I 

110TH CONGRESS 

2D SESSION H. R. 5544 

To amend the Public Health Service Act to authorize a demonstration project 

for integrated health systems to expand access to primary and preventive 

care for the medically underserved, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 6, 2008 

Mr. BURGESS (for himself and Mr. STUPAK) introduced the following bill; 

which was referred to the Committee on Energy and Commerce 

A BILL 

To amend the Public Health Service Act to authorize a 

demonstration project for integrated health systems to 

expand access to primary and preventive care for the 

medically underserved, 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 ‘‘Patients and Public 

5 Health Partnership Act of 2008’’. 

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1 SEC. 2. DEMONSTRATION PROJECT FOR INTEGRATED 

2 HEALTH SYSTEMS TO EXPAND ACCESS TO 

3 PRIMARY AND PREVENTIVE SERVICES FOR 

4 THE MEDICALLY UNDERSERVED. 

5 Part D of title III of the Public Health Service Act 

6 (42 U.S.C. 259b et seq.) is amended by adding at the end 

7 the following new subpart: 

8 ‘‘Subpart XI—Demonstration Project for Integrated 

9 Health Systems to Expand Access to Primary 

10 and Preventive Services for the Medically Un11 derserved 

12 ‘‘SEC. 340H. DEMONSTRATION PROJECT FOR INTEGRATED 

13 HEALTH SYSTEMS TO EXPAND ACCESS TO 

14 PRIMARY AND PREVENTIVE CARE FOR THE 

15 MEDICALLY UNDERSERVED. 

16 ‘‘(a) ESTABLISHMENT OF DEMONSTRATION.— 

17 ‘‘(1) IN GENERAL.—Not later than January 1, 

18 2009, the Secretary shall establish a demonstration 

19 project (hereafter in this section referred to as the 

20 ‘demonstration’) under which up to 30 qualifying in21 tegrated health systems receive grants for the costs 

22 of their operations to expand access to primary and 

23 preventive services for the medically underserved. 

24 ‘‘(2) RULE OF CONSTRUCTION.—Nothing in 

25 this section shall be construed as authorizing grants 

26 to be made or used for the costs of specialty care or 

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1 hospital care furnished by an integrated health sys2 tem. 

3 ‘‘(b) APPLICATION.—Any integrated health system 

4 desiring to participate in the demonstration shall submit 

5 an application in such manner, at such time, and con6 taining such information as the Secretary may require. 

7 ‘‘(c) CRITERIA FOR SELECTION.—In selecting inte8 grated health systems to participate in the demonstration 

9 (hereafter referred to as ‘participating integrated health 

10 systems’), the Secretary shall ensure representation of in11 tegrated health systems that are located in a variety of 

12 States (including the District of Columbia and the terri13 tories and possessions of the United States) and locations 

14 within States, including rural areas, inner-city areas, and 

15 frontier areas. 

16 ‘‘(d) DURATION.—Subject to the availability of ap17 propriations, the demonstration shall be conducted (and 

18 operating grants be made to each participating integrated 

19 health system) for a period of 3 years. 

20 ‘‘(e) REPORTS.— 

21 ‘‘(1) IN GENERAL.—The Secretary shall submit 

22 to the appropriate committees of the Congress in23 terim and final reports with respect to the dem24 onstration, with an interim report being submitted 

25 not later than 3 months after the demonstration has 

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1 been in operation for 24 months and a final report 

2 being submitted not later than 3 months after the 

3 close of the demonstration. 

4 ‘‘(2) CONTENT.—Such reports shall evaluate 

5 the effectiveness of the demonstration in providing 

6 greater access to primary and preventive care for 

7 medically underserved populations, and how the co8 ordinated approach offered by integrated health sys9 tems contributes to improved patient outcomes. 

10 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.— 

11 ‘‘(1) IN GENERAL.—There is authorized to be 

12 appropriated $25,000,000 for each of the fiscal 

13 years 2009, 2010, and 2011 to carry out this sec14 tion. 

15 ‘‘(2) CONSTRUCTION.—Nothing in this section 

16 shall be construed as requiring or authorizing a re17 duction in the amounts appropriated for grants to 

18 health centers under section 330 for the fiscal years 

19 referred to in paragraph (1). 

