I 

111TH CONGRESS 

1ST SESSION H. R. 1614 

To authorize the Secretary of Health and Human Services to make grants 

to community health coalitions to assist in the development of integrated 

health care delivery, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 19, 2009 

Mr. GENE GREEN of Texas (for himself, Mr. WAMP, and Mr. SMITH of Washington) introduced the following bill; which was referred to the Committee 

on Energy and Commerce 

A BILL 

To authorize the Secretary of Health and Human Services 

to make grants to community health coalitions to assist 

in the development of integrated health care delivery, 

and for other purposes. 

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 Coalitions 

5 for Access and Quality Improvement Act of 2009’’. 

6 SEC. 2. PURPOSE. 

7 The purpose of this Act is to provide assistance to 

8 community health coalitions as described in section 3(b) 


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1 with a clearly defined local need to increase access to and 

2 improve the quality of health care services through activi3 ties which— 

4 (1) develop or strengthen coordination of serv5 ices to allow all individuals, including the uninsured 

6 and low-income, to receive efficient and higher qual7 ity care and to gain entry into and receive services 

8 from a comprehensive system of medical, dental, 

9 pharmaceutical, and behavioral health care; 

10 (2) develop efficient and sustainable infrastruc11 ture for a health care delivery system characterized 

12 by effective collaboration, information sharing, and 

13 clinical and financial coordination among all types of 

14 providers of care in the community; and 

15 (3) develop or strengthen activities related to 

16 providing coordinated care for individuals with 

17 chronic conditions. 

18 SEC. 3. GRANTS TO STRENGTHEN THE EFFECTIVENESS, EF19 FICIENCY, AND COORDINATION OF SERVICES. 

20 (a) IN GENERAL.—The Secretary of Health and 

21 Human Services (in this Act referred to as the ‘‘Sec22 retary’’) shall award grants to assist in the development 

23 of integrated health care delivery systems to serve defined 

24 communities of individuals— 


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1 (1) to improve the efficiency of and coordina2 tion among the providers providing services through 

3 such systems; 

4 (2) to assist local communities in developing 

5 programs targeted toward preventing and managing 

6 chronic diseases; and 

7 (3) to expand and enhance the services provided 

8 through such systems. 

9 (b) ELIGIBLE ENTITIES.—To be eligible to receive a 

10 grant under this section, an entity shall be an entity 

11 that— 

12 (1) represents a balanced consortium— 

13 (A) whose principal purpose is to ensure 

14 the sustainable capacity for the provision of a 

15 broad range of coordinated services for all resi16 dents within a community defined in the enti17 ty’s grant application as described in paragraph 

18 (2); and 

19 (B) that includes at least one of each of 

20 the following providers that serve the commu21 nity (unless such provider does not exist within 

22 the community, declines or refuses to partici23 pate, or places unreasonable conditions on their 

24 participation)— 


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1 (i) a federally qualified health center 

2 (as defined in section 1861(aa) of the So3 cial Security Act (42 U.S.C. 1395x(aa))); 

4 (ii) rural health clinics and rural 

5 health networks (as defined in sections 

6 1861(aa) and 1820(d) of the Social Secu7 rity Act, respectively (42 U.S.C. 

8 1395x(aa), 1395i–4(d))); 

9 (iii) a hospital with a low-income utili10 zation rate that is greater than 25 percent 

11 (as defined in section 1923(b)(3) of the 

12 Social Security Act (42 U.S.C. 1396r– 

13 4(b)(3))) or a critical access hospital (as 

14 defined in section 1820(c)(2) of the Social 

15 Security Act (42 U.S.C. 1395i–4(c)(2))); 

16 (iv) a public health department; and 

17 (v) an interested public or private sec18 tor health care provider or an organization 

19 that has traditionally served the medically 

20 uninsured and low-income individuals; and 

21 (2) submits to the Secretary an application, in 

22 such form and manner as the Secretary shall pre23 scribe, that— 

24 (A) clearly defines the community to be 

25 served; 


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1 (B) identifies the providers who will par2 ticipate in the community coalition under the 

3 grant and specifies each provider’s contribution 

4 to the care of individuals in the community; 

5 (C) describes the activities that the appli6 cant and the community coalition propose to 

7 perform under the grant to further the objec8 tives of this section; 

9 (D) demonstrates that it is an established 

10 coalition with ability to build on the current 

11 system for serving the community by involving 

12 providers who have traditionally provided a sig13 nificant volume of care for uninsured and low14 income individuals for that community; 

