I 

111TH CONGRESS 

1ST SESSION H. R. 1643 

To amend title XVIII of the Social Security Act to establish a prospective 

payment system instead of the reasonable cost-based reimbursement 

method for Medicare-covered services provided by Federally qualified 

health centers and to expand the scope of such covered services to 

account for expansions in the scope of services provided by Federally 

qualified health centers since the inclusion of such services for coverage 

under the Medicare Program. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 19, 2009 

Mr. LEWIS of Georgia (for himself and Mrs. EMERSON) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to establish 

a prospective payment system instead of the reasonable 

cost-based reimbursement method for Medicare-covered 

services provided by Federally qualified health centers 

and to expand the scope of such covered services to 

account for expansions in the scope of services provided 

by Federally qualified health centers since the inclusion 

of such services for coverage under the Medicare Program. 


jbell on PROD1PC69 with BILLS
2 

•HR 1643 IH

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 ‘‘Medicare Access to 

5 Community Health Centers (MATCH) Act of 2009’’. 

6 SEC. 2. FINDINGS. 

7 (a) FINDINGS.—Congress makes the following find8 ings regarding community health centers: 

9 (1) NATIONAL IMPORTANCE.—Community 

10 health centers serve as the medical home and family 

11 physician to over 16 million people nationally. Their 

12 patients represent one in seven low-income persons, 

13 one in eight uninsured Americans, one in nine Med14 icaid beneficiaries, one in ten minorities, and one in 

15 ten rural residents. 

16 (2) HEALTH CARE SAFETY NET.—Because Fed17 erally qualified health centers (FQHCs) are gen18 erally located in medically underserved areas, FQHC 

19 patients are disproportionately low income, unin20 sured or publicly insured, and minority, and they 

21 frequently have poorer health and more complicated, 

22 costly medical needs than patients nationally. As a 

23 chief component of the health care safety net, 

24 FQHCs are required by regulation to serve all paVerDate Nov 24 2008 02:02 Mar 21, 2009 Jkt 079200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1643.IH H1643

jbell on PROD1PC69 with BILLS
3 

•HR 1643 IH

1 tients, regardless of insurance status or ability to 

2 pay. 

3 (3) MEDICARE BENEFICIARIES.—Medicare 

4 beneficiaries are typically less healthy and, therefore, 

5 costlier to treat than other FQHC patients. Medi6 care beneficiaries tend to have more complex health 

7 care needs as— 

8 (A) more than half of Medicare patients 

9 have at least two chronic conditions; 

10 (B) 45 percent take five or more medica11 tions; and 

12 (C) over half of Medicare beneficiaries 

13 have more than one prescribing physician. 

14 (4) NEED TO IMPROVE FQHC PAYMENT.—While 

15 the Centers for Medicare & Medicaid Services have 

16 nearly 15 years’ worth of FQHC cost report data, 

17 which would equip the agency to develop a new 

18 Medicare reimbursement system, the agency has 

19 failed to update and improve the Medicare FQHC 

20 payment system. 


jbell on PROD1PC69 with BILLS
4 

•HR 1643 IH

1 SEC. 3. EXPANSION OF MEDICARE-COVERED PRIMARY AND 

2 PREVENTIVE SERVICES AT FEDERALLY 

3 QUALIFIED HEALTH CENTERS. 

4 (a) IN GENERAL.—Section 1861(aa)(3) of the Social 

5 Security Act (42 U.S.C. 1395w(aa)(3) is amended to read 

6 as follows: 

7 ‘‘(3) The term ‘Federally qualified health center serv8 ices’ means— 

9 ‘‘(A) services of the type described in subpara10 graphs (A) through (C) of paragraph (1), and such 

11 other ambulatory services furnished by a Federally 

12 qualified health center for which payment may oth13 erwise be made under this title if such services were 

14 furnished by a health care provider or health care 

15 professional other than a Federally qualified health 

16 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 and such services when provided 

