II 

110TH CONGRESS 

1ST SESSION S. 941 

To increase Federal support for Community Health Centers and the National 

Health Service Corps in order to ensure access to health care for millions 

of Americans living in medically-underserved areas. 

IN THE SENATE OF THE UNITED STATES 

MARCH 20, 2007 

Mr. SANDERS (for himself and Ms. MURKOWSKI) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To increase Federal support for Community Health Centers 

and the National Health Service Corps in order to ensure 

access to health care for millions of Americans living 

in medically-underserved areas. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Community Health 

5 Centers Investment Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 

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1 (1) An estimated 35,000,000 Americans have 

2 no regular source of health care, and lack access to 

3 the most basic health services. 

4 (2) Access to health care is especially difficult 

5 for those Americans who live in medically under6 served rural communities or inner city neighbor7 hoods, who lack public or private health insurance 

8 coverage and the ability to pay directly for care, or 

9 who are members of other vulnerable groups, includ10 ing individuals who are homeless or are migrant 

11 farm workers. 

12 (3) The consequences of poor access to health 

13 care is evidenced in elevated infant and childhood 

14 mortality rates, dangerously low childhood immuni15 zation rates, overutilization of hospital emergency 

16 rooms or other inappropriate providers of primary 

17 care services, and hospitalization rates for prevent18 able conditions that are significantly higher than the 

19 national average. 

20 (4) Community health centers, which serve 

21 more than 16,000,000 needy Americans in more 

22 than 5,000 communities across the country, provide 

23 an effective and proven model for extending access 

24 to all medically underserved Americans. 

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1 (5) Numerous independent studies confirm that 

2 these health centers have compiled a remarkable 

3 record of achievement in providing care of superior 

4 quality, with exceptional cost-effectiveness and effi5 ciency, saving billions of dollars for both taxpayers 

6 and private payers. 

7 (6) Over the past 5 years, with strong bipar8 tisan support from the Congress and encouragement 

9 by the Executive Branch, nearly 900 underserved 

10 communities were funded to establish or expand a 

11 health center, offering care to almost 5,000,000 

12 more needy individuals. Yet during that same pe13 riod, another 800 communities were approved for a 

14 health center but were not funded, because not 

15 enough funding was available for them, and there 

16 are thousands more underserved communities across 

17 America that need a health center but do not have 

18 one today. 

19 (7) Furthermore, the existing, currently funded 

20 health centers have experienced reduced Federal 

21 grant support over the past 2 years, jeopardizing 

22 their ability to be sustained and meet the needs of 

23 the growing number of uninsured in their service 

24 areas. Growing new health centers without sup25 porting existing ones is a failed policy that will ultimstockstill on PROD1PC66 with BILLS

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1 mately weaken this valuable resource for the most 

2 disadvantaged Americans. 

3 (8) Critical to the growth of new and existing 

4 health centers is having a sufficient supply of pri5 mary care health professionals to staff them. Cur6 rently, health centers rely on the National Health 

7 Service Corps for over 20 percent of their physician 

8 workforce. Yet, fewer than half of all Corps place9 ments are made to health centers, even though they 

10 are one of the strongest cords in the health care 

11 safety net. 

12 (9) According to published research, health cen13 ters in the last year experienced a 15 percent physi14 cian vacancy rate and a 19 percent dentist vacancy 

15 rate nationally. In rural areas, vacancy rates were 

16 higher, 19 percent for physicians and 27 percent for 

17 dentists. 

18 (10) Adequate reimbursement for the services 

19 that health centers provide is another pressing need 

20 if health centers are to fulfill their mission. While 

21 health centers provide care to more than 1,000,000 

22 medically underserved Medicare beneficiaries, their 

23 Medicare payments are subject to an arbitrary pay24 ment cap that is now 15 years old and adversely af25 fects more than three-quarters of all health centers, 

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1 causing annual revenue losses in excess of 

2 $50,000,000 nationally. 

3 SEC. 3. COMMUNITY HEALTH CENTERS. 

4 (a) FUNDING.—To carry out the program authorized 

5 under section 330 of the Public Health Service Act (42 

6 U.S.C. 254b), there are authorized to be appropriated, 

7 and there are appropriated— 

8 (1) for fiscal year 2008, $2,563,000,000; 

9 (2) for fiscal year 2009, $2,863,000,000; 

10 (3) for fiscal year 2010, $3,263,000,000; 

11 (4) for fiscal year 2011, $3,663,000,000; 

12 (5) for fiscal year 2012, $4,163,000,000; 

13 (6) for fiscal year 2013, $4,663,000,000; 

14 (7) for fiscal year 2014, $5,263,000,000; and 

15 (8) for fiscal year 2015, $5,863,000,000. 

