I 

109TH CONGRESS 

2D SESSION H. R. 5171 

To amend the Public Health Service Act to provide for community projects 

that will reduce the number of individuals who are uninsured with respect 

to health care, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 25, 2006 

Mr. HOEKSTRA (for himself, Mr. GILLMOR, Mr. MCCOTTER, Mr. ROGERS of 

Michigan, Mr. EHLERS, Mr. BOOZMAN, Mr. SHADEGG, Mr. CAMP, and 

Mr. LATOURETTE) introduced the following bill; which was referred to 

the Committee on Energy and Commerce 

A BILL 

To amend the Public Health Service Act to provide for 

community projects that will reduce the number of individuals who are uninsured with respect to health care, 

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 ‘‘Communities Building 

5 Access Act’’. 

6 SEC. 2. FINDINGS. 

7 The Congress finds as follows: 


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1 (1) Two models of community programs for the 

2 uninsured have emerged as effective in generating 

3 community support and funding in urban and rural 

4 areas; in providing effective care and coverage for 

5 the uninsured; in avoiding displacement of private 

6 coverage; and in avoiding duplication of other fed7 eral programs for the uninsured. 

8 (2) These community models have dem9 onstrated community-wide economic benefit. Em10 ployers in the community experience less health care 

11 cost-shifting, in addition to increased productivity 

12 and employee retention. With greater emphasis on 

13 preventive and chronic care, a community’s unin14 sured population becomes less of a financial burden 

15 on state and local budgets. 

16 (3) These community models have dem17 onstrated potential national solutions for certain un18 insured populations, including the working unin19 sured. Such lessons learned from these models in20 clude, for example, the level of subsidy necessary to 

21 get small employers to purchase coverage for their 

22 employees, how to effectively market access pro23 grams to the uninsured, and how to effectively man24 age chronic care among lower-income populations. 


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1 (4) These community models have succeeded in 

2 raising much of the funding necessary to function, 

3 but have lacked financial stability and would enjoy 

4 greater success with a stable partial funding stream 

5 from the Federal Government. 

6 (5) These community models, if involved in a 

7 Federal partnership, have the ability and willingness 

8 to be accountable for a return on investment for 

9 Federal funding, and to disseminate expertise to 

10 like-minded communities. 

11 SEC. 3. GRANTS FOR MULTI-SHARE HEALTH CARE COV12 ERAGE PROJECTS FOR UNINSURED WORKING 

13 INDIVIDUALS. 

14 Subpart I of part D of title III of the Public Health 

15 Service Act (42 U.S.C. 254b et seq.) is amended by adding 

16 at the end the following: 

17 ‘‘SEC. 330M. MULTI-SHARE HEALTH CARE COVERAGE 

18 PROJECTS FOR UNINSURED WORKING INDI19 VIDUALS. 

20 ‘‘(a) IN GENERAL.—The Secretary shall make grants 

21 to public or nonprofit private entities to carry out dem22 onstration projects for the purpose of— 

23 ‘‘(1) making available, on a cost-sharing basis 

24 as described in subsection (c)(2)(C), health care cov25 erage to qualifying employees through employers 


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1 that have not contributed to health care benefits for 

2 employees during the 12-month period prior to par3 ticipating in such a project; and 

4 ‘‘(2) making available, on such basis, health 

5 care coverage to qualifying self-employed individuals 

6 who have been without such coverage during the 12- 

7 month period prior to participating in such a 

8 project. 

9 ‘‘(b) QUALIFYING EMPLOYEES AND SELF-EMPLOYED

10 INDIVIDUALS.—For purposes of this section, the term 

11 ‘qualifying’, with respect to an employee or self-employed 

12 individual, means that the employee or self-employed indi13 vidual is not eligible for health services under the program 

14 under title XVIII, XIX, or XXI of the Social Security Act 

15 (relating to the Medicare program, the Medicaid program, 

16 and the State children’s health insurance program, respec17 tively). 

