To amend title XIX of the Social Security Act to create a new part under such title to provide access to services for medically underserved populations not currently served by federally qualified health centers, by providing funds for a new program to allow federally qualified health centers and other qualifying entities to expand such centers' and entities' capacity and to develop additional centers.

Summary: Amends title XIX (Medicaid) of the Social Security Act to establish a part B (Health Services Access) to fund grants to federally-qualified health centers (FQHCs) and other entities for the expansion and development of primary health care service programs for medically underserved populations. 
Sets forth grant eligibility criteria and the requirements grant applications must meet.  Outlines limitations on the use of grant funds.  Establishes priorities for the awarding of grants, with the highest priority for those FQHCs and other entities proposing to expand operations to serve medically underserved populations with the highest degree of unmet need in the most efficient manner.  Requires entities receiving program funds to return excess revenues to the Secretary.  Requires termination of grants to entities failing to meet certain requirements. 
Directs the Secretary to study and report to the Congress on the relationship between community health centers and hospitals in providing such services.  Authorizes appropriations.

SECTION 1. FINDINGS.

    The Congress finds that--
            (1) at least 30 million Americans lack access to even the 
        most basic health services;
            (2) access to health care is especially difficult for those 
        Americans who--
                    (A) live in medically underserved rural communities 
                or inner city neighborhoods;
                    (B) lack public or private health insurance 
                coverage and the ability to pay directly for care;
                    (C) must move for work purposes, such as migrant 
                farmworkers;
                    (D) are members of minority groups, or who speak 
                limited English; or
                    (E) are members of other vulnerable groups, 
                including persons who are homeless or are high-risk 
                pregnant women, infants and children;
            (3) the consequences of poor access to health care is 
        evidenced in elevated infant and childhood mortality rates, 
        dangerously low childhood immunization rates, overutilization 
        of hospital emergency rooms or other inappropriate providers of 
        primary care services, and hospitalization rates for 
        preventable conditions that are significantly higher than the 
        national average;
            (4) efforts to provide access to essential health care 
        services for medically underserved Americans will not only 
        contribute to improved health status, but will also result in 
        less unnecessary care and reduced overall costs of health care; 
        and
            (5) the federally qualified health centers, including the 
        community and migrant health centers which serve more than 6 
        million needy Americans, provide an effective and proven model 
        for extending access to all medically underserved Americans.

SEC. 2. ESTABLISHMENT OF NEW PART UNDER THE MEDICAID PROGRAM TO PROVIDE 
              FUNDS FOR A NEW FEDERALLY QUALIFIED HEALTH CENTERS GRANTS 
              PROGRAM.

    (a) In General.--Title XIX of the Social Security Act is amended by 
inserting after the title heading the following:

         ``Part A--Payment to States for Medical Assistance''.

    (b) Purpose.--Section 1901 of the Social Security Act (42 U.S.C. 
1396) is amended--
            (1) in the first sentence--
                    (A) by striking ``and (2)'' and inserting ``(2)''; 
                and
                    (B) by striking ``self care,'' and inserting ``self 
                care; and (3) grants to assist entities in providing 
                health care services to medically underserved 
                individuals,''; and
            (2) by amending the second sentence to read as follows: 
        ``The sums made available under this section shall be used for 
        making payments--
                    (A) under this part to States which have submitted, 
                and had approved by the Secretary, State plans for 
                medical assistance; and
                    (B) under part B to entities meeting the 
                requirements under such part.''.
    (c) Effective Date.--The amendments made by subsections (a) and (b) 
shall become effective on October 1, 1993.

SEC. 3. ESTABLISHMENT OF NEW PROGRAM TO PROVIDE FUNDS TO ALLOW 
              FEDERALLY QUALIFIED HEALTH CENTERS AND OTHER ENTITIES OR 
              ORGANIZATIONS TO PROVIDE EXPANDED SERVICES TO MEDICALLY 
              UNDERSERVED INDIVIDUALS.

