I 

111TH CONGRESS 

1ST SESSION H. R. 1296 

To achieve access to comprehensive primary health care services for all Americans and to reform the organization of primary care delivery through 

an expansion of the Community Health Center and National Health 

Service Corps programs. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 4, 2009 

Mr. CLYBURN (for himself, Mr. ABERCROMBIE, Mr. BERMAN, Mr. BISHOP of 

New York, Mr. BLUMENAUER, Ms. BORDALLO, Mr. BOSWELL, Mr. BOUCHER, Mr. BUTTERFIELD, Mr. CARNEY, Mrs. CHRISTENSEN, Mr. CLAY, 

Mr. COSTA, Mr. DAVIS of Illinois, Mr. DAVIS of Tennessee, Mr. 

DEFAZIO, Ms. DEGETTE, Mr. COOPER, Mr. DELAHUNT, Mr. DOGGETT, 

Mr. ELLISON, Ms. ESHOO, Mr. FILNER, Mr. FRANK of Massachusetts, 

Mr. GRIJALVA, Mr. GUTIERREZ, Mr. HIGGINS, Mr. HINOJOSA, Mr. 

LARSON of Connecticut, Ms. LEE of California, Mr. LEWIS of Georgia, 

Mrs. MALONEY, Mr. MARKEY of Massachusetts, Mr. MEEK of Florida, 

Mr. MOORE of Kansas, Ms. MOORE of Wisconsin, Mr. MORAN of Virginia, Mr. MURTHA, Mr. NADLER of New York, Mrs. NAPOLITANO, Ms. 

NORTON, Mr. OLVER, Mr. ORTIZ, Mr. PASCRELL, Mr. PASTOR of Arizona, Mr. PAYNE, Mr. PERLMUTTER, Mr. PRICE of North Carolina, Mr. 

RAHALL, Mr. RODRIGUEZ, Mr. ROTHMAN of New Jersey, Ms. ROYBALALLARD, Mr. RUSH, Mr. SARBANES, Ms. SCHWARTZ, Mr. SCOTT of Georgia, Mr. SERRANO, Ms. SHEA-PORTER, Mr. SIRES, Ms. SLAUGHTER, Mr. 

SPRATT, Mr. TOWNS, Ms. VELA ́ZQUEZ, Mr. WEINER, Mr. WELCH, Mr. 

WEXLER, Mr. WILSON of Ohio, Mr. WU, Mr. YARMUTH, Mr. CLEAVER, 

Mr. FARR, Ms. CLARKE, Mr. SALAZAR, Mr. ROSS, Mr. THOMPSON of 

California, and Ms. SCHAKOWSKY) introduced the following bill; which 

was referred to the Committee on Energy and Commerce 

A BILL 

To achieve access to comprehensive primary health care services for all Americans and to reform the organization 


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of primary care delivery through an expansion of the 

Community Health Center and National Health Service 

Corps programs. 

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 ‘‘Access for All America 

5 Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 

8 (1) Providing universal coverage for health care 

9 for all Americans will be incomplete if access to 

10 medical and other health services is not improved. 

11 (2) Currently, 56,000,000 Americans, both in12 sured and uninsured, have inadequate access to pri13 mary care due to a shortage of physicians and other 

14 like providers in their community. 

15 (3) Several demonstrations are underway at the 

16 Federal and State level to link patients to a primary 

17 care ‘‘medical home’’ as a means of assuring access, 

18 controlling costs, and improving quality. 

19 (4) Yet, there already exists a proven medical 

20 home model that accomplishes these goals and has 

21 done so over the past 40 years while serving over 

22 18,000,000 Americans. 


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1 (5) Community health centers, also known as 

2 Federally Qualified Health Centers (FQHCs), have 

3 been found to more than pay for themselves by pro4 viding coordinated, comprehensive medical, dental, 

5 behavioral health, and prescription drug services 

6 that reduce unnecessary emergency room visits, am7 bulatory-sensitive hospitalizations, and avoidable 

8 specialty care. 

9 (6) The result is that the American Academy of 

10 Family Physicians’ Robert Graham Center found 

11 that medical expenses for health center patients are 

12 41 percent lower compared to patients seen else13 where, an average savings of $1,810 per person per 

14 year. 

15 (7) The Lewin Group found that providing ac16 cess to a medical home for every American would 

17 produce health care savings of $67,000,000,000 per 

18 year, more than 8 times the subsidy needed to sus19 tain the 1,100 current health centers and to create 

20 3,900 new or expanded health center sites to accom21 plish full access. 

22 (8) Hand in hand with the expansion of the 

23 community health center program, a renewed invest24 ment in the National Health Service Corps is essenVerDate Nov 24 2008 06:40 Mar 05, 2009 Jkt 079200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1296.IH H1296

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1 tial to reverse the decline in the supply of primary 

2 care physicians and dentists. 

3 (9) Both the expansion of the community health 

4 center program and the investment in the National 

5 Health Service Corps can be accomplished for less 

6 than 1 percent of total health care spending today. 