18 ‘‘(c) REQUIREMENTS FOR GRANT.— 

19 ‘‘(1) IN GENERAL.—A grant may be made 

20 under subsection (a) for a project only if the appli21 cant involved— 

22 ‘‘(A) has defined a service area for the 

23 project; 

24 ‘‘(B) has formed a consortium of entities 

25 in such service area, which consortium is comVerDate Aug 31 2005 08:32 Apr 28, 2006 Jkt 049200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5171.IH H5171

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1 posed of employers whose employees may or 

2 may not be served by the project, health care 

3 providers who will provide services through the 

4 project, and other appropriate entities; 

5 ‘‘(C) has ensured that the consortium has 

6 established a set of unified goals for the project; 

7 ‘‘(D) has conducted a basic level of demo8 graphic research to obtain data on the unin9 sured businesses, working uninsured, and pro10 vider community within the service area in 

11 order to determine the potential value and ef12 fectiveness of operating such a project, which 

13 data includes— 

14 ‘‘(i) the rate of uncompensated care; 

15 ‘‘(ii) the number of women lacking 

16 prenatal services; 

17 ‘‘(iii) immunization rates; and 

18 ‘‘(iv) the number of employers that do 

19 not provide health insurance to their em20 ployees; and 

21 ‘‘(E) has conducted a basic evaluation of 

22 State health insurance and local laws that 

23 might impact the implementation of the project. 


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1 ‘‘(2) AGREEMENTS.—A grant may be made 

2 under subsection (a) for a project only if the appli3 cant involved agrees as follows: 

4 ‘‘(A) Eligibility criteria will be established 

5 for employers to participate in the project, in6 cluding the requirement that the employers be 

7 located within the service area defined under 

8 paragraph (1)(A) for the project, which may in9 clude— 

10 ‘‘(i) a maximum average income 

11 earned by the employees of the business; 

12 ‘‘(ii) criteria, in addition to the 12- 

13 month periods under subsection (a), to 

14 avoid creating any incentive for an em15 ployer or self-employed individual to dis16 continue health plans or health insurance 

17 policies; and 

18 ‘‘(iii) such other criteria as the con19 sortium under paragraph (1)(B) considers 

20 to be appropriate. 

21 ‘‘(B) A network of health care providers 

22 will be formed to provide services to qualifying 

23 employees and self-employed individuals who 

24 participate in the project, which services will be 


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1 provided according to a schedule of fees and co2 payments negotiated by the project. 

3 ‘‘(C) Of the cost of providing health care 

4 coverage through the project— 

5 ‘‘(i) not more than 30 percent will be 

6 paid by the project with funds from the 

7 grant; and 

8 ‘‘(ii) not less than 70 percent will be 

9 paid by the employer, the employee, and 

10 any additional sources of funds (such as 

11 the community in which the project is lo12 cated) that may be available pursuant to 

13 arrangements with the project. 

14 ‘‘(D) A minimum benefit package will be 

15 selected that includes— 

16 ‘‘(i) physicians services; 

17 ‘‘(ii) prescription drug benefits; 

18 ‘‘(iii) in-patient hospital services; 

19 ‘‘(iv) out-patient services; 

20 ‘‘(v) emergency room visits; 

21 ‘‘(vi) emergency ambulance services; 

22 and 

23 ‘‘(vii) diagnostic laboratory tests and 

24 x-rays. 


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1 With respect to compliance with the agreement 

2 under this subparagraph, the project is not re3 quired to provide coverage for any service per4 formed outside the service area of the project, 

5 except to the extent that a service specified in 

6 any of clauses (i) through (vii) is not reasonably 

7 available within the service area. 

8 ‘‘(E) The minimum benefit package will 

9 not exclude coverage of a medical condition on 

10 the basis that it is a pre-existing condition. 

11 ‘‘(F) An entity will be selected by the con12 sortium under paragraph (1)(B) to carry out 

13 administrative and accounting functions with 

14 respect to the health care coverage to be offered 

15 by the project, including monthly billings, 

16 verification and enrollment of eligible employers 

17 and employees, maintenance of membership ros18 ters, operation of the utilization management 

19 program under subparagraph (G), and develop20 ment of a marketing plan. 

21 ‘‘(G) A utilization management program 

22 will be selected that ensures delivery of care in 

23 the appropriate setting, using appropriate re24 sources and clinical practice guidelines. 


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1 ‘‘(H) A plan will be implemented for meas2 uring quality and efficiency of care provided 

3 through the project within two years after the 

4 project begins operation. 

5 ‘‘(I) A plan will be implemented for man6 aging care for enrollees with chronic illness, as 

7 well as additional cost-control initiatives that 

8 will be employed by the project within 2 years 

9 after the project begins operation. 

