[Congressional Record Volume 149, Number 43 (Tuesday, March 18, 2003)]
[Senate]
[Pages S3901-S3902]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. SNOWE (for herself, Mr. Bingaman, Mr. Bond, and Mr. 
        Hollings):
  S. 654. A bill to amend title XVIII of the Social Security Act to 
enhance the access of medicare beneficiaries who live in medically 
underserved areas to critical primary and preventive health care 
benefits, to improve the Medicare+Choice program, and for other 
purposes; to the Committee on Finance.
  Ms. SNOWE. Mr. President, I rise today to introduce the ``Medicare 
Safety Net Act of 2003.'' I am particularly pleased to introduce this 
bill with my good friend and colleague, Senator Bingaman. Last year we 
worked together on this bill, and I am confident that with the 
modifications that we made to the legislation, we will be able to get 
it enacted into law.
  This legislation will improve Medicare beneficiaries' access to 
primary care services and preventative treatments by increasing access 
to Community Health Centers. Community Health Centers, also known as 
federally qualified health centers, provide care to more than 1 million 
medically underserved Medicare beneficiaries. In many cases, Community 
Health Centers are the only source of primary and preventive services 
to which Medicare beneficiaries have access. This is especially true 
for people living in America's rural medically underserved areas.
  In Maine, nearly 20 percent of all Community Health Center patients 
are on Medicare, and this figure is expected to rise dramatically in 
the coming years as 25 percent of health center patients will be aging 
into Medicare in the upcoming decades.
  Besides primary and preventive care services, Community Health 
Centers provide other crucial services to seniors and the disabled, 
including treatment of chronic diseases, like diabetes and 
hypertension, mental health services and prescribed medications. 
Community Health Centers also provide transportation services or 
arrange for transportation that allows seniors to access health care in 
the absence of public transportation or a personal vehicle. In short, 
Community Health Centers provide the ease of ``one-stop health care 
shopping,'' meaning that seniors, instead of moving from location to 
location to receive comprehensive primary health services, typically 
can receive all of their essential primary care in one place.
  The Medicare Safety Net Access Act makes four changes to the Medicare 
program to ensure that Community Health Centers can fully participate 
in the Medicare program and provide seniors with the vital services. 
Ensuring that Medicare pays its fair share is important to the 
stability of Community Health Centers. While one in five of all Health 
Center patients in Maine are Medicare beneficiaries, Medicare 
represents only 17 percent of total Health Center revenues. For Health 
Centers to remain a viable part of the health care delivery system, we 
must make changes.
  Because Medicare currently does not reimburse health centers for the 
full cost of providing many vital services, like mammograms, nutrition 
assistance, laboratory and x-rays, health centers must utilize federal 
grant funding intended to serve the uninsured to cover these costs. 
This bill will require that Medicare, like state Medicaid programs, 
allow health centers to provide all Medicare-covered ambulatory 
services to Medicare beneficiaries in their communities.
  Further, Community Health Centers face many challenges in their fight 
to remain in business and serve their communities. In rural communities 
that have Community Health Centers, the health center physicians often 
continue treating patients when they enter long-term care facilities, 
such as a nursing home. And while Congress took steps to ensure that 
the new SNF prospective payment system did not adversely affect this 
relationship, it was not successful in identifying all of the services 
that are provided. This bill will add health centers to the current 
list of providers that can bill for services provided to patients in a 
hospital or nursing home.
  Given the role that Health Centers play in serving low-income and 
uninsured members of the community, providers often are willing to 
establish special arrangements with the Health Centers to provide 
additional assistance to these clients. An example of this type of 
arrangement is offering a reduced price for laboratory work for clients 
of a Community Health Center. However, under Federal anti-kickback laws 
this and other arrangements could be deemed illegal. Given the 
importance of developing community support for Health Centers and the 
need to encourage private-public partnerships to ensure that community 
financial support exists to care for low-income and uninsured 
individuals, this bill creates a safe harbor under the anti-kickback 
statute.
  The final step that this legislation takes to improve access to 
primary and preventative services for Medicare beneficiaries is to 
ensure that Medicare covers a Community Health Center's cost of 
providing care to

[[Page S3902]]

Medicare+Choice beneficiaries. While the federal government requires 
Medicare, under the traditional fee-for-service program, to reimburse 
health centers for their cost to deliver care to beneficiaries, the 
same requirement does not exist for Medicare+Choice plans. This bill 
would require Medicare, like the Medicaid program, to provide wrap-
around payments covering the difference between the amount paid to the 
health center under the managed care arrangement and the amount the 
health center would have received under traditional Medicare.
  By making these four straightforward changes, we will be able to 
enhance the care that all Medicare beneficiaries receive, especially 
those living in underserved communities. And we will ensure that 
Medicare patients are not diluting federal funding intended to help the 
41 million Americans that were uninsured in 2001.
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