II 

111TH CONGRESS 

1ST SESSION S. 1303 

To authorize the Secretary of Health and Human Services to establish a 

women’s medical home demonstration project. 

IN THE SENATE OF THE UNITED STATES 

JUNE 18, 2009 

Mr. MENENDEZ introduced the following bill; which was read twice and 

referred to the Committee on Finance 

A BILL 

To authorize the Secretary of Health and Human Services 

to establish a women’s medical home demonstration project. 

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 ‘‘Women’s Medical 

5 Home Demonstration Act’’. 

6 SEC. 2. WOMEN’S MEDICAL HOME DEMONSTRATION 

7 PROJECT. 

8 (a) DEFINITIONS.—In this Act: 


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1 (1) ADVISORY COUNCIL.—The term ‘‘Advisory 

2 Council’’ means the advisory council established 

3 under subsection (c). 

4 (2) CHIP.—The term ‘‘CHIP’’ means the 

5 State Children’s Health Insurance Program estab6 lished under title XXI of the Social Security Act (42 

7 U.S.C. 1397aa et seq.). 

8 (3) ELIGIBLE INDIVIDUALS.— 

9 (A) IN GENERAL.—The term ‘‘eligible indi10 vidual’’ means a woman who is receiving assist11 ance under Medicaid or CHIP. 

12 (B) PRIORITY FOR CERTAIN WOMEN.—In 

13 enrolling eligible individuals in a demonstration 

14 project conducted under this section, the eligible 

15 entity conducting the project shall give special 

16 consideration to enrolling eligible individuals re17 ceiving services described in any of clauses (i) 

18 through (ix) of paragraph (8)(G). 

19 (4) ELIGIBLE ENTITY.—The term ‘‘eligible enti20 ty’’ means a State, an entity or organization receiv21 ing payments under Medicaid or CHIP, an entity or 

22 organization that is receiving assistance under sec23 tion 330 of the Public Health Service Act (42 

24 U.S.C. 254b), a federally qualified health center (as 

25 defined in subsection (l)(2)(C) of section 1905 of the 


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1 Social Security Act (42 U.S.C. 1396d), a rural 

2 health clinic (as defined in subsection (l)(1) of such 

3 section), or an entity that receives assistance under 

4 title X or XX of the Public Health Service Act (42 

5 U.S.C. 300 et seq., 300z et seq.), that submits an 

6 approved application to the Secretary to conduct a 

7 demonstration project under this section. 

8 (5) MEDICAID.—The term ‘‘Medicaid’’ means 

9 the Federal and State program for medical assist10 ance established under title XIX of the Social Secu11 rity Act (42 U.S.C. 1396 et seq.). 

12 (6) PRINCIPAL WOMEN’S HEALTH PROVIDER.— 

13 The term ‘‘principal women’s health provider’’ 

14 means: 

15 (A) A physician (as defined in section 

16 1861(r)(1) of the Social Security Act (42 

17 U.S.C. 1395x(r)(1)) who meets the following re18 quirements: 

19 (i) The physician is a board certified 

20 physician who specializes in women’s 

21 health issues, such as obstetrics and gyne22 cology, and who provides continuous and 

23 comprehensive care for individuals under 

24 the physician’s care. 


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1 (ii) The physician has the staff and 

2 resources to manage the comprehensive 

3 and coordinated health care of each such 

4 individual. 

5 (iii) The physician practices in a prac6 tice or health center recognized to be a 

7 women’s medical home. 

8 (iv) Such other requirements as are 

9 defined by the Secretary in consultation 

10 with the Advisory Council. 

11 (B) An advance practice nurse, including a 

12 certified nurse-midwife (CNM) or certified mid13 wife (CM) certified by the American Midwifery 

14 Certification Board, or physician assistant, who 

15 meets the following requirements: 

16 (i) The advance practice nurse or phy17 sician assistant specializes in women’s 

18 health issues, such as obstetrics and gyne19 cology, and provides continuous and com20 prehensive care for patients. 

21 (ii) The advance practice nurse or 

22 physician assistant has the staff and re23 sources to manage the comprehensive and 

24 coordinated health care of each such indi25 vidual. 


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1 (iii) The advance practice nurse or 

2 physician assistant practices in a practice 

3 or health center recognized to be a wom4 en’s medical home. 

5 (iv) Such other requirements as are 

6 defined by the Secretary in consultation 

7 with the Advisory Council. 

8 (7) SECRETARY.—The term ‘‘Secretary’’ means 

9 the Secretary of Health and Human Services. 

