I
107TH CONGRESS
2D SESSION
H. R. 4000
To amend title XVIII of the Social Security Act to enhance the access
of Medicare beneficiaries who live in medically underserved areas to
critical primary and preventive health care benefits, to improve the
Medicare+Choice program, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
MARCH 19, 2002
Mr. WELLER (for himself, Mr. LEWIS of Georgia, Mr. BEREUTER, Mr. HIN-
CHEY, Mr. FOLEY, Mr. MCNULTY, Mr. DEAL of Georgia, Ms. CARSON
of Indiana, Mr. BONILLA, Mrs. CHRISTENSEN, Mr. SESSIONS, Mrs.
JONES of Ohio, Mr. LATOURETTE, and Mr. DAVIS of Illinois) introduced
the following bill; which was referred to the Committee on Ways and
Means, and in addition to the Committee on Energy and Commerce, for
a period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the com-
mittee concerned
A BILL
To amend title XVIII of the Social Security Act to enhance
the access of Medicare beneficiaries who live in medically
underserved areas to critical primary and preventive
health care benefits, to improve the Medicare+Choice
program, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Medicare Safety Net Access Act of 2002’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Supplemental reimbursement for Federally qualified health centers par-
ticipating in medicare managed care.
Sec. 3. Revision of Federally qualified health center payment limits.
Sec. 4. Coverage of additional Federally qualified health center services.
Sec. 5. Providing safe harbor for certain collaborative efforts that benefit medi-
cally underserved populations.
SEC. 2. SUPPLEMENTAL REIMBURSEMENT FOR FEDERALLY
QUALIFIED 
HEALTH 
CENTERS 
PARTICI-
PATING IN MEDICARE MANAGED CARE.
(a) 
SUPPLEMENTAL
REIMBURSEMENT.—Section
1833(a)(3) of the Social Security Act (42 U.S.C.
1395l(a)(3)) is amended to read as follows:
‘‘(3) in the case of services described in section
1832(a)(2)(D)—
‘‘(A) except as provided in subparagraph
(B), the costs which are reasonable and related
to the cost of furnishing such services or which
are based on such other tests of reasonableness
as the Secretary may prescribe in regulations,
including 
those 
authorized 
under 
section
1861(v)(1)(A), less the amount a provider may
charge as described in clause (ii) of section
1866(a)(2)(A), but in no case may the payment
for such services (other than for items and serv-
ices described in section 1861(s)(10)(A)) exceed
80 percent of such costs; or
‘‘(B) with respect to the services described
in clause (ii) of section 1832(a)(2)(D) that are
furnished to an individual enrolled with a
Medicare+Choice organization under part C
pursuant to a written agreement described in
section 1853(j), the amount by which—
‘‘(i) the amount of payment that
would have otherwise been provided under
subparagraph (A) (calculated as if ‘100
percent’ were substituted for ‘80 percent’
in such subparagraph) for such services if
the individual had not been so enrolled; ex-
ceeds
‘‘(ii) the amount of the payments re-
ceived under such written agreement for
such services (not including any financial
incentives provided for in such agreement
such as risk pool payments, bonuses, or
withholds),
less the amount the Federally qualified health
center may charge as described in section
1857(e)(3)(C);’’.
(b) CONTINUATION OF MEDICARE+CHOICE MONTH-
LY PAYMENTS.—
(1) IN GENERAL.—Section 1853 of the Social
Security Act (42 U.S.C. 1395w–23) is amended by
adding at the end the following new subsection:
‘‘(j) SPECIAL PAYMENT RULE
FOR FEDERALLY
QUALIFIED HEALTH CENTER SERVICES.—If an indi-
vidual who is enrolled with a Medicare+Choice organiza-
tion under this part receives a service from a Federally
qualified health center that has a written agreement with
such organization for providing such a service (including
any agreement required under section 1857(e)(3))—
‘‘(1) the Secretary shall pay the amount deter-
mined under section 1833(a)(3)(B) directly to the
Federally qualified health center not less frequently
than quarterly; and
‘‘(2) the Secretary shall not reduce the amount
of the monthly payments to the Medicare+Choice
organization made under section 1853(a) as a result
of the application of paragraph (1).’’.
(2) CONFORMING AMENDMENTS.—
(A) Paragraphs (1) and (2) of section
1851(i) of the Social Security Act (42 U.S.C.
1395w–21(i)(1)) are each amended by inserting
‘‘1853(j),’’ after ‘‘1853(h),’’.
(B) Section 1853(c)(5) is amended by
striking ‘‘subsections (a)(3)(C)(iii) and (i)’’ and
inserting ‘‘subsections (a)(3)(C)(iii), (i), and
(j)(1)’’.
(c) ADDITIONAL MEDICARE+CHOICE CONTRACT RE-
QUIREMENTS.—Section 1857(e) of the Social Security Act
(42 U.S.C. 1395w–27(e)) is amended by adding at the end
the following new paragraph:
‘‘(3) AGREEMENTS
WITH
FEDERALLY
QUALI-
FIED HEALTH CENTERS.—
‘‘(A) ENSURING EQUAL ACCESS TO SERV-
ICES OF FQHCS.—A contract under this part
shall require the Medicare+Choice organization
to enter into (and to demonstrate to the Sec-
retary that it has entered into) a sufficient
number of written agreements with Federally
qualified health centers providing Federally
qualified health center services for which pay-
ment may be made under this title in the serv-
ice area of each Medicare+Choice plan offered
by such organization so that such services are
reasonably available to individuals enrolled in
the plan.
‘‘(B) ENSURING EQUAL PAYMENT LEVELS
AND
AMOUNTS.—A contract under this part
shall require the Medicare+Choice organization
to provide a level and amount of payment to
each Federally qualified health center for serv-
ices provided by such health center that are
covered under the written agreement described
in subparagraph (A) that is not less than the
level and amount of payment that the organiza-
tion would make for such services if the services
had been furnished by a provider of services
that was not a Federally qualified health center.
‘‘(C) COST-SHARING.—Under the written
agreement described in subparagraph (A), a
Federally qualified health center must accept
the Medicare+Choice contract price plus the
Federal payment as payment in full for services
covered by the contract, except that such a
health center may collect any amount of cost-
sharing permitted under the contract under this
part, so long as the amounts of any deductible,
coinsurance, or copayment comply with the re-
quirements under section 1854(e) and do not
result in a total payment to the center in excess
of the amount determined under section
1833(a)(3)(A) (calculated as if ‘100 percent’