I 
114TH CONGRESS 
1ST SESSION H. R. 3637 
To amend title XIX of the Social Security Act to provide for payment 
for Medicaid services furnished by Ryan White part C grantees under 
a cost-based prospective payment system. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 29, 2015 
Mr. POCAN (for himself, Ms. LEE, and Mr. MCDERMOTT) introduced the 
following bill; which was referred to the Committee on Energy and Commerce 
A BILL 
To amend title XIX of the Social Security Act to provide 
for payment for Medicaid services furnished by Ryan 
White part C grantees under a cost-based prospective 
payment system. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘HIV Clinical Services 
Improvement Act’’. 
VerDate Sep 11 2014 
23:45 Sep 30, 2015
Jkt 049200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H3637.IH
H3637
SSpencer on DSK4SPTVN1PROD with BILLS
SEC. 2. MEDICAID PAYMENT FOR SERVICES FURNISHED BY 
RYAN WHITE PART C GRANTEES ON A COST- 
BASED PROSPECTIVE PAYMENT SYSTEM. 
(a) IN GENERAL.—Section 1902 of the Social Secu-
rity Act (42 U.S.C. 1396a) is amended— 
(1) in subsection (a)(15), by inserting before 
the semicolon at the end the following: ‘‘and provide 
for payment for services described in section 1905(a) 
provided by a recipient of a grant under part C of 
title XXVI of the Public Health Service Act in ac-
cordance with subsection (ll)’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(ll) PAYMENT FOR SERVICES PROVIDED BY RYAN 
WHITE PART C GRANTEES.— 
‘‘(1) IN GENERAL.—Beginning with fiscal year 
2016 with respect to services furnished on or after 
January 1, 2016, and each succeeding fiscal year, 
the State plan shall provide for payment for services 
described in section 1905(a) (in this subsection re-
ferred to as ‘Medicaid covered services’) furnished by 
a recipient of a grant under part C of title XXVI 
of the Public Health Service Act (in this subsection 
referred to as a ‘grantee’) in accordance with the 
provisions of this subsection. 
VerDate Sep 11 2014 
23:45 Sep 30, 2015
Jkt 049200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H3637.IH
H3637
SSpencer on DSK4SPTVN1PROD with BILLS
‘‘(2) FISCAL YEAR 2016.—Subject to paragraph 
(4), for services furnished on and after January 1, 
2016, during fiscal year 2016, the State plan shall 
provide for payment for such services in an amount 
(calculated on a per visit or similar basis as specified 
by the Secretary) that is equal to 100 percent of the 
average of the costs of the grantee of furnishing 
such services during fiscal years 2014 and 2015 
which are reasonable and related to the cost of fur-
nishing such services, or based on such other tests 
of reasonableness as the Secretary prescribes in reg-
ulations under section 1833(a)(3), or, in the case of 
services to which such regulations do not apply, the 
same methodology used under section 1833(a)(3), 
adjusted to take into account any increase or de-
crease in the scope of such services furnished by the 
grantee during fiscal year 2016. 
‘‘(3) FISCAL YEAR 2017 AND SUCCEEDING FIS-
CAL YEARS.—Subject to paragraph (4), for services 
furnished during fiscal year 2017 or a succeeding 
fiscal year, the State plan shall provide for payment 
for such services in an amount (calculated on a per 
visit or similar basis) that is equal to the amount 
calculated for such services under this subsection for 
the preceding fiscal year— 
VerDate Sep 11 2014 
23:45 Sep 30, 2015
Jkt 049200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H3637.IH
H3637
SSpencer on DSK4SPTVN1PROD with BILLS
‘‘(A) increased by the percentage increase 
in the MEI (as defined in section 1842(i)(3)) 
applicable to primary care services (as defined 
in section 1842(i)(4)) for that fiscal year; and 
‘‘(B) adjusted to take into account any in-
crease or decrease in the scope of such services 
furnished by the grantee during that fiscal year. 
