I

103D CONGRESS

1ST SESSION H. R. 725

To amend title XIX of the Social Security Act to create a new part under

such title to provide access to services for medically underserved populations not currently served by federally qualified health centers, by

providing funds for a new program to allow federally qualified health

centers and other qualifying entities to expand such centers’ and entities’

capacity and to develop additional centers.

IN THE HOUSE OF REPRESENTATIVES

FEBRUARY 2, 1993

Mr. MACHTLEY (for himself, Mr. MCCLOSKEY, and Mr. UPTON) introduced

the following bill; which was referred to the Committee on Energy and

Commerce

A BILL

To amend title XIX of the Social Security Act to create

a new part under such title to provide access to services

for medically underserved populations not currently

served by federally qualified health centers, by providing

funds for a new program to allow federally qualified

health centers and other qualifying entities to expand

such centers’ and entities’ capacity and to develop additional centers.

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

2 The Congress finds that—

3 (1) at least 30 million Americans lack access to

4 even the most basic health services;

5 (2) access to health care is especially difficult

6 for those Americans who—

7 (A) live in medically underserved rural

8 communities or inner city neighborhoods;

9 (B) lack public or private health insurance

10 coverage and the ability to pay directly for care;

11 (C) must move for work purposes, such as

12 migrant farmworkers;

13 (D) are members of minority groups, or

14 who speak limited English; or

15 (E) are members of other vulnerable

16 groups, including persons who are homeless or

17 are high-risk pregnant women, infants and chil18 dren;

19 (3) the consequences of poor access to health

20 care is evidenced in elevated infant and childhood

21 mortality rates, dangerously low childhood immuni22 zation rates, overutilization of hospital emergency

23 rooms or other inappropriate providers of primary

24 care services, and hospitalization rates for prevent25 able conditions that are significantly higher than the

26 national average;
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1 (4) efforts to provide access to essential health

2 care services for medically underserved Americans

3 will not only contribute to improved health status,

4 but will also result in less unnecessary care and re5 duced overall costs of health care; and

6 (5) the federally qualified health centers, in7 cluding the community and migrant health centers

8 which serve more than 6 million needy Americans,

9 provide an effective and proven model for extending

10 access to all medically underserved Americans.

11 SEC. 2. ESTABLISHMENT OF NEW PART UNDER THE MEDIC12 AID PROGRAM TO PROVIDE FUNDS FOR A

13 NEW FEDERALLY QUALIFIED HEALTH CEN14 TERS GRANTS PROGRAM.

15 (a) IN GENERAL.—Title XIX of the Social Security

16 Act is amended by inserting after the title heading the

17 following:

18 ‘‘PART A—PAYMENT TO STATES FOR MEDICAL

19 ASSISTANCE’’.

20 (b) PURPOSE.—Section 1901 of the Social Security

21 Act (42 U.S.C. 1396) is amended—

22 (1) in the first sentence—

23 (A) by striking ‘‘and (2)’’ and inserting

24 ‘‘(2)’’; and
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1 (B) by striking ‘‘self care,’’ and inserting

2 ‘‘self care; and (3) grants to assist entities in

3 providing health care services to medically un4 derserved individuals,’’; and

5 (2) by amending the second sentence to read as

6 follows: ‘‘The sums made available under this section

7 shall be used for making payments—

8 (A) under this part to States which have

9 submitted, and had approved by the Secretary,

10 State plans for medical assistance; and

11 (B) under part B to entities meeting the

12 requirements under such part.’’.

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

14 subsections (a) and (b) shall become effective on October

15 1, 1993.

16 SEC. 3. ESTABLISHMENT OF NEW PROGRAM TO PROVIDE

17 FUNDS TO ALLOW FEDERALLY QUALIFIED

18 HEALTH CENTERS AND OTHER ENTITIES OR

19 ORGANIZATIONS TO PROVIDE EXPANDED

20 SERVICES TO MEDICALLY UNDERSERVED IN21 DIVIDUALS.

22 (a) IN GENERAL.—Title XIX of the Social Security

23 Act (42 U.S.C. 1396 et seq.) is amended by adding at

24 the end the following new part:
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1 ‘‘PART B—GRANTS TO QUALIFIED ENTITIES FOR

2 HEALTH SERVICES

3 ‘‘HEALTH SERVICES ACCESS PROGRAM

4 ‘‘SEC. 1941. (a) ESTABLISHMENT OF HEALTH SERV5 ICES ACCESS PROGRAM.—From amounts appropriated

6 under section 1901, the Secretary shall, acting through

7 the Bureau of Health Care Delivery Assistance, award

8 grants under this section to federally qualified health cen9 ters (each in this part referred to as an ‘FQHC’) and

10 other entities and organizations submitting applications

11 under this section (as described in subsection (c)) for the

12 purpose of providing access to services for medically un13 derserved populations (as defined in section 330(b)(3) of

14 the Public Health Service Act) or in high impact areas

15 (as defined in section 329(a)(5) of the Public Health Serv16 ice Act) not currently being served by an FQHC.