7 (10) Finally, to encourage broader adoption of 

8 the cost-effective community health center model of 

9 care beyond underserved areas and populations and 

10 to encourage the pursuit and practice of primary 

11 care as a career, all willing primary care practi12 tioners should be encouraged to collaborate with 

13 community health centers. 

14 SEC. 3. SPENDING FOR FEDERALLY QUALIFIED HEALTH 

15 CENTERS (FQHCS). 

16 Section 330(r) of the Public Health Service Act (42 

17 U.S.C. 254b(r)) is amended by striking paragraph (1) and 

18 inserting the following: 

19 ‘‘(1) GENERAL AMOUNTS FOR GRANTS.—For 

20 the purpose of carrying out this section, in addition 

21 to the amounts authorized to be appropriated under 

22 subsection (d), there is authorized to be appro23 priated the following: 

24 ‘‘(A) For fiscal year 2010, 

25 $2,988,821,592. 


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1 ‘‘(B) For fiscal year 2011, 

2 $3,862,107,440. 

3 ‘‘(C) For fiscal year 2012, $4,990,553,440. 

4 ‘‘(D) For fiscal year 2013, 

5 $6,448,713,307. 

6 ‘‘(E) For fiscal year 2014, 

7 $7,332,924,155. 

8 ‘‘(F) For fiscal year 2015, 

9 $8,332,924,155. 

10 ‘‘(G) For fiscal year 2016, and each subse11 quent fiscal year, the amount appropriated for 

12 the preceding fiscal year adjusted by the prod13 uct of— 

14 ‘‘(i) one plus the average percentage 

15 increase in costs incurred per patient 

16 served; and 

17 ‘‘(ii) one plus the average percentage 

18 increase in the total number of patients 

19 served.’’. 

20 SEC. 4. OTHER PROVISIONS. 

21 (a) SETTINGS FOR SERVICE DELIVERY.—Section 

22 330(a)(1) of the Public Health Service Act (42 U.S.C. 

23 254b(a)(1)) is amended by adding at the end the fol24 lowing: ‘‘Required primary health services and additional 

25 health services may be provided either at facilities directly 


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1 operated by the center or at any other inpatient or out2 patient settings determined appropriate by the center to 

3 meet the needs of its patents.’’. 

4 (b) LOCATION OF SERVICE DELIVERY SITES.—Sec5 tion 330(a) of the Public Health Service Act (42 U.S.C. 

6 254b(a)) is amended by adding at the end the following: 

7 ‘‘(3) CONSIDERATIONS.— 

8 ‘‘(A) LOCATION OF SITES.—Subject to 

9 subparagraph (B), a center shall not be re10 quired to locate its service facility or facilities 

11 within a designated medically underserved area 

12 in order to serve either the residents of its 

13 catchment area or a special medically under14 served population comprised of migratory and 

15 seasonal agricultural workers, the homeless, or 

16 residents of public housing, if that location is 

17 determined by the center to be reasonably ac18 cessible to and appropriate to meet the needs of 

19 the medically underserved residents of the cen20 ter’s catchment area or the special medically 

21 underserved population, in accordance with sub22 paragraphs (A) and (J) of subsection (k)(3). 

23 ‘‘(B) LOCATION WITHIN ANOTHER CEN24 TER’S AREA.—The Secretary may permit appli25 cants for grants under this section to propose 


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1 the location of a service delivery site within an2 other center’s catchment area if the applicant 

3 demonstrates sufficient unmet need in such 

4 area and can otherwise justify the need for ad5 ditional Federal resources in the catchment 

6 area. In determining whether to approve such a 

7 proposal, the Secretary shall take into consider8 ation whether collaboration between the two 

9 centers exists, or whether the applicant has 

10 made reasonable attempts to establish such col11 laboration, and shall consider any comments 

12 timely submitted by the affected center con13 cerning the potential impact of the proposal on 

14 the availability or accessibility of services the 

15 affected center currently provides or the finan16 cial viability of the affected center.’’. 

17 (c) AFFILIATION AGREEMENTS.—Section 

18 330(k)(3)(B) of the Public Health Service Act (42 U.S.C. 

19 254b(k)(3)(B)) is amended by inserting before the semi20 colon the following: ‘‘, including contractual arrangements 

21 as appropriate, while maintaining full compliance with the 

22 requirements of this section, including the requirements 

23 of subparagraph (H) concerning the composition and au24 thorities of the center’s governing board, and, except as 

25 otherwise provided in clause (ii) of such subparagraph, enVerDate Nov 24 2008 06:40 Mar 05, 2009 Jkt 079200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1296.IH H1296

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1 suring full autonomy of the center over policies, direction, 

2 and operations related to health care delivery, personnel, 

3 finances, and quality assurance’’. 

4 (d) GOVERNANCE REQUIREMENTS.—Section 

5 330(k)(3) of the Public Health Service Act (42 U.S.C. 