15 (E) demonstrates the coalition’s ability to 

16 develop coordinated systems of care that either 

17 directly provide or ensure the prompt provision 

18 of a broad range of high-quality, accessible 

19 services, including, as appropriate, primary, sec20 ondary, and tertiary services as well as phar21 macy, substance abuse, behavioral health and 

22 oral health services, in a manner that ensures 

23 continuity of care in the community; 

24 (F) provides evidence of community in25 volvement, including the business community, in 


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1 the development, implementation, and direction 

2 of the system of care that the coalition proposes 

3 to ensure; 

4 (G) demonstrates the coalition’s ability to 

5 ensure that participating individuals are en6 rolled in health care coverage programs, both 

7 public and private, for which the individuals are 

8 eligible; 

9 (H) presents a plan for leveraging other 

10 sources of revenue, which may include State 

11 and local sources and private grant funds, and 

12 integrating current and proposed new funding 

13 sources in a manner to ensure long-term sus14 tainability of the system of care; 

15 (I) describes a plan for evaluation of the 

16 activities carried out under the grant, including 

17 measurement of progress toward the goals and 

18 objectives of the program and the use of evalua19 tion findings to improve system performance; 

20 (J) demonstrates fiscal responsibility 

21 through the use of appropriate accounting pro22 cedures and management systems; 

23 (K) demonstrates commitment to serve the 

24 community without regard to the ability of an 

25 individual or family to pay by arranging for or 


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1 providing free or reduced charge care for the 

2 poor; and 

3 (L) includes such other information as the 

4 Secretary may prescribe. 

5 (c) LIMITATIONS.— 

6 (1) IN GENERAL.—An eligible entity may re7 ceive a grant under this section for 3 consecutive fis8 cal years and may receive such a grant award for 2 

9 additional years if— 

10 (A) the eligible entity submits to the Sec11 retary a request for a grant for such additional 

12 years; 

13 (B) the Secretary determines that current 

14 performance justifies the granting of such a re15 quest; and 

16 (C) the Secretary determines that granting 

17 such request is necessary to further the objec18 tives described in subsection (a). 

19 (d) PRIORITIES.—In awarding grants under this sec20 tion, the Secretary— 

21 (1) may accord priority to applicants that dem22 onstrate the greatest extent of unmet need in the 

23 community for a more coordinated system of care; 

24 and 


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1 (2) shall accord priority to applicants that best 

2 promote the objectives of this section, taking into 

3 consideration the extent to which the applicant— 

4 (A) identifies a community whose geo5 graphical area has a high or increasing percent6 age of individuals who are uninsured or low-in7 come; 

8 (B) demonstrates that the applicant has 

9 included in its community coalition providers, 

10 support systems, and programs that have a tra11 dition of serving individuals and families in the 

12 community who are uninsured or earn below 

13 200 percent of the Federal poverty level; 

14 (C) shows evidence that the proposed coali15 tion activities would expand utilization of pre16 ventive and primary care services for uninsured 

17 and underinsured individuals and families in 

18 the community, including pharmaceuticals, be19 havioral and mental health services, oral health 

20 services, or substance abuse services; 

21 (D) proposes approaches that would im22 prove coordination between health care pro23 viders and appropriate social service providers; 

24 (E) demonstrates collaboration with State 

25 and local governments; 


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1 (F) demonstrates that the applicant makes 

2 use of non-Federal contributions to the greatest 

3 extent possible; or 

4 (G) demonstrates likelihood that the pro5 posed activities will lead to sustainable inte6 grated delivery system as additional efforts of 

7 health systems development evolve. 

8 (e) USE OF FUNDS.— 

9 (1) USE BY GRANTEES.— 

10 (A) IN GENERAL.—Except as provided in 

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

12 amounts provided under this section only for— 

13 (i) direct expenses associated with 

14 achieving the greater integration of a 

15 health care delivery system so that the sys16 tem either directly provides or ensures the 

17 provision of a broad range of culturally 

18 competent services, including as appro19 priate primary, secondary, and tertiary 

20 care and oral health, substance abuse, be21 havioral and mental health, and pharma22 ceutical services; and 

23 (ii) direct patient care and service ex24 pansions to fill identified or documented 

25 gaps within an integrated delivery system. 


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1 (B) SPECIFIC USES.—The following are ex2 amples of purposes for which a grantee may use 

3 grant funds under this section, when such use 

4 meets the conditions stated in subparagraph 

5 (A): 

6 (i) Increases in outreach activities and 

7 closing gaps in health care service, includ8 ing referral to specialty services and pre9 scription drugs and conducting ongoing 

10 outreach to health disparity populations. 

11 (ii) Improvements to care manage12 ment and delivery of patient-centered care, 

13 including patient navigation services. 

