least one of each of the
following providers that serve the community (unless
such provider does not exist within the community,
declines or refuses to participate, or places
unreasonable conditions on their participation)--
(i) a federally qualified health center (as
defined in section 1861(aa) of the Social
Security Act (42 U.S.C. 1395x(aa)));
(ii) rural health clinics and rural health
networks (as defined in sections 1861(aa) and
1820(d) of the Social Security Act,
respectively (42 U.S.C. 1395x(aa), 1395i-
4(d)));
(iii) a hospital with a low-income
utilization rate that is greater than 25
percent (as defined in section 1923(b)(3) of
the Social Security Act (42 U.S.C. 1396r-
4(b)(3))) or a critical access hospital (as
defined in section 1820(c)(2) of the Social
Security Act (42 U.S.C. 1395i-4(c)(2)));
(iv) a public health department; and
(v) an interested public or private sector
health care provider or an organization that
has traditionally served the medically
uninsured and low-income individuals; and
(2) submits to the Secretary an application, in such form
and manner as the Secretary shall prescribe, that--
(A) clearly defines the community to be served;
(B) identifies the providers who will participate
in the community coalition under the grant and
specifies each provider's contribution to the care of
individuals in the community;
(C) describes the activities that the applicant and
the community coalition propose to perform under the
grant to further the objectives of this section;
(D) demonstrates that it is an established
coalition with ability to build on the current system
for serving the community by involving providers who
have traditionally provided a significant volume of
care for uninsured and low-income individuals for that
community;
(E) demonstrates the coalition's ability to develop
coordinated systems of care that either directly
provide or ensure the prompt provision of a broad range
of high-quality, accessible services, including, as
appropriate, primary, secondary, and tertiary services
as well as pharmacy, substance abuse, behavioral health
and oral health services, in a manner that ensures
continuity of care in the community;
(F) provides evidence of community involvement,
including the business community, in the development,
implementation, and direction of the system of care
that the coalition proposes to ensure;
(G) demonstrates the coalition's ability to ensure
that participating individuals are enrolled in health
care coverage programs, both public and private, for
which the individuals are eligible;
(H) presents a plan for leveraging other sources of
revenue, which may include State and local sources and
private grant funds, and integrating current and
proposed new funding sources in a manner to ensure
long-term sustainability of the system of care;
(I) describes a plan for evaluation of the
activities carried out under the grant, including
measurement of progress toward the goals and objectives
of the program and the use of evaluation findings to
improve system performance;
(J) demonstrates fiscal responsibility through the
use of appropriate accounting procedures and management
systems;
(K) demonstrates commitment to serve the community
without regard to the ability of an individual or
family to pay by arranging for or providing free or
reduced charge care for the poor; and
(L) includes such other information as the
Secretary may prescribe.
(c) Limitations.--
(1) In general.--An eligible entity may receive a grant
under this section for 3 consecutive fiscal years and may
receive such a grant award for 2 additional years if--
(A) the eligible entity submits to the Secretary a
request for a grant for such additional years;
(B) the Secretary determines that current
performance justifies the granting of such a request;
and
(C) the Secretary determines that granting such
request is necessary to further the objectives
described in subsection (a).
(d) Priorities.--In awarding grants under this section, the
Secretary--
(1) may accord priority to applicants that demonstrate the
greatest extent of unmet need in the community for a more
coordinated system of care; and
(2) shall accord priority to applicants that best promote
the objectives of this section, taking into consideration the
extent to which the applicant--
(A) identifies a community whose geographical area
has a high or increasing percentage of individuals who
are uninsured or low-income;
(B) demonstrates that the applicant has included in
its community coalition providers, support systems, and
programs that have a tradition of serving individuals
and families in the community who are uninsured or earn
below 200 percent of the Federal poverty level;
(C) shows evidence that the proposed coalition
activities would expand utilization of preventive and
primary care services for uninsured and underinsured
individuals and families in the community, including
pharmaceuticals, behavioral and mental health services,
oral health services, or substance abuse services;
(D) proposes approaches that would improve
coordination between health care providers and
appropriate social service providers;
(E) demonstrates collaboration with State and local
governments;
(F) demonstrates that the applicant makes use of
non-Federal contributions to the greatest extent
possible; or
(G) demonstrates likelihood that the proposed
activities will lead to sustainable integrated delivery
system as additional efforts of health systems
development evolve.