17 ‘‘(b) ELIGIBILITY FOR GRANTS.—(1) The Secretary

18 shall award grants under this section to entities or organi19 zations described in this paragraph and paragraph (2)

20 which have submitted a proposal to the Secretary to ex21 pand such entities or organizations operations (including

22 expansions to new sites (as determined necessary by the

23 Secretary)) to serve medically underserved populations or

24 high impact areas not currently served by an FQHC and

25 which—
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1 ‘‘(A) have as of January 1, 1993, been certified

2 by the Secretary as an FQHC under section

3 1905(l)(2)(B); or

4 ‘‘(B) have submitted applications to the Sec5 retary to qualify as FQHC’s under section

6 1905(l)(2)(B); or

7 ‘‘(C) have submitted a plan to the Secretary

8 which provides that the entity will meet the require9 ments to qualify as an FQHC when operational.

10 ‘‘(2)(A) The Secretary shall also make grants under

11 this section to public or private nonprofit agencies, health

12 care entities or organizations which meet the requirements

13 necessary to qualify as an FQHC except, the requirement

14 that such entity have a consumer majority governing

15 board and which have submitted a proposal to the Sec16 retary to provide those services provided by an FQHC as

17 defined in section 1905(l)(2)(B) and which are designed

18 to promote access to primary care services or to reduce

19 reliance on hospital emergency rooms or other high cost

20 providers of primary health care services, provided such

21 proposal is developed by the entity or organizations (or

22 such entities or organizations acting in a consortium in

23 a community) with the review and approval of the Gov24 ernor of the State in which such entity or organization

25 is located.
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1 ‘‘(B) The Secretary shall provide in making grants

2 to entities or organizations described in this paragraph

3 that no more than 10 percent of the funds provided for

4 grants under this section shall be made available for

5 grants to such entities or organizations.

6 ‘‘(c) APPLICATION REQUIREMENTS.—(1) In order to

7 be eligible to receive a grant under this section, an FQHC

8 or other entity or organization must submit an application

9 in such form and at such time as the Secretary shall pre10 scribe and which meets the requirements of this sub11 section.

12 ‘‘(2) An application submitted under this section

13 must provide—

14 ‘‘(A)(i) for a schedule of fees or payments for

15 the provision of the services provided by the entity

16 designed to cover its reasonable costs of operations;

17 and

18 ‘‘(ii) for a corresponding schedule of discounts

19 to be applied to such fees or payments, based upon

20 the patient’s ability to pay (determined by using a

21 sliding scale formula based on the income of the pa22 tient);

23 ‘‘(B) assurances that the entity or organization

24 provides services to persons who are eligible for ben25 efits under title XVIII, for medical assistance under
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1 a State plan approved under part A or for assistance

2 for medical expenses under any other public assist3 ance program or private health insurance program;

4 and

5 ‘‘(C) assurances that the entity or organization

6 has made and will continue to make every reason7 able effort to collect reimbursement for services—

8 ‘‘(i) from persons eligible for assistance

9 under any of the programs described in sub10 paragraph (B); and

11 ‘‘(ii) from patients not entitled to benefits

12 under any such programs.

13 ‘‘(d) LIMITATIONS ON USE OF FUNDS.—(1) From

14 the amounts awarded to an entity or organization under

15 this section, funds may be used for purposes of planning

16 but may only be expended for the costs of—

17 ‘‘(A) assessing the needs of the populations or

18 proposed areas to be served;

19 ‘‘(B) preparing a description of how the needs

20 identified will be met;

21 ‘‘(C) development of an implementation plan

22 that addresses—

23 ‘‘(i) recruitment and training of personnel;

24 and
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1 ‘‘(ii) activities necessary to achieve oper2 ational status in order to meet FQHC require3 ments under 1905(l)(2)(B).

4 ‘‘(2) From the amounts awarded to an entity or orga5 nization under this section, funds may be used for the pur6 poses of paying for the costs of recruiting, training and

7 compensating staff (clinical and associated administrative

8 personnel (to the extent such costs are not already reim9 bursed under part A or any other State or Federal pro10 gram)) to the extent necessary to allow the entity to oper11 ate at new or expanded existing sites.

12 ‘‘(3) From the amounts awarded to an entity or orga13 nization under this section, funds may be expended for

14 the purposes of acquiring facilities and equipment but only

15 for the costs of—

16 ‘‘(A) construction of new buildings (to the ex17 tent that new construction is found to be the most

18 cost-efficient approach by the Secretary);

19 ‘‘(B) acquiring, expanding, or modernizing of

20 existing facilities;

21 ‘‘(C) purchasing essential (as determined by the

22 Secretary) equipment; and

23 ‘‘(D) amortization of principal and payment of

24 interest on loans obtained for purposes of site con-
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1 struction, acquisition, modernization, or expansion,

2 as well as necessary equipment.