14 (iii) Improvements to coordination of 

15 transportation to health care facilities. 

16 (iv) Development of provider networks 

17 and other innovative models to engage phy18 sicians in voluntary efforts to serve the 

19 medically underserved within a community. 

20 (v) Recruitment, training, and com21 pensation of necessary personnel. 

22 (vi) Coordinate the acquisition or 

23 interconnected use of technology within a 

24 community for the purpose of coordinating 

25 care and improving provider communicaVerDate Nov 24 2008 07:19 Mar 20, 2009 Jkt 079200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H1614.IH H1614

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1 tion, including implementation of shared 

2 information systems or shared clinical sys3 tems to improve the quality of health care. 

4 (vii) Development of common proc5 esses such as mechanisms for determining 

6 eligibility for the programs provided 

7 through the system, common identification 

8 cards, sliding scale discounts, and moni9 toring and tracking of outcomes. 

10 (viii) Development of specific preven11 tion and disease management tools and 

12 processes. 

13 (ix) Language access services. 

14 (x) Facilitating the involvement of 

15 community organizations to provide better 

16 access to high-quality health care services 

17 to individuals at risk for or who have 

18 chronic diseases or cancer. 

19 (xi) Helping patients overcome bar20 riers within the health care system to en21 sure prompt diagnostic and treatment res22 olution of an abnormal finding of cancer or 

23 chronic disease. 

24 (2) DIRECT PATIENT CARE LIMITATION.—Not 

25 more than 20 percent of the funds provided under 


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1 a grant awarded under this section may be used for 

2 providing direct patient care and services. 

3 (3) RESERVATION OF FUNDS FOR NATIONAL

4 PROGRAM PURPOSES.—The Secretary may use not 

5 more than 7 percent of funds appropriated to carry 

6 out this section for providing technical assistance to 

7 grantees, obtaining assistance of experts and con8 sultants, holding meetings, developing of tools, dis9 seminating of information, and evaluation. 

10 (f) REPORTING BY GRANTEE.—A grantee under this 

11 section shall report to the Secretary annually regarding— 

12 (1) progress in meeting the goals and measur13 able objectives set forth in the grant application sub14 mitted by the grantee under subsection (b); and 

15 (2) the extent to which activities conducted by 

16 such grantee have— 

17 (A) improved the effectiveness, efficiency, 

18 and coordination of services for uninsured and 

19 low-income individuals in the community served 

20 by such grantee, using commonly accepted out21 come measures; 

22 (B) resulted in the provision of better qual23 ity health care for individuals and families in 

24 the community served; and 


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1 (C) resulted in the provision of health care 

2 to such individuals at lower cost than would 

3 have been possible in the absence of the activi4 ties conducted by such grantee. 

5 (g) MAINTENANCE OF EFFORT.—With respect to ac6 tivities for which a grant under this section is authorized, 

7 the Secretary may award such a grant only if the applicant 

8 and each of the participating providers agree that the 

9 grantee and each such provider will maintain its expendi10 tures of non-Federal funds for such activities at a level 

11 that is not less then the level of such expenditures during 

12 the fiscal year immediately preceding the fiscal year for 

13 which the applicant is applying to receive such grant. 

14 (h) TECHNICAL ASSISTANCE.—The Secretary may 

15 provide any entity that receives a grant under this section 

16 with technical and other nonfinancial assistance necessary 

17 to meet the requirements of this section. The Secretary 

18 may choose to provide such assistance by awarding a grant 

19 to, or entering into a contract with, a State or national 

20 not-for-profit organization with expertise in building suc21 cessful community coalitions. 

22 (i) EVALUATION OF PROGRAM.—Not later than Sep23 tember 30, 2014, the Secretary shall prepare and submit 

24 to the appropriate committees of Congress a report that 

25 describes the extent to which projects funded under this 


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1 section have been successful in improving the effective2 ness, efficiency, and coordination of services in the com3 munities served by such projects, including whether the 

4 projects resulted in the provision of better quality health 

5 care for such individuals, and whether such care was pro6 vided at lower costs than would have been provided in the 

7 absence of such projects. 

8 (j) AUTHORIZATION OF APPROPRIATIONS.—There 

9 are authorized to be appropriated to carry out this sec10 tion— 

11 (1) $75,000,000 for fiscal year 2010; 

12 (2) $100,000,000 for fiscal year 2011; 

13 (3) $125,000,000 for fiscal year 2012; 

14 (4) $150,000,000 for fiscal year 2013; and 

15 (5) $175,000,000 for fiscal year 2014. 

Æ 


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