I

106TH CONGRESS

2D SESSION H. R. 4970

To amend part D of title III of the Public Health Service Act to provide

grants to strengthen the effectiveness, efficiency, and coordination of

services for the uninsured and underinsured.

IN THE HOUSE OF REPRESENTATIVES

JULY 26, 2000

Mr. GREEN of Texas introduced the following bill; which was referred to the

Committee on Commerce

A BILL

To amend part D of title III of the Public Health Service

Act to provide grants to strengthen the effectiveness,

efficiency, and coordination of services for the uninsured

and underinsured.

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 Access to

5 Health Care Act of 2000’’.

6 SEC. 2. PURPOSE.

7 The purpose of this Act is to provide assistance to

8 communities and to consortia of health care providers and
2

•HR 4970 IH

1 others, including those in rural areas and including Amer2 ican Indian and Alaska Native entities, in order to develop

3 or strengthen integrated health care delivery systems that

4 coordinate health services for individuals who are unin5 sured and individuals who are underinsured, through—

6 (1) coordination of services to allow such indi7 viduals to receive efficient and higher quality care

8 and to gain entry into a comprehensive system of

9 care;

10 (2) development of the infrastructure for a

11 health care delivery system characterized by effective

12 collaboration, information sharing, and clinical and

13 financial coordination among all providers of care in

14 the community; and

15 (3) provision of new Federal resources that do

16 not supplant funding for existing Federal categorical

17 programs that support entities providing services to

18 low-income populations.

19 SEC. 3. CREATION OF COMMUNITY ACCESS PROGRAM.

20 Part D of title III of the Public Health Service Act

21 (42 U.S.C. 254b et seq.) is amended by inserting after

22 subpart IV the following new subpart:
3

•HR 4970 IH

1 ‘‘Subpart V—Community Access Program

2 ‘‘SEC. 340. GRANTS TO STRENGTHEN THE EFFECTIVENESS,

3 EFFICIENCY, AND COORDINATION OF SERV4 ICES FOR THE UNINSURED AND UNDER5 INSURED.

6 ‘‘(a) IN GENERAL.—The Secretary may make grants

7 for the purpose of assisting the development of integrated

8 health care delivery systems—

9 ‘‘(1) to serve communities of individuals who

10 are uninsured and individuals who are underinsured;

11 ‘‘(2) to expand the scope of services provided;

12 and

13 ‘‘(3) to improve the efficiency and coordination

14 among the providers of such services.

15 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive

16 a grant under this section, an entity must—

17 ‘‘(1) be a public or nonprofit private entity such

18 as—

19 ‘‘(A) a Federally qualified health center

20 (as defined under section 1861(aa)(4) of the

21 Social Security Act);

22 ‘‘(B) a hospital that meets the require23 ments of section 340B(a)(4)(L) (or, if none are

24 available in the area, a hospital that is a pro25 vider of a substantial volume of non-emergency
4

•HR 4970 IH

1 health services to uninsured individuals and

2 families without regard to their ability to pay)

3 without regard to 340B(a)(4)(L)(iii); or

4 ‘‘(C) a public health department; and

5 ‘‘(2) represent a consortium of providers and,

6 as appropriate, related agencies or entities—

7 ‘‘(A) whose principal purpose is to provide

8 a broad range of coordinated health care serv9 ices for a community defined in the entity’s

10 grant application (which may be a special popu11 lation group such as migrant and seasonal farm

12 workers, homeless persons or individuals with

13 disabilities);

14 ‘‘(B) that includes all health care providers

15 that serve the community and that have tradi16 tionally provided care (beyond emergency serv17 ices) to uninsured and underinsured individuals

18 without regard to the individuals’ ability to pay

19 (if there are any such providers) unless any

20 such provider or providers declines to partici21 pate; and

22 ‘‘(C) that may include other health care

23 providers and related agencies and organiza24 tions;
5

•HR 4970 IH

1 except that preference shall be given to applicants that

2 are health care providers identified in paragraph (1).