    (a) In General.--Title XIX of the Social Security Act (42 U.S.C. 
1396 et seq.) is amended by adding at the end the following new part:

       ``Part B--Grants to Qualified Entities for Health Services

                    ``health services access program

    ``Sec. 1941. (a) Establishment of Health Services Access Program.--
From amounts appropriated under section 1901, the Secretary shall, 
acting through the Bureau of Health Care Delivery Assistance, award 
grants under this section to federally qualified health centers (each 
in this part referred to as an `FQHC') and other entities and 
organizations submitting applications under this section (as described 
in subsection (c)) for the purpose of providing access to services for 
medically underserved populations (as defined in section 330(b)(3) of 
the Public Health Service Act) or in high impact areas (as defined in 
section 329(a)(5) of the Public Health Service Act) not currently being 
served by an FQHC.
    ``(b) Eligibility for Grants.--(1) The Secretary shall award grants 
under this section to entities or organizations described in this 
paragraph and paragraph (2) which have submitted a proposal to the 
Secretary to expand such entities or organizations operations 
(including expansions to new sites (as determined necessary by the 
Secretary)) to serve medically underserved populations or high impact 
areas not currently served by an FQHC and which--
            ``(A) have as of January 1, 1993, been certified by the 
        Secretary as an FQHC under section 1905(l)(2)(B); or
            ``(B) have submitted applications to the Secretary to 
        qualify as FQHC's under section 1905(l)(2)(B); or
            ``(C) have submitted a plan to the Secretary which provides 
        that the entity will meet the requirements to qualify as an 
        FQHC when operational.
    ``(2)(A) The Secretary shall also make grants under this section to 
public or private nonprofit agencies, health care entities or 
organizations which meet the requirements necessary to qualify as an 
FQHC except, the requirement that such entity have a consumer majority 
governing board and which have submitted a proposal to the Secretary to 
provide those services provided by an FQHC as defined in section 
1905(l)(2)(B) and which are designed to promote access to primary care 
services or to reduce reliance on hospital emergency rooms or other 
high cost providers of primary health care services, provided such 
proposal is developed by the entity or organizations (or such entities 
or organizations acting in a consortium in a community) with the review 
and approval of the Governor of the State in which such entity or 
organization is located.
    ``(B) The Secretary shall provide in making grants to entities or 
organizations described in this paragraph that no more than 10 percent 
of the funds provided for grants under this section shall be made 
available for grants to such entities or organizations.
    ``(c) Application Requirements.--(1) In order to be eligible to 
receive a grant under this section, an FQHC or other entity or 
organization must submit an application in such form and at such time 
as the Secretary shall prescribe and which meets the requirements of 
this subsection.
    ``(2) An application submitted under this section must provide--
            ``(A)(i) for a schedule of fees or payments for the 
        provision of the services provided by the entity designed to 
        cover its reasonable costs of operations; and
            ``(ii) for a corresponding schedule of discounts to be 
        applied to such fees or payments, based upon the patient's 
        ability to pay (determined by using a sliding scale formula 
        based on the income of the patient);
            ``(B) assurances that the entity or organization provides 
        services to persons who are eligible for benefits under title 
        XVIII, for medical assistance under a State plan approved under 
        part A or for assistance for medical expenses under any other 
        public assistance program or private health insurance program; 
        and
            ``(C) assurances that the entity or organization has made 
        and will continue to make every reasonable effort to collect 
        reimbursement for services--
                    ``(i) from persons eligible for assistance under 
                any of the programs described in subparagraph (B); and
                    ``(ii) from patients not entitled to benefits under 
                any such programs.
    ``(d) Limitations on Use of Funds.--(1) From the amounts awarded to 
an entity or organization under this section, funds may be used for 
purposes of planning but may only be expended for the costs of--
            ``(A) assessing the needs of the populations or proposed 
        areas to be served;
            ``(B) preparing a description of how the needs identified 
        will be met;
            ``(C) development of an implementation plan that 
        addresses--
                    ``(i) recruitment and training of personnel; and
                    ``(ii) activities necessary to achieve operational 
                status in order to meet FQHC requirements under 
                1905(l)(2)(B).
    ``(2) From the amounts awarded to an entity or organization under 
this section, funds may be used for the purposes of paying for the 
costs of recruiting, training and compensating staff (clinical and 
associated administrative personnel (to the extent such costs are not 
already reimbursed under part A or any other State or Federal program)) 
to the extent necessary to allow the entity to operate at new or 
expanded existing sites.
    ``(3) From the amounts awarded to an entity or organization under 
this section, funds may be expended for the purposes of acquiring 
facilities and equipment but only for the costs of--
            ``(A) construction of new buildings (to the extent that new 
        construction is found to be the most cost-efficient approach by 
        the Secretary);
            ``(B) acquiring, expanding, or modernizing of existing 