20 ‘‘(g) DEFINITIONS.—For purposes of this section: 

21 ‘‘(1) FRONTIER AREA.—The term ‘frontier 

22 area’ has the meaning given to such term in regula23 tions promulgated pursuant to section 330I(r). 

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1 ‘‘(2) INTEGRATED HEALTH SYSTEM.—The term 

2 ‘integrated health system’ means a health system 

3 that— 

4 ‘‘(A) has a demonstrated capacity and 

5 commitment to provide a full range of primary 

6 care, specialty care, and hospital care in both 

7 inpatient and outpatient settings; and 

8 ‘‘(B) is organized to provide such care in 

9 a coordinated fashion. 

10 ‘‘(3) QUALIFYING INTEGRATED HEALTH SYS11 TEM.— 

12 ‘‘(A) IN GENERAL.—The term ‘qualifying 

13 integrated health system’ means a public or pri14 vate nonprofit entity that is an integrated 

15 health system that meets the requirements of 

16 subparagraph (B) and serves a medically under17 served population (either through the staff and 

18 supporting resources of the integrated health 

19 system or through contracts or cooperative ar20 rangements) by providing— 

21 ‘‘(i) required primary and preventive 

22 health and related services (as defined in 

23 paragraph (4)); and 

24 ‘‘(ii) as may be appropriate for a pop25 ulation served by a particular integrated 

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1 health system, integrative health services 

2 (as defined in paragraph (5)) that are nec3 essary for the adequate support of the re4 quired primary and preventive health and 

5 related services and that improve care co6 ordination. 

7 ‘‘(B) OTHER REQUIREMENTS.—The re8 quirements of this subparagraph are that the 

9 integrated health system— 

10 ‘‘(i) will make the required primary 

11 and preventive health and related services 

12 of the integrated health system available 

13 and accessible in the service area of the in14 tegrated health system promptly, as appro15 priate, and in a manner which assures con16 tinuity; 

17 ‘‘(ii) will demonstrate financial re18 sponsibility by the use of such accounting 

19 procedures and other requirements as may 

20 be prescribed by the Secretary; 

21 ‘‘(iii) provides or will provide services 

22 to individuals who are eligible for medical 

23 assistance under title XIX of the Social 

24 Security Act or for assistance under title 

25 XXI of such Act; 

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1 ‘‘(iv) has prepared a schedule of fees 

2 or payments for the provision of its serv3 ices consistent with locally prevailing rates 

4 or charges and designed to cover its rea5 sonable costs of operation and has pre6 pared a corresponding schedule of dis7 counts to be applied to the payment of 

8 such fees or payments, which discounts are 

9 adjusted on the basis of the patient’s abil10 ity to pay; 

11 ‘‘(v) will assure that no patient will be 

12 denied health care services due to an indi13 vidual’s inability to pay for such services; 

14 ‘‘(vi) will assure that any fees or pay15 ments required by the system for such 

16 services will be reduced or waived to enable 

17 the system to fulfill the assurance de18 scribed in clause (v); 

19 ‘‘(vii) provides assurances that any 

20 grant funds will be expended to supple21 ment, and not supplant, the expenditures 

22 of the integrated health system for primary 

23 and preventive health services for the 

24 medically underserved; and 

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1 ‘‘(viii) submits to the Secretary such 

2 reports as the Secretary may require to de3 termine compliance with this subpara4 graph. 

5 ‘‘(C) TREATMENT OF CERTAIN ENTI6 TIES.—The term ‘qualifying integrated health 

7 system’ may include a nurse-managed health 

8 clinic if such clinic meets the requirements of 

9 subparagraphs (A) and (B) (except those re10 quirements that have been waived under para11 graph (4)(B)). 