3 ‘‘(c) APPLICATIONS.—To be eligible to receive a grant

4 under this section, an eligible entity shall submit to the

5 Secretary an application, in such form and manner as the

6 Secretary shall prescribe, that shall—

7 ‘‘(1) define a community of uninsured and

8 underinsured individuals that consists of all such

9 individuals—

10 ‘‘(A) in a specified geographical area; or

11 ‘‘(B) in a specified population within such

12 an area;

13 ‘‘(2) identify the providers who will participate

14 in the consortium’s program under the grant, and

15 specify each one’s contribution to the care of unin16 sured and underinsured individuals in the commu17 nity, including the volume of care it provides to

18 medicare and medicaid beneficiaries and to privately

19 paid patients;

20 ‘‘(3) describe the activities that the applicant

21 and the consortium propose to perform under the

22 grant to further the purposes of this section;

23 ‘‘(4) demonstrate the consortium’s ability to

24 build on the current system for serving uninsured

25 and underinsured individuals by involving providers
6

•HR 4970 IH

1 who have traditionally provided a significant volume

2 of care for that community;

3 ‘‘(5) demonstrate the consortium’s ability to de4 velop coordinated systems of care that either directly

5 provide or ensure the prompt provision of a broad

6 range of high-quality, accessible services, including,

7 as appropriate, primary, secondary, and tertiary

8 services, as well as substance abuse treatment and

9 mental health services in a manner which assures

10 continuity of care in the community;

11 ‘‘(6) provide evidence of community involvement

12 in the development, implementation, and direction of

13 the program that it proposes to operate;

14 ‘‘(7) demonstrate the consortium’s ability to en15 sure that individuals participating in the program

16 are enrolled in public insurance programs for which

17 they are eligible;

18 ‘‘(8) present a plan for leveraging other sources

19 of revenue, which may include State and local

20 sources and private grant funds, and integrating

21 current and proposed new funding sources in a way

22 to assure long-term sustainability;

23 ‘‘(9) describe a plan for evaluation of the activi24 ties carried out under the grant, including measure-
7

•HR 4970 IH

1 ment of progress toward the goals and objectives of

2 the program;

3 ‘‘(10) demonstrate fiscal responsibility through

4 the use of appropriate accounting procedures and

5 appropriate management systems;

6 ‘‘(11) include such other information as the

7 Secretary may prescribe; and

8 ‘‘(12) demonstrate the commitment to serve the

9 community without regard to the ability of the indi10 vidual or family to pay by arranging for or providing

11 free or reduced charge care for the poor.

12 ‘‘(d) PRIORITIES.—In awarding grants under this

13 section, the Secretary may accord priority to applicants—

14 ‘‘(1) whose consortium includes public hospitals,

15 Federally qualified health centers (as defined in sec16 tion 1905(l)(2)(B) of the Social Security Act), and

17 other providers that are covered entities as defined

18 by section 340B(a)(4) of this Act (or that would be

19 covered entities as so defined but for subparagraph

20 (L)(iii) of such section);

21 ‘‘(2) that identify a community whose geo22 graphical area has a high or increasing percentage

23 of individuals who are uninsured;

24 ‘‘(3) whose consortium includes other health

25 care providers that have a tradition of serving unin-
8

•HR 4970 IH

1 sured individuals and underinsured individuals in

2 the community;

3 ‘‘(4) who show evidence that the program would

4 expand utilization of preventive and primary care

5 services for uninsured and underinsured individuals

6 and families in the community, including mental

7 health services or substance abuse services;

8 ‘‘(5) whose proposed program would improve

9 coordination between health care providers and ap10 propriate social service providers, including local and

11 regional human services agencies, school systems,

12 and agencies on aging;

13 ‘‘(6) that demonstrate collaboration with State

14 and local governments;

15 ‘‘(7) that make use of non-Federal contribu16 tions to the greatest extent possible; or

17 ‘‘(8) that demonstrate a likelihood that the pro18 posed program will continue after support under this

19 section ceases.