6 254b(k)(3)) is amended— 

7 (1) in subparagraph (H)— 

8 (A) in clause (ii), by striking ‘‘; and’’ and 

9 inserting ‘‘, except that in the case of a public 

10 center (as defined in the second sentence of this 

11 paragraph), the public entity may retain au12 thority to establish financial and personnel poli13 cies for the center; and’’; 

14 (B) in clause (iii), by adding ‘‘and’’ at the 

15 end; and 

16 (C) by inserting after clause (iii) the fol17 lowing: 

18 ‘‘(iv) in the case of a co-applicant with 

19 a public entity, meets the requirements of 

20 clauses (i) and (ii);’’; and 

21 (2) in the second sentence, by inserting before 

22 the period the following: ‘‘that is governed by a 

23 board that satisfies the requirements of subpara24 graph (H) or that jointly applies (or has applied) for 


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1 funding with a co-applicant board that meets such 

2 requirements’’. 

3 (e) ADJUSTMENT IN CENTER’S OPERATING PLAN

4 AND BUDGET.—Section 330(k)(3)(I)(i) of the Public 

5 Health Service Act (42 U.S.C. 254b(k)(3)(I)(i)) is amend6 ed by inserting before the semicolon the following: ‘‘, 

7 which may be modified by the center at any time during 

8 the fiscal year involved if such modifications do not require 

9 additional grant funds, do not compromise the availability 

10 or accessibility of services currently provided by the center, 

11 and otherwise meet the conditions of subsection (a)(3)(B), 

12 except that any such modifications that do not comply 

13 with this clause, as determined by the health center, shall 

14 be submitted to the Secretary for approval’’. 

15 (f) JOINT PURCHASING ARRANGEMENTS FOR RE16 DUCED COST.—Section 330(l) of the Public Health Serv17 ice Act (42 U.S.C. 254b(l)) is amended— 

18 (1) by striking ‘‘The Secretary’’ and inserting 

19 the following: 

20 ‘‘(1) IN GENERAL.—The Secretary’’; and 

21 (2) by adding at the end the following: 

22 ‘‘(2) ASSISTANCE WITH SUPPLIES AND SERV23 ICES COSTS.—The Secretary, directly or through 

24 grants or contracts, may carry out projects to estab25 lish and administer arrangements under which the 


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1 costs of providing the supplies and services needed 

2 for the operation of federally qualified health centers 

3 are reduced through collaborative efforts of the cen4 ters, through making purchases that apply to mul5 tiple centers, or through such other methods as the 

6 Secretary determines to be appropriate.’’. 

7 (g) OPPORTUNITY TO CORRECT MATERIAL FAILURE

8 REGARDING GRANT CONDITIONS.—Section 330(e) of the 

9 Public Health Service Act (42 U.S.C. 254b(e)) is amended 

10 by adding at the end the following: 

11 ‘‘(6) OPPORTUNITY TO CORRECT MATERIAL

12 FAILURE REGARDING GRANT CONDITIONS.—If the 

13 Secretary finds that a center materially fails to meet 

14 any requirement (except for any requirements 

15 waived by the Secretary) necessary to qualify for its 

16 grant under this subsection, the Secretary shall pro17 vide the center with an opportunity to achieve com18 pliance (over a period of up to 1 year from making 

19 such finding) before terminating the center’s grant. 

20 A center may appeal and obtain an impartial review 

21 of any Secretarial determination made with respect 

22 to a grant under this subsection, or may appeal and 

23 receive a fair hearing on any Secretarial determina24 tion involving termination of the center’s grant enti25 tlement, modification of the center’s service area, 


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1 termination of a medically underserved population 

2 designation within the center’s service area, disallow3 ance of any grant expenditures, or a significant re4 duction in a center’s grant amount.’’. 

5 SEC. 5. FUNDING FOR NATIONAL HEALTH SERVICE CORPS. 

6 Section 338H(a) of the Public Health Service Act (42 

7 U.S.C. 254q(a)) is amended to read as follows: 

8 ‘‘(a) AUTHORIZATION OF APPROPRIATIONS.—For the 

9 purpose of carrying out this section, there is authorized 

10 to be appropriated, out of any funds in the Treasury not 

11 otherwise appropriated, the following: 

12 ‘‘(1) For fiscal year 2010, $320,461,632. 

13 ‘‘(2) For fiscal year 2011, $414,095,394. 

14 ‘‘(3) For fiscal year 2012, $535,087,442. 

15 ‘‘(4) For fiscal year 2013, $691,431,432. 

16 ‘‘(5) For fiscal year 2014, $893,456,433. 

17 ‘‘(6) For fiscal year 2015, $1,154,510,336. 

18 ‘‘(7) For fiscal year 2016, and each subsequent 

19 fiscal year, the amount appropriated for the pre20 ceding fiscal year adjusted by the product of— 

21 ‘‘(A) one plus the average percentage in22 crease in the costs of health professions edu23 cation during the prior fiscal year; and 

24 ‘‘(B) one plus the average percentage 

25 change in the number of individuals residing in 


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1 health professions shortage areas designated 

2 under section 333 during the prior fiscal year, 

3 relative to the number of individuals residing in 

4 such areas during the previous fiscal year.’’. 

Æ 


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