16 (b) USE OF FUNDS.—In each of the fiscal years de17 scribed in subsection (a), amounts appropriated under 

18 such section shall be used in accordance with the following 

19 priorities: 

20 (1) FISCAL YEAR 2008.—With respect to fiscal 

21 year 2008: 

22 (A) First priority shall be given to pro23 viding continuing operating grants to all health 

24 centers that received operating grants under 

25 section 330 of the Public Health Service Act 

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1 (42 U.S.C. 254b) during the previous fiscal 

2 year, and which continue to meet all eligibility 

3 requirements for the receipt of funding under 

4 such section. 

5 (B) Second priority shall be given to pro6 viding an adjustment (not to exceed 

7 $100,000,000 for all health centers) in the 

8 amount of each operating grant awarded to a 

9 health center pursuant to subparagraph (A) to 

10 account for— 

11 (i) the increased cost of providing 

12 services through each such health center 

13 based on the average increase in costs per 

14 encounter reported by all health centers 

15 during the most recent reporting period for 

16 which such information is available prior to 

17 the beginning of the fiscal year; and 

18 (ii) the change in the number of users 

19 reported by each such health center during 

20 the most recent reporting period for which 

21 such information is available prior to the 

22 beginning of the fiscal year; 

23 (C) Third priority shall be given to pro24 viding initial operating grants (or expanded op25 erating grants, as the case may be) to all eligimstockstill on PROD1PC66 with BILLS

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1 ble applicants for New Access Point or Ex2 panded Medical Capacity grants during fiscal 

3 years 2002 through 2007 (not to exceed 

4 $225,000,000 for all such grantees), that— 

5 (i) received a score of ‘‘Fully Accept6 able’’ or better from an Objective Review 

7 Committee established by the Health Re8 sources and Services Administration dur9 ing that period; and 

10 (ii) did not receive funding because of 

11 a lack of available appropriated funds dur12 ing that period to permit the funding of 

13 such applications. 

14 (D) Fourth priority shall be given to pro15 viding initial operating grants (or expanded op16 erating grants, as the case may be) to all eligi17 ble applicants for New Access Point or Ex18 panded Medical Capacity grants during fiscal 

19 year 2008, that received a score of ‘‘Fully Ac20 ceptable’’ or better from an Objective Review 

21 Committee established by the Health Resources 

22 and Services Administration during that fiscal 

23 year, subject to the availability of appropria24 tions. Notwithstanding any funding criteria that 

25 may otherwise be utilized in the selection of 

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1 grantees under the programs described in this 

2 subparagraph, the criteria to be used for the 

3 approval of applications under this subpara4 graph shall ensure an equitable geographic dis5 tribution with respect to the service areas of the 

6 grantees that receive such assistance. 

7 (E)(i) Fifth priority shall be given to sup8 porting the planning and development of new 

9 health centers (not to exceed $25,000,000 for 

10 all such support) in communities that dem11 onstrate need for a health center under section 

12 330 of the Public Health Service Act (42 

13 U.S.C. 254b), including counties, other eligible 

14 geographic or governmental subdivisions such 

15 as cities, towns, neighborhoods, or groups of 

16 such subdivisions in contiguous areas. 

17 (ii) Funds made available under clause (i) 

18 shall be used to award grants in accordance 

19 with section 330(c) of the Public Health Service 

20 Act (42 U.S.C. 254b(c)), particularly to entities 

21 that will serve medically underserved areas 

22 identified through the use of criteria including 

23 the distance of the area from other sources of 

24 primary medical or dental care, the lack of ac25 cess to existing primary health care practices 

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1 among the population of the community, the 

2 lack of acceptance of Medicaid beneficiaries 

3 among existing primary health care practices in 

4 the community, significant disparities in health 

5 status, the percentage of uninsured and under6 insured, and other measures that indicate bar7 riers to appropriate primary health care. 

8 (iii) Of the amount made available for 

9 grants under clause (i), not more than 

10 $20,000,000 may be used to provide support to 

11 health center networks (as defined in section 

12 330(e)(1)(C) of the Public Health Service Act 

13 (42 U.S.C. 254b(e)(1)(C)), or to organizations 

14 that represent all health centers in a State, and 

15 that have established or have made a commit16 ment to establishing Statewide systems of 

17 health centers that will ensure the presence of 

18 health centers in all underserved areas in that 

19 State. 

20 (iv) Notwithstanding any funding criteria 

21 that may otherwise be utilized in awarding 

22 grants of the type described in this subpara23 graph, the criteria used for the approval of ap24 plications under this subparagraph shall ensure 

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1 spect to the service areas of the grantees that 

2 receive such assistance. 

3 (2) SUCCEEDING FISCAL YEARS.—For fiscal 

4 year 2009, and for each succeeding fiscal year, 

5 funds shall be distributed under this section in ac6 cordance with the priorities described in subpara7 graphs (A), (B), (D), and (E) of paragraph (1). 