10 (8) WOMEN’S MEDICAL HOME.—The term 

11 ‘‘women’s medical home’’ means a physician-led 

12 practice, or advanced practice nurse-directed prac13 tice in those States in which independent practice is 

14 included in the scope of practice of licensed ad15 vanced practice nurses, that uses practice innova16 tions to improve the management and coordination 

17 of women’s health care and that meets the following 

18 standards: 

19 (A) The practice, health center, or clinic is 

20 able to provide or coordinate a continuum of 

21 care for women across their life spans, includ22 ing wellness care, preconception care, prenatal 

23 care, family planning, medical care, mental and 

24 behavioral health care, screening, and followup 

25 care for health needs later in life. 


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1 (B) The practice, health center, or clinic 

2 applies standards for access to care and com3 munication with eligible individuals partici4 pating in the demonstration project established 

5 under this section, including direct and ongoing 

6 access to the principal women’s health provider 

7 who accepts responsibility for providing contin8 uous care, including coordination for com9 prehensive health care to the whole person, in 

10 collaboration with teams of other health profes11 sionals, including other nurses, primary care 

12 and specialist physicians, and mental health 

13 professionals, as needed and appropriate. Care 

14 is patient and family centered, culturally and 

15 linguistically appropriate, structured to ensure 

16 women receive complete and accurate health in17 formation to make their own health care deci18 sions, and structured to assure confidentiality 

19 so that teens and women may seek needed care 

20 in a timely way. 

21 (C) The practice, health center, or clinic 

22 has readily accessible, clinically useful informa23 tion on eligible individuals participating in the 

24 demonstration project established under this 


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1 section that enables the practice to treat such 

2 individuals comprehensively and systematically. 

3 (D) The practice, health center, or clinic 

4 maintains continuous relationships with eligible 

5 individuals participating in the demonstration 

6 project established under this section by imple7 menting evidence-based guidelines and applying 

8 them to the identified needs of such individuals 

9 over time and with the intensity needed by such 

10 individuals. 

11 (E) The practice, health center, or clinic 

12 provides ongoing assistance and encouragement 

13 in patient management. The practice— 

14 (i) collaborates with eligible individ15 uals participating in the demonstration 

16 project established under this section to 

17 pursue their goals for optimal achievable 

18 health; and 

19 (ii) assesses patient-specific barriers 

20 to communication and conducts activities 

21 to support patient self-management. 

22 (F) The practice, health center, or clinic 

23 has in place the resources and processes nec24 essary to achieve improvements in the manage25 ment and coordination of care for eligible indiVerDate Nov 24 2008 00:43 Jun 19, 2009 Jkt 079200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1303.IS S1303

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1 viduals participating in the demonstration 

2 project established under this section, includ3 ing— 

4 (i) providing training programs for 

5 personnel involved in the coordination of 

6 care; and 

7 (ii) utilizing information technology to 

8 support optimal patient care, performance 

9 measurement, patient education, and en10 hanced communication. 

11 (G) The practice, health center, or clinic is 

12 able to provide 1 or more of the following serv13 ices: 

14 (i) Treats women who are deemed at 

15 risk for premature birth. 

16 (ii) Provides services related to pre17 vention of cervical cancer by immunization, 

18 periodic cervical cytology and early treat19 ment of precursor lesions. 

20 (iii) Provides and coordinates care for 

21 women with breast or gynecologic cancer. 

22 (iv) Provides and coordinates services 

23 for women experiencing menopause, 

24 perimenopause and related issues such as 


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1 osteoporosis, fracture prevention, and men2 tal health concerns. 

3 (v) Provides family planning care. 

4 (vi) Provides and coordinates 

5 postpartum health services, including care 

6 for women experiencing perinatal depres7 sion. 

8 (vii) Provides and coordinates care for 

9 women who are members of a minority 

10 population that experiences health dispari11 ties. 

12 (viii) Provides and coordinates care 

13 for chronic conditions. 

14 (ix) Any other services specified by 

15 the Secretary, in consultation with the Ad16 visory Council. 

17 (H) The practice, health center, or clinic 

18 monitors its clinical process and performance 

19 (including process and outcome measures) and 

20 provides information in a form and manner 

21 specified by the Secretary and Advisory Council 

22 with respect to such process and performance. 

23 (I) The practice, health center, or clinic 

24 meets the requirements imposed on a covered 

25 entity for purposes of applying part C of title 


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1 XI of the Public Health Service Act (42 U.S.C. 