22 by a health care provider or health care professional em23 ployed by or under contract with a Federally qualified 

24 health center and for this purpose, any reference to a rural 

25 health clinic or a physician described in paragraph (2)(B) 

26 is deemed a reference to a Federally qualified health cenVerDate Nov 24 2008 02:02 Mar 21, 2009 Jkt 079200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1643.IH H1643

jbell on PROD1PC69 with BILLS
5 

•HR 1643 IH

1 ter or a physician at the center, respectively. Services de2 scribed in the previous sentence shall be treated as billable 

3 visits for purposes of payment to the Federally qualified 

4 health center.’’. 

5 (b) CONFORMING AMENDMENT TO PERMIT PAY6 MENT FOR HOSPITAL-BASED SERVICES.—Section 

7 1862(a)(14) of such Act (42 U.S.C. 1395y(a)(14)) is 

8 amended by inserting ‘‘Federally qualified health center 

9 services,’’ after ‘‘qualified psychologist services,’’. 

10 (c) EFFECTIVE DATES.—The amendments made by 

11 subsections (a) and (b) shall apply to services furnished 

12 on or after January 1, 2010. 

13 SEC. 4. ESTABLISHMENT OF A MEDICARE PROSPECTIVE 

14 PAYMENT SYSTEM FOR FEDERALLY QUALI15 FIED HEALTH CENTER SERVICES. 

16 (a) IN GENERAL.—Paragraph (3) section 1833(a) of 

17 the Social Security Act (42 U.S.C. 1395l(a)) is amended 

18 to read as follows: 

19 ‘‘(3)(A) in the case of services described in sec20 tion 1832(a)(2)(D)(i) the costs which are reasonable 

21 and related to the furnishing of such services or 

22 which are based on such other tests of reasonable23 ness as the Secretary may prescribe in regulations 

24 including those authorized under section 

25 1861(v)(1)(A), less the amount a provider may 


jbell on PROD1PC69 with BILLS
6 

•HR 1643 IH

1 charge as described in clause (ii) of section 

2 1866(a)(2)(A) but in no case may the payment for 

3 such services (other than for items and services de4 scribed in 1861(s)(10)(A)) exceed 80 percent of such 

5 costs; and 

6 ‘‘(B) in the case of services described in section 

7 1832(a)(2)(D)(ii) furnished by a Federally qualified 

8 health center— 

9 ‘‘(i) subject to clauses (iii) and (iv), for 

10 services furnished on and after January 1, 

11 2010, during the center’s fiscal year that ends 

12 in 2010, an amount (calculated on a per visit 

13 basis) that is equal to 100 percent of the aver14 age of the costs of the center of furnishing such 

15 services during such center’s fiscal years ending 

16 during 2008 and 2009 which are reasonable 

17 and related to the cost of furnishing such serv18 ices, or which are based on such other tests of 

19 reasonableness as the Secretary prescribes in 

20 regulations including those authorized under 

21 section 1861(v)(1)(A) (except that in calcu22 lating such cost in a center’s fiscal years ending 

23 during 2008 and 2009 and applying the aver24 age of such cost for a center’s fiscal year end25 ing during fiscal year 2010, the Secretary shall 


jbell on PROD1PC69 with BILLS
7 

•HR 1643 IH

1 not apply a per visit payment limit or produc2 tivity screen), less the amount a provider may 

3 charge as described in clause (ii) of section 

4 1866(a)(2)(A), but in no case may the payment 

5 for such services (other than for items or serv6 ices described in section 1861(s)(10)(A)) exceed 

7 80 percent of such average of such costs; 

8 ‘‘(ii) subject to clauses (iii) and (iv), for 

9 services furnished during the center’s fiscal 

10 year ending during 2011 or a succeeding fiscal 

11 year, an amount (calculated on a per visit basis 

12 and without the application of a per visit limit 

13 or productivity screen) that is equal to the 

14 amount determined under this subparagraph 

15 for the center’s preceding fiscal year (without 

16 regard to any copayment)— 

17 ‘‘(I) increased for a center’s fiscal 

18 year ending during 2011 by the percentage 

19 increase in the MEI (as defined in section 

20 1842(i)(3)) applicable to primary care 

21 services (as defined in section 1842(i)(4)) 