20 ‘‘(e) USE OF FUNDS.—

21 ‘‘(1) USE BY GRANTEES.—

22 ‘‘(A) IN GENERAL.—Except as provided in

23 paragraphs (2) and (3), a grantee may use

24 amounts provided under this section only for—
9

•HR 4970 IH

1 ‘‘(i) direct expenses associated with

2 planning, developing, and operating the

3 greater integration of a health care deliv4 ery system so that it either directly pro5 vides or ensures the provision of a broad

6 range of services, as appropriate, including

7 primary, secondary, and tertiary services,

8 as well as substance abuse treatment and

9 mental health services; and

10 ‘‘(ii) direct patient care and service

11 expansions to fill identified or documented

12 gaps within an integrated delivery system.

13 ‘‘(B) SPECIFIC USES.—The following are

14 examples of purposes for which a grantee may

15 use grant funds, when such use meets the con16 ditions stated in subparagraph (A):

17 ‘‘(i) Increase in outreach activities.

18 ‘‘(ii) Improvements to case manage19 ment.

20 ‘‘(iii) Improvements to coordination of

21 transportation to health care facilities.

22 ‘‘(iv) Development of provider net23 works.

24 ‘‘(v) Recruitment, training, and com25 pensation of necessary personnel.
10

•HR 4970 IH

1 ‘‘(vi) Acquisition of technology.

2 ‘‘(vii) Identifying and closing gaps in

3 services being provided.

4 ‘‘(viii) Improvements to provider com5 munication, including implementation of

6 shared information systems or shared clin7 ical systems.

8 ‘‘(ix) Other activities that may be ap9 propriate to a community that would in10 crease access to the uninsured.

11 ‘‘(2) DIRECT PATIENT CARE LIMITATION.—No

12 more than 15 percent of the funds provided under

13 a grant may be used for providing direct patient

14 care and services.

15 ‘‘(3) RESERVATION OF FUNDS FOR NATIONAL

16 PROGRAM PURPOSES.—The Secretary may use not

17 more than 3 percent of funds appropriated to carry

18 out this section for technical assistance to grantees,

19 obtaining assistance of experts and consultants,

20 meetings, dissemination of information, evaluation,

21 and activities that will extend the benefits of funded

22 programs to communities other than the one funded.

23 ‘‘(f) MAINTENANCE OF EFFORT.—With respect to

24 activities for which a grant under this section is author25 ized, the Secretary may award such a grant only if the
11

•HR 4970 IH

1 recipient of the grant and each of the participating pro2 viders agree that each one will maintain its expenditures

3 of non-Federal funds for such activities at a level that is

4 not less than the level of such expenditures during the year

5 immediately preceding the fiscal year for which the appli6 cant is applying to receive such grant.

7 ‘‘(g) REPORTS TO THE SECRETARY.—The recipient

8 of a grant under this section shall report to the Secretary

9 annually regarding—

10 ‘‘(1) progress in meeting the goals stated in its

11 grant application; and

12 ‘‘(2) such additional information as the Sec13 retary may require.

14 The Secretary may not renew an annual grant under this

15 section unless the Secretary is satisfied that the consor16 tium has made reasonable and demonstrable progress in

17 meeting the goals set forth in its grant application for the

18 preceding year.

19 ‘‘(h) AUDITS.—Each entity which receives a grant

20 under this section shall provide for an independent annual

21 financial audit of all records that relate to the disposition

22 of funds received through this grant.

23 ‘‘(i) TECHNICAL ASSISTANCE.—The Secretary may,

24 either directly or by grant or contract, provide any funded
12

•HR 4970 IH

1 entity with technical and other non-financial assistance

2 necessary to meet the requirements of this section.

3 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—For the

4 purpose of carrying out this section, there are authorized

5 to be appropriated $125,000,000 in fiscal year 2001 and

6 such sums as may be necessary for each of fiscal years

7 2002 through 2005.’’.

Æ