2 300b–1 et seq.) and all regulatory provisions 

3 promulgated there under, including regulations 

4 (relating to privacy) adopted pursuant to the 

5 authority of the Secretary under section 264(c) 

6 of the Health Insurance Portability and Ac7 countability Act of 1996 (42 U.S.C. 1320d–2 

8 note). 

9 (b) ESTABLISHMENT.— 

10 (1) IN GENERAL.—Not later than 2 years after 

11 the date of enactment of this Act, the Secretary 

12 shall establish a women’s medical home demonstra13 tion project (in this section referred to as the 

14 ‘‘project’’) to— 

15 (A) guide the redesign of the health care 

16 delivery system for women to provide targeted, 

17 accessible, continuous, coordinated, confidential, 

18 and comprehensive care to eligible individuals 

19 with a particular focus on— 

20 (i) coordinating and improving care of 

21 women who are deemed at risk for pre22 mature birth; 

23 (ii) preventing cervical cancer by im24 munization, periodic cervical cytology and 

25 early treatment of precursor lesions; 


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1 (iii) coordinating and improving care 

2 of women with breast or gynecologic can3 cer; 

4 (iv) coordinating and improving care 

5 for women experiencing menopause, 

6 perimenopause and related issues such as 

7 osteoporosis, fracture prevention and men8 tal health concerns; 

9 (v) providing and improving care in 

10 family planning services; 

11 (vi) providing and coordinating care 

12 for women postpartum, including those 

13 deemed to be at risk for perinatal depres14 sion; 

15 (vii) providing, coordinating, and im16 proving care of women who are members 

17 of a minority population that experiences 

18 health disparities; 

19 (viii) providing and coordinating care 

20 for individuals with chronic conditions; and 

21 (ix) providing any other services speci22 fied by the Secretary, in consultation with 

23 the Advisory Council. 

24 (B) provide principal care management 

25 payments, performance-based bonus payments, 


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1 incentive payments for additional operations 

2 costs, and any other services, specified by the 

3 Secretary in consultation with the Advisory 

4 Council, to providers participating in a women’s 

5 medical home under the project. 

6 (2) NATURE AND SCOPE OF PROJECT.— 

7 (A) DURATION; SCOPE.—The project shall 

8 be conducted for a 3-year period and shall in9 clude a nationally representative sample of phy10 sicians, advance practice nurses, and physician 

11 assistants who specialize in women’s health and 

12 who serve urban, rural, and underserved areas 

13 in a total of no more than 8 States. 

14 (B) ENCOURAGING PARTICIPATION OF

15 SMALL PHYSICIAN PRACTICES.—The project 

16 shall be designed to include the participation of 

17 physicians in practices with fewer than 4 full18 time equivalent physicians, as well as physicians 

19 in larger practices, particularly in rural and un20 derserved areas. 

21 (3) PROJECT GOALS.—The project shall be de22 signed in order to determine whether and to what 

23 extent women’s medical homes accomplish the fol24 lowing, with special consideration given to the servVerDate Nov 24 2008 00:43 Jun 19, 2009 Jkt 079200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S1303.IS S1303

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1 ices and outcomes described in clauses (i) through 

2 (ix) of paragraph (1)(A): 

3 (A) Increase— 

4 (i) cost efficiencies of health care de5 livery; 

6 (ii) access to appropriate health care 

7 services; 

8 (iii) patient satisfaction; 

9 (iv) communication among providers, 

10 hospitals, and other health care providers; 

11 and 

12 (v) the quality of health care services 

13 provided, as based on measures of quality 

14 the Secretary, in consultation with the Ad15 visory Council, has specified. 

16 (B) Decrease— 

17 (i) inappropriate emergency room uti18 lization; 

19 (ii) avoidable hospitalizations; 

20 (iii) duplication of health care services 

21 provided; and 

22 (iv) health disparities. 

23 (C) Provide appropriate referrals to multi24 disciplinary services. 


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1 (4) SERVICES PERFORMED.—A principal pro2 vider operating within a women’s medical home shall 

3 perform or provide for the performance of services— 

4 (A) described in subsection (a)(8)(G); and 

5 (B) any additional services specified by 

6 Secretary in consultation with the Advisory 

7 Council. 

8 (5) ELIGIBLE INDIVIDUAL AND ELIGIBLE ENTI9 TY PARTICIPATION.— 

10 (A) ELIGIBLE INDIVIDUALS.—The Sec11 retary shall establish a process under which— 

12 (i) an eligible individual may elect to 

13 participate in a women’s medical home 

14 under the project; and 

15 (ii) no cost sharing shall be imposed 

16 with respect to any service required under 

17 paragraph (4) to be provided to the indi18 vidual under the project. 

