HIV Clinical Services Improvement Act

Summary: HIV Clinical Services Improvement Act This bill amends title XIX (Medicaid) of the Social Security Act to require payment under the Medicaid program for services furnished by recipients of Ryan White Part C grants, which support comprehensive primary care in outpatient settings for individuals living with HIV. Providers must be paid an amount equivalent to the prior average costs of providing these services. However, a state plan may establish an alternative payment methodology that: (1) is agreed to by the state and the grantee, and (2) results in payment to the grantee that at least equals the amount otherwise required to be paid to the grantee under the bill. As a condition of receiving payment under the bill, a grantee shall be subject to specified quality management and reporting requirements.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``HIV Clinical Services Improvement 
Act''.

SEC. 2. MEDICAID PAYMENT FOR SERVICES FURNISHED BY RYAN WHITE PART C 
              GRANTEES ON A COST-BASED PROSPECTIVE PAYMENT SYSTEM.

    (a) In General.--Section 1902 of the Social Security Act (42 U.S.C. 
1396a) is amended--
            (1) in subsection (a)(15), by inserting before the 
        semicolon at the end the following: ``and provide for payment 
        for services described in section 1905(a) provided by a 
        recipient of a grant under part C of title XXVI of the Public 
        Health Service Act in accordance with subsection (ll)''; and
            (2) by adding at the end the following new subsection:
    ``(ll) Payment for Services Provided by Ryan White Part C 
Grantees.--
            ``(1) In general.--Beginning with fiscal year 2016 with 
        respect to services furnished on or after January 1, 2016, and 
        each succeeding fiscal year, the State plan shall provide for 
        payment for services described in section 1905(a) (in this 
        subsection referred to as `Medicaid covered services') 
        furnished by a recipient of a grant under part C of title XXVI 
        of the Public Health Service Act (in this subsection referred 
        to as a `grantee') in accordance with the provisions of this 
        subsection.
            ``(2) Fiscal year 2016.--Subject to paragraph (4), for 
        services furnished on and after January 1, 2016, during fiscal 
        year 2016, the State plan shall provide for payment for such 
        services in an amount (calculated on a per visit or similar 
        basis as specified by the Secretary) that is equal to 100 
        percent of the average of the costs of the grantee of 
        furnishing such services during fiscal years 2014 and 2015 
        which are reasonable and related to the cost of furnishing such 
        services, or based on such other tests of reasonableness as the 
        Secretary prescribes in regulations under section 1833(a)(3), 
        or, in the case of services to which such regulations do not 
        apply, the same methodology used under section 1833(a)(3), 
        adjusted to take into account any increase or decrease in the 
        scope of such services furnished by the grantee during fiscal 
        year 2016.
            ``(3) Fiscal year 2017 and succeeding fiscal years.--
        Subject to paragraph (4), for services furnished during fiscal 
        year 2017 or a succeeding fiscal year, the State plan shall 
        provide for payment for such services in an amount (calculated 
        on a per visit or similar basis) that is equal to the amount 
        calculated for such services under this subsection for the 
        preceding fiscal year--
                    ``(A) increased 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 that fiscal year; and
                    ``(B) adjusted to take into account any increase or 
                decrease in the scope of such services furnished by the 
                grantee during that fiscal year.
            ``(4) Establishment of initial year payment amount for new 
        grantees.--In any case in which an entity first becomes a 
        grantee after fiscal year 2015, the State plan shall provide 
        for payment for Medicaid covered services furnished by the 
        entity in the first fiscal year in which the entity so 
        qualifies in an amount (calculated on a per visit or similar 
        basis) that is equal to 100 percent of the costs of furnishing 
        such services during such fiscal year based on the rates 
        established under this subsection for the fiscal year for other 
        such grantees located in the same or adjacent area with a 
        similar case load or, in the absence of such a grantee, in 
        accordance with the regulations and methodology referred to in 
        paragraph (2) or based on such other tests of reasonableness as 
        the Secretary may specify. For each fiscal year following the 
        fiscal year in which the entity first qualifies, the State plan 
        shall provide for the payment amount to be calculated in 
        accordance with paragraph (3).
            ``(5) Administration in the case of managed care.--
                    ``(A) In general.--In the case of services 
                furnished by a grantee pursuant to a contract between 
                the grantee and a managed care entity (as defined in 
                section 1932(a)(1)(B)), the State plan shall provide 
                for payment to the grantee by the State of a 
                supplemental payment equal to the amount (if any) by 
                which the amount determined under paragraphs (2), (3), 
                and (4) exceeds the amount of the payments provided 
                under the contract.
                    ``(B) Payment schedule.--The supplemental payment 
                required under subparagraph (A) shall be made pursuant 
                to a payment schedule agreed to by the State and the 
                grantee, but in no case less frequently than every 4 
                months.
            ``(6) Alternative payment methodologies.--Notwithstanding 
        any other provision of this section, the State plan may provide 
        for payment in any fiscal year to a grantee for Medicaid 
        covered services in an amount which is determined under an 
        alternative payment methodology that--
                    ``(A) is agreed to by the State and the grantee; 
                and
                    ``(B) results in payment to the grantee of an 
                amount which is at least equal to the amount otherwise 
                required to be paid to the grantee under this 
                subsection.
            ``(7) Quality management and reporting requirements.--The 
        Secretary shall require that, as appropriate, a grantee shall 
        be subject to quality management and reporting requirements 
        comparable to those imposed on Federally-qualified health 
        centers, including reporting of encounter data, clinical 
        outcomes data, quality data, and such other data as the 
        Secretary shall require, as a condition of such grantee 
        receiving payment for Medicaid covered services under this 
        subsection.''.
    (b) Effective Date.--
            (1) Except as provided in paragraph (2), the amendments 
        made by subsection (a) shall apply to services furnished on or 
        after January 1, 2016, without regard to whether or not final 
        regulations to carry out such amendments have been promulgated 
        by such date.
            (2) In the case of a State plan for medical assistance 
        under title XIX of the Social Security Act which the Secretary 
        of Health and Human Services determines requires State 
        legislation (other than legislation appropriating funds) in 
        order for the plan to meet the additional requirement imposed 
        by the amendments made by subsection (a), the State plan shall 
        not be regarded as failing to comply with the requirements of 
        such title solely on the basis of its failure to meet this 
        additional requirement before the first day of the first 
        calendar quarter beginning after the close of the first regular 
        session of the State legislature that begins after the date of 
        the enactment of this Act. For purposes of the previous 
        sentence, in the case of a State that has a 2-year legislative 
        session, each year of such session shall be deemed to be a 
        separate regular session of the State legislature.