22 for 2011 and increased for a center’s fiscal 

23 year ending during 2012 or any succeeding 

24 fiscal year by the percentage increase for 

25 such year of a market basket of Federally 


jbell on PROD1PC69 with BILLS
8 

•HR 1643 IH

1 qualified health center costs as developed 

2 and promulgated through regulations by 

3 the Secretary; and 

4 ‘‘(II) adjusted to take into account 

5 any increase or decrease in the scope of 

6 services, including a change in the type, in7 tensity, duration, or amount of services, 

8 furnished by the center during the center’s 

9 fiscal year, 

10 less the amount a provider may charge as de11 scribed in clause (ii) of section 1866(a)(2)(A), 

12 but in no case may the payment for such serv13 ices (other than for items or services described 

14 in section 1861(s)(10)(A)) exceed 80 percent of 

15 the amount determined under this clause (with16 out regard to any copayment); 

17 ‘‘(iii) subject to clause (iv), in the case of 

18 an entity that first qualifies as a Federally 

19 qualified health center in a center’s fiscal year 

20 ending after 2009— 

21 ‘‘(I) for the first such center fiscal 

22 year, an amount (calculated on a per visit 

23 basis and without the application of a per 

24 visit payment limit or productivity screen) 

25 that is equal to 100 percent of the costs of 


jbell on PROD1PC69 with BILLS
9 

•HR 1643 IH

1 furnishing such services during such center 

2 fiscal year based on the per visit payment 

3 rates established under clause (i) or (ii) for 

4 a comparable period for other such centers 

5 located in the same or adjacent areas with 

6 a similar caseload or, in the absence of 

7 such a center, in accordance with the regu8 lations and methodology referred to in 

9 clause (i) or based on such other tests of 

10 reasonableness (without the application of 

11 a per visit payment limit or productivity 

12 screen) as the Secretary may specify, less 

13 the amount a provider may charge as de14 scribed in clause (ii) of section 1866 

15 (a)(2)(A), but in no case may the payment 

16 for such services (other than for items and 

17 services described in section 

18 1861(s)(10)(A)) exceed 80 percent of such 

19 costs; and 

20 ‘‘(II) for each succeeding center fiscal 

21 year, the amount calculated in accordance 

22 with clause (ii); and 

23 ‘‘(iv) with respect to Federally qualified 

24 health center services that are furnished to an 

25 individual enrolled with a MA plan under part 


jbell on PROD1PC69 with BILLS
10 

•HR 1643 IH

1 C pursuant to a written agreement described in 

2 section 1853(a)(4) (or, in the case of MA pri3 vate fee for service plan, without such written 

4 agreement) the amount (if any) by which— 

5 ‘‘(I) the amount of payment that 

6 would have otherwise been provided under 

7 clauses (i), (ii), or (iii) (calculated as if 

8 ‘100 percent’ were substituted for ‘80 per9 cent’ in such clauses) for such services if 

10 the individual had not been enrolled; ex11 ceeds 

12 ‘‘(II) the amount of the payments re13 ceived under such written agreement (or, 

14 in the case of MA private fee for service 

15 plans, without such written agreement) for 

16 such services (not including any financial 

17 incentives provided for in such agreement 

18 such as risk pool payments, bonuses, or 

19 withholds) less the amount the Federally 

20 qualified health center may charge as de21 scribed in section 1857(e)(3)(B);’’. 

22 (b) EFFECTIVE DATE.—The amendment made by 

23 subsection (a) shall apply to services furnished on or after 

24 January 1, 2010. 

Æ 


jbell on PROD1PC69 with BILLS