II 

109TH CONGRESS 

2D SESSION S. 3819 

To amend title XIX of the Social Security Act to provide for redistribution 

and extended availability of unexpended medicaid DSH allotments, and 

for other purposes. 

IN THE SENATE OF THE UNITED STATES 

AUGUST 3, 2006 

Mr. BINGAMAN (for himself, Mr. SMITH, Mrs. LINCOLN, Mr. PRYOR, and Mr. 

AKAKA) introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To amend title XIX of the Social Security Act to provide 

for redistribution and extended availability of unexpended 

medicaid DSH allotments, 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 ‘‘Strengthening the 

5 Safety Net Act of 2006’’. 

6 SEC. 2. REDISTRIBUTION AND EXTENDED AVAILABILITY OF 

7 UNEXPENDED MEDICAID DSH ALLOTMENTS. 

8 Section 1923(f) of the Social Security Act (42 U.S.C. 

9 1396r–4(f)) is amended— 


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1 (1) in paragraph (3)(A), by striking ‘‘paragraph 

2 (5)’’ and inserting ‘‘paragraphs (5) and (7)’’; 

3 (2) by redesignating paragraph (7) as para4 graph (8); and 

5 (3) by inserting after paragraph (6), the fol6 lowing new paragraph: 

7 ‘‘(7) REDISTRIBUTION AND EXTENDED AVAIL8 ABILITY OF UNEXPENDED ALLOTMENTS.— 

9 ‘‘(A) ESTABLISHMENT OF REDISTRIBU10 TION POOL.— 

11 ‘‘(i) IN GENERAL.—Subject to clauses 

12 (ii) and (iii), the Secretary shall establish, 

13 as of October 1 of fiscal year 2007, and of 

14 each fiscal year thereafter, the following 

15 redistribution pool: 

16 ‘‘(I) In the case of fiscal year 

17 2007, a $150,000,000 redistribution 

18 pool from the total amount of the un19 expended State DSH allotments for 

20 fiscal year 2004. 

21 ‘‘(II) In the case of fiscal year 

22 2008, a $250,000,000 redistribution 

23 pool from the total amount of the un24 expended State DSH allotments for 

25 fiscal year 2005. 


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1 ‘‘(III) In the case of fiscal year 

2 2009 and each succeeding fiscal year 

3 thereafter, a $400,000,000 redistribu4 tion pool from the total amount of the 

5 unexpended State DSH allotments for 

6 the third preceding fiscal year. 

7 ‘‘(ii) UNEXPENDED STATE DSH AL8 LOTMENTS.—If a State claims Federal fi9 nancial participation for a payment adjust10 ment made under this section for a fiscal 

11 year from which a redistribution pool of 

12 unexpended State DSH allotments has al13 ready been created under clause (i), then, 

14 for purposes of this paragraph, the total 

15 amount of unexpended State DSH allot16 ments in the fiscal year following the State 

17 claim for such Federal financial participa18 tion, shall be reduced by the Federal finan19 cial participation related to such claim. 

20 ‘‘(iii) REDUCTION IN AMOUNTS AVAIL21 ABLE.—If the total amount of the unex22 pended State DSH allotments for a fiscal 

23 year (taking into account any adjustment 

24 to such amount required under clause (ii)) 

25 is less than the amount necessary to proVerDate Aug 31 2005 23:17 Aug 07, 2006 Jkt 049200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S3819.IS S3819

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1 vide, for such fiscal year, the redistribution 

2 pool described in clause (i) and the 

3 amounts to be made available for grants 

4 under section 3(g) of the Strengthening 

5 the Safety Net Act of 2006 for such fiscal 

6 year, the Secretary shall reduce the 

7 amounts that are to be available for the re8 distribution pool under this paragraph and 

9 grants under such section, respectively, to 

10 such total amount. 

11 ‘‘(B) REDISTRIBUTION.— 

12 ‘‘(i) IN GENERAL.—Not later than Oc13 tober 1, 2006, and October 1 of each year 

14 thereafter, the Secretary shall allot the re15 distribution pool established for that fiscal 

16 year among eligible States. 

17 ‘‘(ii) PRIORITY.—In making allot18 ments under clause (i), the Secretary shall 

19 give priority— 

20 ‘‘(I) first to eligible States de21 scribed in paragraph (5)(B) (without 

22 regard to the requirement that total 

23 expenditures under the State plan for 

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1 ments for fiscal year 2000 is greater 

2 than 0); and 

3 ‘‘(II) then to eligible States 

4 whose State DSH allotment per med5 icaid enrollee and uninsured individual 

6 for the third preceding fiscal year is 

7 below the national average DSH allot8 ment per medicaid enrollee and unin9 sured individual for that fiscal year. 