3 ‘‘(4) From the amounts awarded to an entity or orga4 nization under this section, funds may be expended for

5 the payment of services but only for the costs of—

6 ‘‘(A) providing or arranging for the provision of

7 all services through the entity necessary to qualify

8 such entity as an FQHC under section

9 1905(l)(2)(B);

10 ‘‘(B) providing or arranging for any other serv11 ice that an FQHC may provide and be reimbursed

12 for under this title; and

13 ‘‘(C) providing any unreimbursed costs of pro14 viding services as described in section 330(a) of the

15 Public Health Service Act to patients.

16 ‘‘(e) PRIORITIES IN THE AWARDING OF GRANTS.—

17 (1) The Secretary shall give priority in awarding grants

18 under this section to entities which have, as of January

19 1, 1993, been certified as an FQHC under section

20 1905(l)(2)(B) and which have submitted a proposal to the

21 Secretary to expand their operations (including expansion

22 to new sites) to serve medically underserved populations

23 for high impact areas not currently served by an FQHC.

24 The Secretary shall give first priority in awarding grants

25 under this section to those FQHCs or other entities which
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1 propose to serve populations with the highest degree of

2 unmet need, and which can demonstrate the ability to ex3 pand their operations in the most efficient manner.

4 ‘‘(2) The Secretary shall give second priority in

5 awarding grants to entities which have submitted applica6 tions to the Secretary which demonstrate that the entity

7 will qualify as an FQHC under section 1905(l)(2)(B) be8 fore it provides or arranges for the provision of services

9 supported by funds awarded under this section, and which

10 are serving or proposing to serve medically underserved

11 populations or high impact areas which are not currently

12 served (or proposed to be served) by an FQHC.

13 ‘‘(3) The Secretary shall give third priority in award14 ing grants in subsequent years to those FQHCs or other

15 entities which have provided for expanded services and

16 project and are able to demonstrate that such entity will

17 incur significant unreimbursed costs in providing such ex18 panded services.

19 ‘‘(f) RETURN OF FUNDS TO SECRETARY FOR COSTS

20 REIMBURSED FROM OTHER SOURCES.—To the extent

21 that an entity or organization receiving funds under this

22 part is reimbursed from another source for the provision

23 of services to an individual, and does not use such in24 creased reimbursement to expand services furnished, areas

25 served, to compensate for costs of unreimbursed services
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1 provided to patients, or to promote recruitment, training,

2 or retention of personnel, such excess revenues shall be

3 returned to the Secretary.

4 ‘‘(g) TERMINATION OF GRANTS.—(1)(A) With re5 spect to any entity that is receiving funds awarded under

6 this section and which subsequently fails to meet the re7 quirements to qualify as an FQHC under section

8 1905(l)(2)(B) or is an entity that is not required to meet

9 the requirements to qualify as an FQHC under section

10 1905(l)(2)(B) but fails to meet the requirements of this

11 section, the Secretary shall terminate the award of funds

12 under this section to such entity.

13 ‘‘(B) Prior to any termination of funds under this

14 section to an entity, the entities shall be entitled to 60

15 days prior notice of termination and, as provided by the

16 Secretary in regulations, an opportunity to correct any de17 ficiencies in order to allow the entity to continue to receive

18 funds under this section.

19 ‘‘(2) Upon any termination of funding under this sec20 tion, the Secretary may (to the extent practicable)—

21 ‘‘(A) sell any property (including equipment)

22 acquired or constructed by the entity using funds

23 made available under this section or transfer such

24 property to another FQHC, in which case the Sec25 retary shall reimburse any costs which were incurred
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1 by the entity in acquiring or constructing such prop2 erty (including equipment) which were not supported

3 by grants under this section; and

4 ‘‘(B) recoup any funds provided to an entity

5 terminated under this section.

6 ‘‘(h) LIMITATION ON AMOUNT OF EXPENDITURES.—

7 The amount of funds that may be expended under this

8 title to carry out the purposes of this part shall be for

9 fiscal year 1994, $200,000,000, for fiscal year 1995,

10 $400,000,000, for fiscal year 1996, $600,000,000, for fis11 cal year 1997, $800,000,000, for fiscal year 1998,

12 $800,000,000, and for fiscal years thereafter such sums

13 as provided by Congress.’’.

14 (b) EFFECTIVE DATE.—The amendments made by

15 subsection (a) shall become effective with respect to serv16 ices furnished by a federally qualified health center or

17 other qualifying entity described in this section beginning

18 on or after October 1, 1993.

19 SEC. 4. STUDY AND REPORT ON SERVICES PROVIDED BY

20 COMMUNITY HEALTH CENTERS AND HOS21 PITALS.

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

23 Human Services (in this section referred to as the ‘‘Sec24 retary’’) shall provide for a study to examine the relation25 ship and interaction between community health centers
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1 and hospitals in providing services to individuals residing

2 in medically underserved areas. The Secretary shall ensure

3 that the National Rural Research Centers participate in

4 such study.

5 (b) REPORT.—The Secretary shall provide to the ap6 propriate committees of Congress a report summarizing

7 the findings of the study within 90 days of the end of

8 each project year and shall include in such report rec9 ommendations on methods to improve the coordination of

10 and provision of services in medically underserved areas

11 by community health centers and hospitals.

12 (c) AUTHORIZATION.—There are authorized to carry

13 out the study provided for in this section $150,000 for

14 each of fiscal years 1994 and 1995.

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