10 ‘‘(J) A plan will be implemented for pro11 tecting the project from high risks, which may 

12 include affiliation with State high-risk pool or 

13 local safety net program, and purchase of rein14 surance. 

15 ‘‘(K) A plan will be implemented for evalu16 ating the project on an interim basis, not less 

17 frequently than annually. 

18 ‘‘(d) APPLICATION FOR GRANT.—A grant may be 

19 made under subsection (a) only if an application for the 

20 grant is submitted to the Secretary and the application 

21 is in such form, is made in such manner, and contains 

22 such agreements, assurances, and information as the Sec23 retary determines to be necessary to carry out this section. 

24 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—For the 

25 purpose of making grants under subsection (a), there is 


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1 authorized to be appropriated $36,000,000 in the aggre2 gate for the fiscal years 2007 through 2013, of which 

3 there are authorized to be appropriated amounts as fol4 lows: 

5 ‘‘(1) For fiscal year 2007, $2,000,000. 

6 ‘‘(2) For each of the fiscal years 2008 and 

7 2009, $5,000,000. 

8 ‘‘(3) For each of the fiscal years 2010 through 

9 2013, $6,000,000. 

10 ‘‘SEC. 330N. GRANTS FOR VOLUNTEER SPECIALTY PRO11 VIDER NETWORKS. 

12 ‘‘(a) IN GENERAL.—The Secretary shall make grants 

13 to public or nonprofit private entities to carry out dem14 onstration projects for the purpose of forming and main15 taining networks composed of health care specialists who 

16 volunteer health services to eligible individuals. 

17 ‘‘(b) ELIGIBLE INDIVIDUALS.—For purposes of this 

18 section, the term ‘eligible individual’ means an individual 

19 who has been enrolled by a project under subsection (a) 

20 and— 

21 ‘‘(1) whose employer does not provide health 

22 care coverage; 

23 ‘‘(2) is unable to obtain health care coverage 

24 through a family member or common law partner; 


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1 ‘‘(3) is at or below a poverty level specified by 

2 the Secretary; and 

3 ‘‘(4) is not eligible for health services under the 

4 program under title XVIII, XIX, or XXI of the So5 cial Security Act (relating to the Medicare program, 

6 the Medicaid program, and the State children’s 

7 health insurance program, respectively). 

8 ‘‘(c) QUALIFIED GRANT EXPENDITURES.—A grant 

9 may be made under subsection (a) for a project only if 

10 the applicant involved agrees that the grant will be ex11 pended to assist specialists that are participants in the 

12 network involved through any or all of the following 

13 means: 

14 ‘‘(1) Paying nominal administrative or fees to 

15 the participants for the costs of providing services to 

16 eligible individuals. 

17 ‘‘(2) Assisting with the cost of training primary 

18 care practitioners to manage the chronic conditions 

19 that are most often treated by the network special20 ists. 

21 ‘‘(3) Assisting participants with the costs of 

22 providing fees to recruit specialists to practice in the 

23 service area of the project. 


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1 ‘‘(4) Assisting with the costs of operating a 

2 community clinic staffed by volunteer network spe3 cialists. 

4 ‘‘(5) Assisting participants with the costs of in5 stalling or operating information technology that is 

6 of benefit to patients, such as technology to avoid 

7 medical errors or to facilitate the authorized elec8 tronic transfer of the health records of eligible indi9 viduals. 

10 ‘‘(6) Paying for necessary prescription drug 

11 costs for necessary treatment prescribed by network 

12 specialists. 

13 ‘‘(7) Such additional means as the Secretary 

14 may authorize. 

15 ‘‘(d) CERTAIN REQUIREMENTS FOR GRANT.—A 

16 grant may be made under subsection (a) for a project only 

17 if the applicant involved— 

18 ‘‘(1) has defined a service area for the project; 

19 ‘‘(2) has formed a consortium of various com20 munity members, leaders, and organizations in such 

21 area; 

22 ‘‘(3) has ensured that the consortium has estab23 lished a set of unified goals for the project; 


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1 ‘‘(4) has conducted the basic level of demo2 graphic research described in section 

3 330M(c)(1)(D); 

4 ‘‘(5) has a plan for managing the care of eligi5 ble individuals with chronic illness; and 

6 ‘‘(6) has a plan for evaluating the project on an 

7 interim basis, not less frequently than once each 

8 year. 