10 ‘‘(C) EXPENDITURE RULES.—An amount 

11 allotted to a State from the redistribution pool 

12 established for a fiscal year— 

13 ‘‘(i) shall not be included in the deter14 mination of the State’s DSH allotment for 

15 any fiscal year under this section; 

16 ‘‘(ii) notwithstanding any other provi17 sion of law, shall remain available for ex18 penditure by the State through the end of 

19 the second fiscal year after the fiscal year 

20 in which the allotment from the redistribu21 tion pool is made for expenditures incurred 

22 in any of such fiscal years; and 

23 ‘‘(iii) shall only be used to make pay24 ment adjustments to disproportionate 


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1 share hospitals in accordance with the re2 quirements of this section. 

3 ‘‘(D) DEFINITIONS.—In this paragraph: 

4 ‘‘(i) ELIGIBLE STATE.—The term ‘eli5 gible State’ means, with respect to the fis6 cal year from which a redistribution pool is 

7 established under subparagraph (A)(i), a 

8 State that has expended at least 90 per9 cent of the State DSH allotment for that 

10 fiscal year by the end of the succeeding fis11 cal year. 

12 ‘‘(ii) STATE DSH ALLOTMENT PER

13 MEDICAID ENROLLEE AND UNINSURED IN14 DIVIDUAL.—The term ‘State DSH allot15 ment per medicaid enrollee and uninsured 

16 individual’ means the amount equal to the 

17 State DSH allotment for a fiscal year di18 vided by the sum of the number of individ19 uals who received medical assistance under 

20 the State program under this title for that 

21 fiscal year and the number of State resi22 dents with no health insurance coverage 

23 for that fiscal year, as determined by the 

24 Bureau of the Census. 


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1 ‘‘(iii) NATIONAL AVERAGE DSH AL2 LOTMENT PER MEDICAID ENROLLEE AND

3 UNINSURED INDIVIDUAL.—The term ‘na4 tional average DSH allotment per medicaid 

5 enrollee and uninsured individual’ means 

6 the amount equal to the total amount of 

7 State DSH allotments for a fiscal year di8 vided by the sum of the total number of in9 dividuals who received medical assistance 

10 under a State program under this title for 

11 that fiscal year and the total number of 

12 residents with respect to all States who did 

13 not have health insurance coverage for that 

14 fiscal year, as determined by the Bureau of 

15 the Census.’’. 

16 SEC. 3. HEALTH SERVICES FOR THE UNINSURED. 

17 (a) DEMONSTRATION GRANTS TO HEALTH ACCESS

18 NETWORKS.— 

19 (1) IN GENERAL.—The Secretary of Health and 

20 Human Services (in this section referred to as the 

21 ‘‘Secretary’’) shall award demonstration grants to 

22 health access networks. 

23 (2) APPLICATION.—Each applying health access 

24 network shall submit a plan that meets the require25 ments of subsection (c) for the purpose of improving 


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1 access, quality, and continuity of care for uninsured 

2 individuals through better coordination of care by 

3 the network. 

4 (3) AUTHORITY TO LIMIT NUMBER OF

5 GRANTS.—The number of demonstration grants 

6 awarded under this section shall be limited, in the 

7 discretion of the Secretary, so that grants are suffi8 cient to permit grantees to provide patient care serv9 ices to no fewer than the number of uninsured indi10 viduals specified by each network in its grant appli11 cation. 

12 (b) DEFINITION OF HEALTH ACCESS NETWORK.— 

13 (1) IN GENERAL.—In this section, the term 

14 ‘‘health access network’’ means a collection of safety 

15 net providers, including hospitals, community health 

16 centers, public health departments, physicians, safe17 ty net health plans, or other recognized safety net 

18 providers organized for the purpose of restructuring 

19 and improving the access, quality, and continuity of 

20 care to the uninsured and underinsured, that offers 

21 patients access to all levels of care, including pri22 mary, outpatient, specialty, certain ancillary services, 

23 and acute inpatient care, within a community or 

24 across a broad spectrum of providers across a serv25 ice region or State. 