8 SEC. 4. NATIONAL HEALTH SERVICE CORPS. 

9 (a) FUNDING.—To carry out the programs author10 ized under sections 331 through 338G of the Public 

11 Health Service Act (42 U.S.C. 254d–254p), there are au12 thorized to be appropriated, and there are appropriated— 

13 (1) for fiscal year 2008, $150,000,000; 

14 (2) for fiscal year 2009, $175,000,000; 

15 (3) for fiscal year 2010, $200,000,000; 

16 (4) for fiscal year 2011, $225,000,000; 

17 (5) for fiscal year 2012, $250,000,000; 

18 (6) for fiscal year 2013, $275,000,000; 

19 (7) for fiscal year 2014, $300,000,000; and 

20 (8) for fiscal year 2015, $325,000,000. 

21 (b) ASSIGNMENT OF PERSONNEL.— 

22 (1) IN GENERAL.—Section 333(a)(3) of the 

23 Public Health Service Corps (42 U.S.C. 254f(a)(3)) 

24 is amended to read as follows: 

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1 ‘‘(3)(A) In approving applications for assignment of 

2 members of the Corps, the Secretary shall not discriminate 

3 against application from entities that are not receiving 

4 Federal financial assistance under this Act. 

5 ‘‘(B) In approving such applications, the Secretary 

6 shall— 

7 ‘‘(i) give preference to applications in which a 

8 nonprofit entity or public entity shall provide a site 

9 to which Corps members may be assigned; and 

10 ‘‘(ii) give the highest preference to applica11 tions— 

12 ‘‘(I) from entities described in clause (i) 

13 that are federally qualified health centers as de14 fined in section 1905(l)(2)(B) of the Social Se15 curity Act; and 

16 ‘‘(II) from entities described in clause (i) 

17 that primarily serve racial and ethnic minority 

18 and other health disparity populations with an19 nual incomes at or below twice those set forth 

20 in the most recent poverty guidelines issued by 

21 the Secretary pursuant to section 673(2) of the 

22 Community Services Block Grant Act (42 

23 U.S.C. 9902(2)).’’. 

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1 (2) PRIORITIES IN ASSIGNMENT OF CORPS PER2 SONNEL.—Section 333A of the Public Health Serv3 ice Act (42 U.S.C. 254f–1) is amended— 

4 (A) in subsection (a)— 

5 (i) by redesignating paragraphs (1), 

6 (2), and (3) as paragraphs (2), (3), and 

7 (4), respectively; and 

8 (ii) by inserting before paragraph (2) 

9 (as so redesignated) the following: 

10 ‘‘(1) give preference to applications as set forth 

11 in subsection (a)(3) of section 333;’’; and 

12 (B) by striking ‘‘subsection (a)(1)’’ each 

13 place such appears and inserting ‘‘subsection 

14 (a)(2)’’. 

15 (3) CONFORMING AMENDMENT.—Section 

16 338I(c)(3)(B)(ii) of the Public Health Service Act 

17 (42 U.S.C. 254q–1(c)(3)(B)(ii)) is amended by 

18 striking ‘‘section 333A(a)(1)’’ and inserting ‘‘section 

19 333A(a)(2)’’. 

20 (c) REVISION OF SCHOLARSHIP LIMITATION.—Sec21 tion 338H(b) of the Public Health Service Act (42 U.S.C. 

22 254q(b)) is amended to read as follows: 

23 ‘‘(b) SCHOLARSHIPS.—Of the amount appropriated 

24 under subsection (a) for a fiscal year, the Secretary shall 

25 obligate not less than 40 percent for the purpose of awardmstockstill on PROD1PC66 with BILLS

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1 ing contracts for scholarships under this subpart (includ2 ing scholarships to individuals from disadvantaged back3 grounds).’’. 

4 SEC. 5. MEDICARE. 

5 (a) COVERAGE FOR FQHC AMBULATORY SERV6 ICES.—Section 1861(aa)(3) of the Social Security Act (42 

7 U.S.C. 1395x(aa)(3)) is amended to read as follows: 

8 ‘‘(3) The term ‘Federally qualified health center serv9 ices’ means— 

10 ‘‘(A) services of the type described in subpara11 graphs (A) through (C) of paragraph (1), and such 

12 other services furnished by a Federally qualified 

13 health center for which payment may otherwise be 

14 made under this title if such services were furnished 

15 by a health care provider or health care professional 

16 other than a Federally qualified health center; and 

17 ‘‘(B) preventive primary health services that a 

18 center is required to provide under section 330 of 

19 the Public Health Service Act; 

20 when furnished to an individual as a patient of a Federally 

21 qualified health center.’’. 

22 (b) PER VISIT PAYMENT REQUIREMENTS FOR

23 FQHCS.—Section 1833(a)(3)(A) of the Social Security 

24 Act (42 U.S.C. 1395l(a)(3)(A)), is amended by adding 

25 ‘‘(which regulations may not limit the per visit payment 

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1 amount, or a component of such amount, for services de2 scribed in section 1832(a)(2)(D)(ii))’’ after ‘‘the Secretary 

3 may prescribe in regulations’’. 

4 (c) EFFECTIVE DATE.—The amendments made by 

5 this section shall apply to services provided on or after 

6 January 1, 2007. 

Æ 

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