(e) Use of Funds.--
(1) Use by grantees.--
(A) In general.--Except as provided in paragraphs
(2) and (3), a grantee may use amounts provided under
this section only for--
(i) direct expenses associated with
achieving the greater integration of a health
care delivery system so that the system either
directly provides or ensures the provision of a
broad range of culturally competent services,
including as appropriate primary, secondary,
and tertiary care and oral health, substance
abuse, behavioral and mental health, and
pharmaceutical services; and
(ii) direct patient care and service
expansions to fill identified or documented
gaps within an integrated delivery system.
(B) Specific uses.--The following are examples of
purposes for which a grantee may use grant funds under
this section, when such use meets the conditions stated
in subparagraph (A):
(i) Increases in outreach activities and
closing gaps in health care service, including
referral to specialty services and prescription
drugs and conducting ongoing outreach to health
disparity populations.
(ii) Improvements to care management and
delivery of patient-centered care, including
patient navigation services.
(iii) Improvements to coordination of
transportation to health care facilities.
(iv) Development of provider networks and
other innovative models to engage physicians in
voluntary efforts to serve the medically
underserved within a community.
(v) Recruitment, training, and compensation
of necessary personnel.
(vi) Coordinate the acquisition or
interconnected use of technology within a
community for the purpose of coordinating care
and improving provider communication, including
implementation of shared information systems or
shared clinical systems to improve the quality
of health care.
(vii) Development of common processes such
as mechanisms for determining eligibility for
the programs provided through the system,
common identification cards, sliding scale
discounts, and monitoring and tracking of
outcomes.
(viii) Development of specific prevention
and disease management tools and processes.
(ix) Language access services.
(x) Facilitating the involvement of
community organizations to provide better
access to high-quality health care services to
individuals at risk for or who have chronic
diseases or cancer.
(xi) Helping patients overcome barriers
within the health care system to ensure prompt
diagnostic and treatment resolution of an
abnormal finding of cancer or chronic disease.
(2) Direct patient care limitation.--Not more than 20
percent of the funds provided under a grant awarded under this
section may be used for providing direct patient care and
services.
(3) Reservation of funds for national program purposes.--
The Secretary may use not more than 7 percent of funds
appropriated to carry out this section for providing technical
assistance to grantees, obtaining assistance of experts and
consultants, holding meetings, developing of tools,
disseminating of information, and evaluation.
(f) Reporting by Grantee.--A grantee under this section shall
report to the Secretary annually regarding--
(1) progress in meeting the goals and measurable objectives
set forth in the grant application submitted by the grantee
under subsection (b); and
(2) the extent to which activities conducted by such
grantee have--
(A) improved the effectiveness, efficiency, and
coordination of services for uninsured and low-income
individuals in the community served by such grantee,
using commonly accepted outcome measures;
(B) resulted in the provision of better quality
health care for individuals and families in the
community served; and
(C) resulted in the provision of health care to
such individuals at lower cost than would have been
possible in the absence of the activities conducted by
such grantee.
(g) Maintenance of Effort.--With respect to activities for which a
grant under this section is authorized, the Secretary may award such a
grant only if the applicant and each of the participating providers
agree that the grantee and each such provider will maintain its
expenditures of non-Federal funds for such activities at a level that
is not less then the level of such expenditures during the fiscal year
immediately preceding the fiscal year for which the applicant is
applying to receive such grant.
(h) Technical Assistance.--The Secretary may provide any entity
that receives a grant under this section with technical and other
nonfinancial assistance necessary to meet the requirements of this
section. The Secretary may choose to provide such assistance by
awarding a grant to, or entering into a contract with, a State or
national not-for-profit organization with expertise in building
successful community coalitions.
(i) Evaluation of Program.--Not later than September 30, 2014, the
Secretary shall prepare and submit to the appropriate committees of
Congress a report that describes the extent to which projects funded
under this section have been successful in improving the effectiveness,
efficiency, and coordination of services in the communities served by
such projects, including whether the projects resulted in the provision
of better quality health care for such individuals, and whether such
care was provided at lower costs than would have been provided in the
absence of such projects.
(j) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section--
(1) $75,000,000 for fiscal year 2010;
(2) $100,000,000 for fiscal year 2011;
(3) $125,000,000 for fiscal year 2012;
(4) $150,000,000 for fiscal year 2013; and
(5) $175,000,000 for fiscal year 2014.
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