[Congressional Record Volume 153, Number 157 (Wednesday, October 17, 2007)]
[Senate]
[Pages S12998-S13000]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN (for himself, Ms. Snowe, Mr. Salazar, Mr. Smith, 
        Mr. Akaka, and Mr. Sanders):
  S. 2188. 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

[[Page S12999]]

services provided by Federally qualified health centers since the 
inclusion of such services for coverage under the Medicare Program; to 
the Committee on Finance.
  Mr. BINGAMAN. Mr. President, I rise today with Senators Snowe, 
Salazar, Smith, Akaka, and Sanders to introduce the Medicare Access to 
Community Health Center, MATCH, Act, which would address a long 
standing problem for a key component of our Nation's health care safety 
net, community health centers. These facilities serve as medical homes 
to nearly 16 million underserved patients. Over 1 million of those 
patients are Medicare beneficiaries. Health centers are known for 
providing high quality, comprehensive care to some of our Nation's most 
vulnerable populations.
  Over 15 years ago, Congress created the Federally Qualified Health 
Center, FQHC, Medicare benefit to ensure that health centers were not 
forced to subsidize Medicare payments with Federal grant dollars. 
Congress required centers to be paid their reasonable costs for 
providing care to their patients. The Centers for Medicare and Medicaid 
Services later established a per visit payment cap in regulations based 
on a statute applicable to Rural Health Clinics. CMS applied the cap to 
FQHCs without meaningful data to support the payment limit but with the 
promise of future reviews to guarantee that health centers were 
adequately reimbursed. However, these reviews have not taken place. 
Now, 15 years later, over \3/4\ of health centers are losing money 
serving Medicare beneficiaries, with losses totaling over $50 million 
annually according to an analysis done by the National Association of 
Community Health Centers. In my home State of New Mexico, NACHC 
estimates that health centers have lost more than a million dollars 
annually.
  I have repeatedly asked CMS to review this antiquated cap but I have 
had little success. So I rise today to introduce legislation to improve 
the Medicare payment mechanism for FQHCs. MATCH will establish a 
Prospective Payment System for FQHCs, based on actual cost of providing 
care to health center patients. This new mechanism mirrors the 
successful Medicaid FQHC Prospective Payment System. By reforming the 
payment structure at FQHCs, we will ensure health centers are able to 
dedicate their Federal grant dollars for their original intent, 
providing care to the uninsured. This new mechanism will also increase 
efficiency and stability in the Medicare program for health centers.
  This legislation is long overdue. I ask my colleagues to join me in 
strengthening the Medicare FQHC program to ensure that health centers 
can continue to provide high quality, affordable primary and preventive 
care to our Nation's seniors and people with disabilities.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the text of the bill was ordered to be 
placed in the Record, as follows:

                                S. 2188

       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 2007''.

     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, 2008.

     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 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, 2008, during the center's 
     fiscal year that ends in 2008, 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 2006 and 2007 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 2006 and 2007 and applying the average of 
     such cost for a center's fiscal year ending during fiscal 
     year 2008, 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 2009 
     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 
     2009 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 2009 and increased for a 
     center's fiscal year ending during 2010 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,


[[Page S13000]]


     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 2007--
       ``(I) for the first such center 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 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 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 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 clauses (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, 
     2008.
                                 ______