12 ‘‘(4) REQUIRED PRIMARY AND PREVENTIVE

13 HEALTH AND RELATED SERVICES.— 

14 ‘‘(A) IN GENERAL.—Except as provided in 

15 subparagraph (B), the term ‘required primary 

16 and preventive health and related services’ 

17 means basic health services consisting of— 

18 ‘‘(i) health services related to family 

19 medicine, internal medicine, pediatrics, ob20 stetrics, or gynecology that are furnished 

21 by physicians where appropriate, physician 

22 assistants, nurse practitioners, and nurse 

23 midwives; 

24 ‘‘(ii) diagnostic laboratory services 

25 and radiologic services; 

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1 ‘‘(iii) preventive health services, in2 cluding prenatal and perinatal care; appro3 priate cancer screening; well-child services; 

4 immunizations against vaccine-preventable 

5 diseases; screenings for elevated blood lead 

6 levels, communicable diseases, and choles7 terol; pediatric eye, ear, and dental 

8 screenings to determine the need for vision 

9 and hearing correction and dental care; 

10 and voluntary family planning services; 

11 ‘‘(iv) emergency medical services; and 

12 ‘‘(v) pharmaceutical services, behav13 ioral, mental health, and substance abuse 

14 services, preventive dental services, and re15 cuperative care, as may be appropriate. 

16 ‘‘(B) EXCEPTION.—In the case of an inte17 grated health system serving a targeted popu18 lation, the Secretary shall, upon a showing of 

19 good cause, waive the requirement that the in20 tegrated health system provide each required 

21 primary and preventive health and related serv22 ice under this paragraph if the Secretary deter23 mines one or more such services are inappro24 priate or unnecessary for such population. 

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1 ‘‘(5) INTEGRATIVE HEALTH SERVICES.—The 

2 term ‘integrative health services’ means services that 

3 are not included as required primary and preventive 

4 health and related services and are associated with 

5 achieving the greater integration of a health care de6 livery system to improve patient care coordination so 

7 that the system either directly provides or ensures 

8 the provision of a broad range of culturally com9 petent services. Integrative health services include 

10 but are not limited to the following: 

11 ‘‘(A) Outreach activities. 

12 ‘‘(B) Case management and patient navi13 gation services. 

14 ‘‘(C) Chronic care management. 

15 ‘‘(D) Transportation to health care facili16 ties. 

17 ‘‘(E) Development of provider networks 

18 and other innovative models to engage local 

19 physicians and other providers to serve the 

20 medically underserved within a community. 

21 ‘‘(F) Recruitment, training, and compensa22 tion of necessary personnel. 

23 ‘‘(G) Acquisition of technology for the pur24 pose of coordinating care. 

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1 ‘‘(H) Improvements to provider commu2 nication, including implementation of shared in3 formation systems or shared clinical systems. 

4 ‘‘(I) Determination of eligibility for Fed5 eral, State, and local programs that provide, or 

6 financially support the provision of, medical, so7 cial, housing, educational, or other related serv8 ices. 

9 ‘‘(J) Development of prevention and dis10 ease management tools and processes. 

11 ‘‘(K) Translation services. 

12 ‘‘(L) Development and implementation of 

13 evaluation measures and processes to assess pa14 tient outcomes. 

15 ‘‘(M) Integration of primary care and men16 tal health services. 

17 ‘‘(N) Carrying out other activities that 

18 may be appropriate to a community and that 

19 would increase access by the uninsured to 

20 health care, such as access initiatives for which 

21 private entities provide non-Federal contribu22 tions to supplement the Federal funds provided 

23 through the grants for the initiatives. 

24 ‘‘(6) SPECIALTY CARE.—The term ‘specialty 

25 care’ means care that is provided through a referral 

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1 and by a physician or nonphysician practitioner, 

2 such as surgical consultative services, radiology serv3 ices requiring the immediate presence of a physician, 

4 audiology, optometric services, cardiology services, 

5 magnetic resonance imagery (MRI) services, comput6 erized axial tomography (CAT) scans, nuclear medi7 cine studies, and ambulatory surgical services. 

8 ‘‘(7) NURSE-MANAGED HEALTH CLINIC.—The 

9 term ‘nurse-managed health clinic’ means a nurse10 practice arrangement, managed by advanced practice 

11 nurses, that provides care for underserved and vul12 nerable populations and is associated with a school, 

13 college, or department of nursing or an independent 

14 nonprofit health or social services agency.’’. 

Æ 

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