19 (B) ASSURANCE OF PARTICIPATION OF EL20 IGIBLE ENTITIES THAT ARE NOT PARTICI21 PATING PROVIDERS OR ARE IN STATES WITH

22 MANAGED CARE.—The Secretary shall establish 

23 a process to ensure that eligible entities that 

24 are not participating providers under the State 

25 Medicaid or CHIP program, or, in the case of 


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1 a State that contracts with a private entity to 

2 manage parts of the State Medicaid or CHIP 

3 program, do not participate with that entity, 

4 are able to participate in the project. 

5 (6) STANDARD SETTING PROCESS.—The Sec6 retary shall, in consultation with the Advisory Coun7 cil— 

8 (A) specify standards for practices, health 

9 centers, and clinics to qualify for certification 

10 as women’s medical homes, including standards 

11 described in subsection (a)(8)(B); 

12 (B) specify characteristics of principal 

13 women’s health providers consistent with sub14 section (a)(6); 

15 (C) specify services a principal physician, 

16 principal advance practice nurse, or principal 

17 physician assistant operating within a women’s 

18 medical home shall perform or provide for the 

19 performance of; 

20 (D) develop a women’s medical home reim21 bursement methodology which shall include at a 

22 minimum— 

23 (i) recognition of the value of physi24 cian and clinical staff work associated with 

25 patient care that falls outside the face-toVerDate Nov 24 2008 00:43 Jun 19, 2009 Jkt 079200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\S1303.IS S1303

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1 face visit, such as the time and effort 

2 spent on educating family caregivers and 

3 arranging appropriate followup services 

4 with other health care professionals, such 

5 as nurse educators; 

6 (ii) services associated with coordina7 tion of care both within a given practice 

8 and between consultants, ancillary pro9 viders, and community resources; 

10 (iii) recognition of expenses that the 

11 women’s medical home practices will incur 

12 to acquire and utilize health information 

13 technology, such as clinical decision sup14 port tools, patient registries, or electronic 

15 medical records; 

16 (iv) reimbursement for separately 

17 identifiable e-mail and telephonic consulta18 tions, either as separately billable services 

19 or as part of a global management fee; 

20 (v) recognition of the value of provider 

21 work associated with remote monitoring of 

22 clinical data using technology; 

23 (vi) allowance for separate fee-for24 service payments for face-to-face visits; 


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1 (vii) recognition of case mix dif2 ferences in the patient population being 

3 treated within the practice; 

4 (viii) recognition and sharing of sav5 ings with respect to reductions in the oc6 currence of health and pregnancy com7 plications, hospitalization rates, medical er8 rors, adverse drug reactions, and other oc9 currences, as defined by the Advisory 

10 Council; 

11 (ix) allowance for additional payments 

12 for achieving measurable and continuous 

13 quality improvements, including under a 

14 process established by the Secretary for 

15 paying a performance-based bonus to wom16 en’s medical homes which meet or achieve 

17 substantial improvements in performance 

18 (as specified under clinical, patient satis19 faction, and efficiency benchmarks estab20 lished by the Secretary in consultation with 

21 the Advisory Council); 

22 (x) recognition of the existing pay23 ment methodology for federally qualified 

24 health centers when determining the most 

25 appropriate mechanism for providing 


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1 bonus payments for women’s medical home 

2 services delivered at such centers; and 

3 (xi) such other methods as the Sec4 retary, in consultation with the Advisory 

5 Council, finds appropriate; 

6 (E) develop appropriate risk-adjustment 

7 mechanisms to account for varying costs of 

8 women’s medical homes based upon characteris9 tics of the eligible individuals participating in 

10 the project; 

11 (F) select the outcomes and quality meas12 ures and level of improvements required to 

13 qualify for performance-based bonus payments, 

14 with special consideration such payments re15 lated to services and outcomes described in 

16 clauses (i) through (ix) of paragraph (1)(A); 

17 and 

18 (G) evaluate the project in accordance with 

19 subsection (d). 

20 (7) PLANNING OR IMPLEMENTATION GRANTS.— 

21 The Secretary may award planning or implementa22 tion grants to eligible entities desiring or selected to 

23 participate in the project. 