9 ‘‘(e) MATCHING FUNDS.— 

10 ‘‘(1) IN GENERAL.—With respect to the costs of 

11 the project to be carried out under subsection (a) by 

12 an applicant, a grant under such subsection may be 

13 made only if the applicant agrees to make available 

14 (directly or through donations from public or private 

15 entities) non-Federal contributions toward such 

costs in an amount that is not less than 1 16 ⁄3 of such 

17 costs ($1 for each $2 provided in the grant). 

18 ‘‘(2) DETERMINATION OF AMOUNT CONTRIB19 UTED.—Non-Federal contributions required in para20 graph (1) may be in cash or in kind, fairly evalu21 ated, including plant, equipment, or services. 

22 Amounts provided by the Federal Government, or 

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1 cluded in determining the amount of such non-Fed2 eral contributions. 

3 ‘‘(f) APPLICATION FOR GRANT.—A grant may be 

4 made under subsection (a) only if an application for the 

5 grant is submitted to the Secretary and the application 

6 is in such form, is made in such manner, and contains 

7 such agreements, assurances, and information as the Sec8 retary determines to be necessary to carry out this section. 

9 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—For the 

10 purpose of making grants under subsection (a), there is 

11 authorized to be appropriated $9,000,000 in the aggregate 

12 for the fiscal years 2007 through 2013, of which there 

13 are authorized to be appropriated amounts as follows: 

14 ‘‘(1) For each of the fiscal years 2007 and 

15 2008, $500,000. 

16 ‘‘(2) For each of the fiscal years 2009 and 

17 2010, $1,000,000. 

18 ‘‘(3) For each of the fiscal years 2011 through 

19 2013, $2,000,000. 

20 ‘‘SEC. 330O. CLEARINGHOUSE FOR INFORMATION ON COM21 MUNITY-INITIATED PROJECTS TO PROVIDE 

22 HEALTH CARE COVERAGE TO UNINSURED IN23 DIVIDUALS. 

24 ‘‘(a) IN GENERAL.—The Secretary shall make an 

25 award of a grant or contract for the establishment and 


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1 operation of a clearinghouse to collect and make available, 

2 on a national basis, information on projects under sections 

3 330M and 330N and similar projects that are community4 initiated (referred to in this section as ‘access projects’). 

5 ‘‘(b) CERTAIN REQUIREMENTS.—The Secretary shall 

6 ensure that the information collected and made available 

7 under subsection (a) by the Clearinghouse includes the fol8 lowing: 

9 ‘‘(1) A database identifying technical-assistance 

10 experts who are or have been involved in the plan11 ning or operation of access projects. 

12 ‘‘(2) Information regarding the success and 

13 progress of access projects, including— 

14 ‘‘(A) information on best-practices identi15 fied for such projects; 

16 ‘‘(B) the number of individuals who lacked 

17 health care coverage prior to receiving such cov18 erage through the projects; 

19 ‘‘(C) the number of individuals served by 

20 the projects who have chronic conditions that 

21 are managed by the projects; 

22 ‘‘(D) the economic impact of the projects 

23 for businesses in the communities in which the 

24 projects operated; and 


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1 ‘‘(E) the savings of hospitals and other 

2 health care providers in such communities that 

3 resulted from the operation of the projects. 

4 ‘‘(c) APPLICATION.—An award may be made under 

5 subsection (a) only if an application for the award is sub6 mitted to the Secretary and the application is in such 

7 form, is made in such manner, and contains such agree8 ments, assurances, and information as the Secretary de9 termines to be necessary to carry out this section. 

10 ‘‘(d) SOLICITATION OF REPORTS.—The Secretary 

11 may carry out a program to encourage public and private 

12 entities that plan or operate access projects to submit to 

13 the Clearinghouse reports that provide information on the 

14 projects. 

15 ‘‘(e) DEFINITION.—For purposes of this section, the 

16 term ‘Clearinghouse’ means the clearinghouse under sub17 section (a). 

18 ‘‘(f) AUTHORIZATION OF APPROPRIATION.—For the 

19 purpose of making awards under subsection (a), there are 

20 authorized to be appropriated such sums as may be nec21 essary for each of the fiscal years 2007 through 2013.’’. 

Æ 


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