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1 (2) INCLUSION OF SECTION 330 NETWORKS AND

2 PLANS.—The term ‘‘health access network’’ includes 

3 networks and plans that meet the requirements for 

4 funding under section 330(e)(1)(C) of the Public 

5 Health Service Act (42 U.S.C. 254b(e)(1)(C)). 

6 (3) INCLUSION OF INTEGRATED HEALTH CARE

7 SYSTEMS.— 

8 (A) IN GENERAL.—Such term also includes 

9 an integrated health care system (including a 

10 pediatric system). 

11 (B) DEFINITION OF INTEGRATED HEALTH

12 CARE SYSTEM.—For purposes of this section, 

13 an integrated health care system (including a 

14 pediatric system) is a health care provider that 

15 is organized to provide care in a coordinated 

16 fashion and assures access to a full range of 

17 primary, specialty, and hospital care, to unin18 sured and under-insured individuals, as appro19 priate. 

20 (c) PLAN REQUIREMENTS.— 

21 (1) IN GENERAL.—A health access network that 

22 desires a grant under this section shall submit a 

23 plan to the Secretary that details how the network 

24 intends to— 


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1 (A) manage costs associated with the pro2 vision of health care services to uninsured and 

3 underinsured individuals served by the health 

4 access network; 

5 (B) improve access to, and the availability 

6 of, health care services provided to uninsured 

7 and underinsured individuals served by the 

8 health access network; 

9 (C) enhance the quality and coordination 

10 of health care services provided to uninsured 

11 and underinsured individuals served by the 

12 health access network; 

13 (D) improve the health status of uninsured 

14 and underinsured individuals served by the 

15 health access network; and 

16 (E) reduce health disparities in the popu17 lation of uninsured and underinsured individ18 uals served by the health access network. 

19 (2) IDENTIFICATION OF MEASURABLE GOALS.— 

20 The health access network shall— 

21 (A) identify in the plan measurable per22 formance targets for at least 3 of the goals de23 scribed in paragraph (1); and 

24 (B) agree that a portion of the payment of 

25 grant funds for patient care services after the 


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1 first year for which such payment is made shall 

2 be contingent upon the health access network 

3 demonstrating success in achieving such tar4 gets. 

5 (d) USE OF FUNDS.—A health access network that 

6 receives funds under this section shall expend— 

7 (1) an amount equal to not less than 90 percent 

8 of such funds for direct patient care services; and 

9 (2) an amount equal to not more than 10 per10 cent of such funds for the network’s operation and 

11 development for the purpose of improving the effi12 ciency and effectiveness of the business and clinical 

13 operations of providers within the health access net14 work, including through the integration of manage15 ment information systems (including development 

16 and implementation of electronic medical records) 

17 and financial, administrative, or clinical functions 

18 across providers. 

19 (e) RULE OF CONSTRUCTION REGARDING DIRECT

20 PATIENT CARE SERVICES.—With respect to health access 

21 networks described in subsection (b)(2), the term ‘‘direct 

22 patient care services’’ shall be construed to mean the pro23 vision or purchase of services, such as specialty medical 

24 care and diagnostic services, that are not available or are 

25 insufficiently available through the network’s providers. In 


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1 purchasing such services for uninsured and underinsured 

2 individuals, networks shall, to the maximum extent fea3 sible, endeavor to purchase such services from safety net 

4 providers. 

5 (f) SUPPLEMENT, NOT SUPPLANT.—Funds paid to a 

6 health access network under a grant made under this sec7 tion shall supplement and not supplant, other Federal or 

8 State payments that are made to the health access net9 work to support the provision of health care services to 

10 low-income or uninsured patients. 

11 (g) FUNDING.— 

12 (1) TRANSFER OF PORTION OF UNEXPENDED

13 DSH ALLOTMENTS.—Notwithstanding any other pro14 vision of law, as of October 1 of fiscal year 2007, 

15 and each fiscal year thereafter, amounts described in 

16 paragraph (2) are hereby transferred from the total 

17 amount of the unexpended State DSH allotments 

18 under section 1923 of the Social Security Act (42 

19 U.S.C. 1396r–4) and made available for grants 

20 under this section. 

21 (2) AMOUNTS MADE AVAILABLE FOR GRANTS.— 

22 The amounts to be made available under this section 

23 for each fiscal year beginning with fiscal year 2007 

24 are equal to the redistribution pool amounts deter25 mined for each fiscal year under section 


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1 1923(f)(7)(A)(i) of the Social Security Act (42 

2 U.S.C. 1396r–4(f)(7)(A)(i)) (as amended by section 

3 2(3) of the Strengthening the Safety Net Act of 

4 2006). 

Æ 


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