24 (8) ONGOING OVERSIGHT AND PERFORMANCE

25 ASSESSMENT.—The Secretary shall establish proceVerDate Nov 24 2008 00:43 Jun 19, 2009 Jkt 079200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\S1303.IS S1303

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1 dures to ensure that practices, health centers, and 

2 clinics participating as women’s medical homes 

3 under the project, and the physicians, advance prac4 tice nurses, and physician assistants providing serv5 ices at such practices, centers, and clinics, have ac6 cess to confidential feedback and benchmarking re7 ports as a function of the practice’s, health center’s, 

8 or clinic’s monitoring of its clinical process and per9 formance (including process and outcome measures). 

10 (9) TECHNICAL ASSISTANCE.—The Secretary 

11 shall establish mechanisms to provide technical as12 sistance to practices, health centers, and clinics par13 ticipating as women’s medical homes under the 

14 project. 

15 (10) PAYMENTS TO STATES.—The Secretary 

16 shall pay each State participating in the project an 

17 amount equal to 100 percent of the amounts ex18 pended by the State for services provided to an eligi19 ble individual under the project, including adminis20 trative expenses. 

21 (c) ADVISORY COUNCIL.— 

22 (1) ESTABLISHMENT.—Not later than 60 days 

23 after the date of enactment of this Act, the Sec24 retary shall establish a Women’s Medical Home Ad25 visory Council. 


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1 (2) TERMS OF MEMBERS.— 

2 (A) IN GENERAL.—Each appointed mem3 ber of the Advisory Council shall hold office for 

4 the duration of the project. 

5 (B) VACANCIES.—The Secretary shall fill 

6 any vacancy in the membership of the Advisory 

7 Council in the same manner as the original ap8 pointment. The vacancy shall not affect the 

9 power of the remaining members to execute the 

10 duties of the Advisory Council. 

11 (3) COMPOSITION.—Membership in the Advi12 sory Council shall include— 

13 (A) one representative from the Agency for 

14 Healthcare Research and Quality; 

15 (B) one representative from the Health 

16 Resources and Services Administration; 

17 (C) one representative from the Office of 

18 Women’s Health of the Department of Health 

19 and Human Services; 

20 (D) one representative from the Centers 

21 for Medicare & Medicaid Services; 

22 (E) representatives from other appropriate 

23 Federal agencies; 


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1 (F) four physicians who specialize in wom2 en’s health care, including 3 of which are 

3 board-certified in obstetrics and gynecology; 

4 (G) one certified nurse midwife; 

5 (H) one advanced practice nurse; 

6 (I) one physician assistant; 

7 (J) one mental health professional; 

8 (K) one individual with expertise in coding 

9 and reimbursement-related issues; 

10 (L) one individual with expertise in quality 

11 improvement efforts; and 

12 (M) one consumer representative. 

13 (4) APPLICATION OF FACA.—The Federal Advi14 sory Committee Act (5 U.S.C. App.) shall apply to 

15 the Advisory Council except that, for purposes of 

16 section 14 of that Act, the Advisory Council shall 

17 terminate 6 years after the date of the Secretary es18 tablishes the Council. 

19 (5) WORKING GROUPS.—The Secretary may 

20 convene additional working groups to report to the 

21 Advisory Committee in order to assist with fulfill22 ment of its duties. 

23 (6) DUTIES.—It shall be the duty of the Advi24 sory Council to assist the Secretary in carrying out 

25 the Secretary’s duties under this section. 


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1 (d) EVALUATIONS AND PROJECT REPORTS.— 

2 (1) ANNUAL INTERIM EVALUATIONS AND RE3 PORTS.—For each year of the project, the Secretary, 

4 in consultation with the Advisory Council, shall pro5 vide for an interim evaluation of the project and 

6 shall submit to Congress reports on the results of 

7 such evaluations. 

8 (2) FINAL EVALUATION AND REPORT.—The 

9 Secretary, in consultation with the Advisory Council, 

10 shall provide for a final evaluation of the project and 

11 shall submit to Congress, not later than 1 year after 

12 completion of the project, a final report on the 

13 project based on the results of such evaluation. The 

14 final report required under this paragraph shall in15 clude— 

16 (A) an assessment of quality improvements 

17 and clinical outcomes as a result of the project; 

18 (B) an assessment of patient and provider 

19 satisfaction; 

20 (C) an assessment of which women, based 

21 on demographic factors, such as age, race, sex22 ual orientation, disability, ethnicity, and socio23 economic status, benefit the most from partici24 pating in a women’s medical home; 


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1 (D) estimates of cost savings to Medicaid, 

2 CHIP, and other Federal programs resulting 

3 from the project; and 

4 (E) recommendations for such legislation 

5 and administrative action as the Secretary de6 termines to be appropriate. 

Æ 


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