[Congressional Record Volume 155, Number 48 (Thursday, March 19, 2009)]
[Senate]
[Pages S3556-S3557]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN (for himself, Ms. Snowe, and Mr. Sanders):
  S. 648. 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; to the Committee 
on Finance.
  Mr. BINGAMAN. Mr. president, I rise today with Senators Snowe and 
Sanders to introduce the Medicare Access to Community Health Centers, 
MATCH, Act of 2009.
  This legislation addresses a long standing payment issue experienced 
by a key component of our Nation's health care safety net, community 
health centers. These centers provide high quality, comprehensive care 
and serve as the medical home to 18 millions individuals. Over one 
million of those patients are medicare beneficiaries.
  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 that centers be paid their reasonable costs for 
providing care to their Medicare patients. The centers for Medicare and 
Medicaid Services, CMS, later established a per visit payment cap in 
regulations based on a payment cap applicable to Rural Health Clinics. 
CMS applied the cap to FQHCs without much data support and with the 
promise of future reviews to guarantee that Health Centers were 
adequately reimbursed. However, these reviews have not taken place. 
Currently, over 75 percent 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, NACHC. In my home State of New Mexico, NACHC estimates 
that health centers lose 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. The MATCH Act will establish 
a Prospective Payment System for FQHCs, based on the 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.
  Mr. President, 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 
printed in the Record, as follows:

                                 S. 648

       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

[[Page S3557]]

     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.

  Ms. SNOWE. Mr. President, I rise today to join Senator Bingaman to 
introduce legislation to rectify a long standing problem for community 
health centers and the millions of Americans who depend on them for 
primary care access. Health centers serve as the medical home for over 
18 million underserved patients. Annually, over 1.2 million of those 
patients are Medicare beneficiaries and 8.5 million patients are living 
below the Federal poverty level. Health centers are known for providing 
high quality, comprehensive care to some of our nation's most 
vulnerable populations.
  Over 17 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. 
Therefore, Congress required that centers be paid their reasonable 
costs for providing care to their Medicare patients. The Centers for 
Medicare and Medicaid Services, CMS, later established a per visit 
payment cap in regulations based on a payment cap applicable to rural 
health clinics. CMS applied the cap to FQHCs with the promise of future 
reviews to guarantee that health centers were adequately reimbursed. 
However, CMS has failed to update payments.
  Today, the majority of health centers are losing money serving 
Medicare beneficiaries, causing them to use their Federal grant 
dollars, intended for care for the uninsured, to supplement Medicare 
payments. These losses exceed $50 million annually according to an 
analysis completed by the National Association of Community Health 
Centers.
  We have repeatedly requested that CMS review this antiquated payment 
structure with little success. So I rise today again with Senator 
Bingaman to see that FQHCs receive payment for services they provide. 
This bill will establish a prospective payment system for FQHCs, based 
on the 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 
that health centers are able to dedicate their Federal grant dollars 
for their originally intended purpose--providing care to the uninsured.
  This legislation is long overdue. I ask my colleagues to join me in 
strengthening the Medicare FQHC program to make certain that health 
centers can continue to provide high quality, affordable primary and 
preventive care to our Nation's seniors and people with disabilities.
                                 ______