        facilities;
            ``(C) purchasing essential (as determined by the Secretary) 
        equipment; and
            ``(D) amortization of principal and payment of interest on 
        loans obtained for purposes of site construction, acquisition, 
        modernization, or expansion, as well as necessary equipment.
    ``(4) From the amounts awarded to an entity or organization under 
this section, funds may be expended for the payment of services but 
only for the costs of--
            ``(A) providing or arranging for the provision of all 
        services through the entity necessary to qualify such entity as 
        an FQHC under section 1905(l)(2)(B);
            ``(B) providing or arranging for any other service that an 
        FQHC may provide and be reimbursed for under this title; and
            ``(C) providing any unreimbursed costs of providing 
        services as described in section 330(a) of the Public Health 
        Service Act to patients.
    ``(e) Priorities in the Awarding of Grants.--(1) The Secretary 
shall give priority in awarding grants under this section to entities 
which have, as of January 1, 1993, been certified as an FQHC under 
section 1905(l)(2)(B) and which have submitted a proposal to the 
Secretary to expand their operations (including expansion to new sites) 
to serve medically underserved populations for high impact areas not 
currently served by an FQHC. The Secretary shall give first priority in 
awarding grants under this section to those FQHCs or other entities 
which propose to serve populations with the highest degree of unmet 
need, and which can demonstrate the ability to expand their operations 
in the most efficient manner.
    ``(2) The Secretary shall give second priority in awarding grants 
to entities which have submitted applications to the Secretary which 
demonstrate that the entity will qualify as an FQHC under section 
1905(l)(2)(B) before it provides or arranges for the provision of 
services supported by funds awarded under this section, and which are 
serving or proposing to serve medically underserved populations or high 
impact areas which are not currently served (or proposed to be served) 
by an FQHC.
    ``(3) The Secretary shall give third priority in awarding grants in 
subsequent years to those FQHCs or other entities which have provided 
for expanded services and project and are able to demonstrate that such 
entity will incur significant unreimbursed costs in providing such 
expanded services.
    ``(f) Return of Funds to Secretary for Costs Reimbursed From Other 
Sources.--To the extent that an entity or organization receiving funds 
under this part is reimbursed from another source for the provision of 
services to an individual, and does not use such increased 
reimbursement to expand services furnished, areas served, to compensate 
for costs of unreimbursed services provided to patients, or to promote 
recruitment, training, or retention of personnel, such excess revenues 
shall be returned to the Secretary.
    ``(g) Termination of Grants.--(1)(A) With respect to any entity 
that is receiving funds awarded under this section and which 
subsequently fails to meet the requirements to qualify as an FQHC under 
section 1905(l)(2)(B) or is an entity that is not required to meet the 
requirements to qualify as an FQHC under section 1905(l)(2)(B) but 
fails to meet the requirements of this section, the Secretary shall 
terminate the award of funds under this section to such entity.
    ``(B) Prior to any termination of funds under this section to an 
entity, the entities shall be entitled to 60 days prior notice of 
termination and, as provided by the Secretary in regulations, an 
opportunity to correct any deficiencies in order to allow the entity to 
continue to receive funds under this section.
    ``(2) Upon any termination of funding under this section, the 
Secretary may (to the extent practicable)--
            ``(A) sell any property (including equipment) acquired or 
        constructed by the entity using funds made available under this 
        section or transfer such property to another FQHC, in which 
        case the Secretary shall reimburse any costs which were 
        incurred by the entity in acquiring or constructing such 
        property (including equipment) which were not supported by 
        grants under this section; and
            ``(B) recoup any funds provided to an entity terminated 
        under this section.
    ``(h) Limitation on Amount of Expenditures.--The amount of funds 
that may be expended under this title to carry out the purposes of this 
part shall be for fiscal year 1994, $200,000,000, for fiscal year 1995, 
$400,000,000, for fiscal year 1996, $600,000,000, for fiscal year 1997, 
$800,000,000, for fiscal year 1998, $800,000,000, and for fiscal years 
thereafter such sums as provided by Congress.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
become effective with respect to services furnished by a federally 
qualified health center or other qualifying entity described in this 
section beginning on or after October 1, 1993.

SEC. 4. STUDY AND REPORT ON SERVICES PROVIDED BY COMMUNITY HEALTH 
              CENTERS AND HOSPITALS.

    (a) In General.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') shall provide for a 
study to examine the relationship and interaction between community 
health centers and hospitals in providing services to individuals 
residing in medically underserved areas. The Secretary shall ensure 
that the National Rural Research Centers participate in such study.
    (b) Report.--The Secretary shall provide to the appropriate 
committees of Congress a report summarizing the findings of the study 
within 90 days of the end of each project year and shall include in 
such report recommendations on methods to improve the coordination of 
and provision of services in medically underserved areas by community 
health centers and hospitals.
    (c) Authorization.--There are authorized to carry out the study 
provided for in this section $150,000 for each of fiscal years 1994 and 
1995.