‘‘(4) ESTABLISHMENT OF INITIAL YEAR PAY-
MENT AMOUNT FOR NEW GRANTEES.—In any case 
in which an entity first becomes a grantee after fis-
cal year 2015, the State plan shall provide for pay-
ment for Medicaid covered services furnished by the 
entity in the first fiscal year in which the entity so 
qualifies in an amount (calculated on a per visit or 
similar basis) that is equal to 100 percent of the 
costs of furnishing such services during such fiscal 
year based on the rates established under this sub-
section for the fiscal year for other such grantees lo-
cated in the same or adjacent area with a similar 
case load or, in the absence of such a grantee, in ac-
cordance with the regulations and methodology re-
ferred to in paragraph (2) or based on such other 
tests of reasonableness as the Secretary may specify. 
For each fiscal year following the fiscal year in 
which the entity first qualifies, the State plan shall 
VerDate Sep 11 2014 
23:45 Sep 30, 2015
Jkt 049200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H3637.IH
H3637
SSpencer on DSK4SPTVN1PROD with BILLS
provide for the payment amount to be calculated in 
accordance with paragraph (3). 
‘‘(5) ADMINISTRATION IN THE CASE OF MAN-
AGED CARE.— 
‘‘(A) IN GENERAL.—In the case of services 
furnished by a grantee pursuant to a contract 
between the grantee and a managed care entity 
(as defined in section 1932(a)(1)(B)), the State 
plan shall provide for payment to the grantee 
by the State of a supplemental payment equal 
to the amount (if any) by which the amount de-
termined under paragraphs (2), (3), and (4) ex-
ceeds the amount of the payments provided 
under the contract. 
‘‘(B) PAYMENT SCHEDULE.—The supple-
mental payment required under subparagraph 
(A) shall be made pursuant to a payment 
schedule agreed to by the State and the grant-
ee, but in no case less frequently than every 4 
months. 
‘‘(6) ALTERNATIVE
PAYMENT
METHODOLO-
GIES.—Notwithstanding any other provision of this 
section, the State plan may provide for payment in 
any fiscal year to a grantee for Medicaid covered 
VerDate Sep 11 2014 
23:45 Sep 30, 2015
Jkt 049200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H3637.IH
H3637
SSpencer on DSK4SPTVN1PROD with BILLS
services in an amount which is determined under an 
alternative payment methodology that— 
‘‘(A) is agreed to by the State and the 
grantee; and 
‘‘(B) results in payment to the grantee of 
an amount which is at least equal to the 
amount otherwise required to be paid to the 
grantee under this subsection. 
‘‘(7) QUALITY MANAGEMENT AND REPORTING 
REQUIREMENTS.—The Secretary shall require that, 
as appropriate, a grantee shall be subject to quality 
management and reporting requirements comparable 
to those imposed on Federally-qualified health cen-
ters, including reporting of encounter data, clinical 
outcomes data, quality data, and such other data as 
the Secretary shall require, as a condition of such 
grantee receiving payment for Medicaid covered 
services under this subsection.’’. 
(b) EFFECTIVE DATE.— 
(1) Except as provided in paragraph (2), the 
amendments made by subsection (a) shall apply to 
services furnished on or after January 1, 2016, 
without regard to whether or not final regulations to 
carry out such amendments have been promulgated 
by such date. 
VerDate Sep 11 2014 
23:45 Sep 30, 2015
Jkt 049200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H3637.IH
H3637
SSpencer on DSK4SPTVN1PROD with BILLS
(2) In the case of a State plan for medical as-
sistance under title XIX of the Social Security Act 
which the Secretary of Health and Human Services 
determines requires State legislation (other than leg-
islation appropriating funds) in order for the plan to 
meet the additional requirement imposed by the 
amendments made by subsection (a), the State plan 
shall not be regarded as failing to comply with the 
requirements of such title solely on the basis of its 
failure to meet this additional requirement before 
the first day of the first calendar quarter beginning 
after the close of the first regular session of the 
State legislature that begins after the date of the en-
actment of this Act. For purposes of the previous 
sentence, in the case of a State that has a 2-year 
legislative session, each year of such session shall be 
deemed to be a separate regular session of the State 
legislature. 
Æ 
VerDate Sep 11 2014 
23:45 Sep 30, 2015
Jkt 049200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6301
E:\BILLS\H3637.IH
H3637
SSpencer on DSK4SPTVN1PROD with BILLS