I 
111TH CONGRESS 
1ST SESSION H. R. 1614 
To authorize the Secretary of Health and Human Services to make grants 
to community health coalitions to assist in the development of integrated 
health care delivery, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 19, 2009 
Mr. GENE GREEN of Texas (for himself, Mr. WAMP, and Mr. SMITH of Wash-
ington) introduced the following bill; which was referred to the Committee 
on Energy and Commerce 
A BILL 
To authorize the Secretary of Health and Human Services 
to make grants to community health coalitions to assist 
in the development of integrated health care delivery, 
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. 
This Act may be cited as the ‘‘Community Coalitions 
for Access and Quality Improvement Act of 2009’’. 
SEC. 2. PURPOSE. 
The purpose of this Act is to provide assistance to 
community health coalitions as described in section 3(b) 
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with a clearly defined local need to increase access to and 
improve the quality of health care services through activi-
ties which— 
(1) develop or strengthen coordination of serv-
ices to allow all individuals, including the uninsured 
and low-income, to receive efficient and higher qual-
ity care and to gain entry into and receive services 
from a comprehensive system of medical, dental, 
pharmaceutical, and behavioral health care; 
(2) develop efficient and sustainable infrastruc-
ture for a health care delivery system characterized 
by effective collaboration, information sharing, and 
clinical and financial coordination among all types of 
providers of care in the community; and 
(3) develop or strengthen activities related to 
providing coordinated care for individuals with 
chronic conditions. 
SEC. 3. GRANTS TO STRENGTHEN THE EFFECTIVENESS, EF-
FICIENCY, AND COORDINATION OF SERVICES. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (in this Act referred to as the ‘‘Sec-
retary’’) shall award grants to assist in the development 
of integrated health care delivery systems to serve defined 
communities of individuals— 
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(1) to improve the efficiency of and coordina-
tion among the providers providing services through 
such systems; 
(2) to assist local communities in developing 
programs targeted toward preventing and managing 
chronic diseases; and 
(3) to expand and enhance the services provided 
through such systems. 
(b) ELIGIBLE ENTITIES.—To be eligible to receive a 
grant under this section, an entity shall be an entity 
that— 
(1) represents a balanced consortium— 
(A) whose principal purpose is to ensure 
the sustainable capacity for the provision of a 
broad range of coordinated services for all resi-
dents within a community defined in the enti-
ty’s grant application as described in paragraph 
(2); and 
(B) that includes at least one of each of 
the following providers that serve the commu-
nity (unless such provider does not exist within 
the community, declines or refuses to partici-
pate, or places unreasonable conditions on their 
participation)— 
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(i) a federally qualified health center 
(as defined in section 1861(aa) of the So-
cial Security Act (42 U.S.C. 1395x(aa))); 
(ii) rural health clinics and rural 
health networks (as defined in sections 
1861(aa) and 1820(d) of the Social Secu-
rity 
Act, 
respectively 
(42 
U.S.C. 
1395x(aa), 1395i–4(d))); 
(iii) a hospital with a low-income utili-
zation rate that is greater than 25 percent 
(as defined in section 1923(b)(3) of the 
Social Security Act (42 U.S.C. 1396r– 
4(b)(3))) or a critical access hospital (as 
defined in section 1820(c)(2) of the Social 
Security Act (42 U.S.C. 1395i–4(c)(2))); 
(iv) a public health department; and 
(v) an interested public or private sec-
tor health care provider or an organization 
that has traditionally served the medically 
uninsured and low-income individuals; and 
(2) submits to the Secretary an application, in 
such form and manner as the Secretary shall pre-
scribe, that— 
(A) clearly defines the community to be 
served; 
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(B) identifies the providers who will par-
ticipate in the community coalition under the 
grant and specifies each provider’s contribution 
to the care of individuals in the community; 
(C) describes the activities that the appli-
cant and the community coalition propose to 
perform under the grant to further the objec-
tives of this section; 
(D) demonstrates that it is an established 
coalition with ability to build on the current 
system for serving the community by involving 
providers who have traditionally provided a sig-
nificant volume of care for uninsured and low- 
income individuals for that community; 
(E) demonstrates the coalition’s ability to 
develop coordinated systems of care that either 
directly provide or ensure the prompt provision 
of a broad range of high-quality, accessible 
services, including, as appropriate, primary, sec-
ondary, and tertiary services as well as phar-
macy, substance abuse, behavioral health and 
oral health services, in a manner that ensures 
continuity of care in the community; 
(F) provides evidence of community in-
volvement, including the business community, in 
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the development, implementation, and direction 
of the system of care that the coalition proposes 
to ensure; 
(G) demonstrates the coalition’s ability to 
ensure that participating individuals are en-
rolled in health care coverage programs, both 
public and private, for which the individuals are 
eligible; 
(H) presents a plan for leveraging other 
sources of revenue, which may include State 
and local sources and private grant funds, and 
integrating current and proposed new funding 
sources in a manner to ensure long-term sus-
tainability of the system of care; 
(I) describes a plan for evaluation of the 
activities carried out under the grant, including 
measurement of progress toward the goals and 
objectives of the program and the use of evalua-
tion findings to improve system performance; 
(J) 
demonstrates 
fiscal 
responsibility 
through the use of appropriate accounting pro-
cedures and management systems; 
(K) demonstrates commitment to serve the 
community without regard to the ability of an 
individual or family to pay by arranging for or 
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providing free or reduced charge care for the 
poor; and 
(L) includes such other information as the 
Secretary may prescribe. 
(c) LIMITATIONS.— 
(1) IN GENERAL.—An eligible entity may re-
ceive a grant under this section for 3 consecutive fis-
cal years and may receive such a grant award for 2 
additional years if— 
(A) the eligible entity submits to the Sec-
retary a request for a grant for such additional 
years; 
(B) the Secretary determines that current 
performance justifies the granting of such a re-
quest; and 
(C) the Secretary determines that granting 
such request is necessary to further the objec-
tives described in subsection (a). 
(d) PRIORITIES.—In awarding grants under this sec-
tion, the Secretary— 
(1) may accord priority to applicants that dem-
onstrate the greatest extent of unmet need in the 
community for a more coordinated system of care; 
and 
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(2) shall accord priority to applicants that best 
promote the objectives of this section, taking into 
consideration the extent to which the applicant— 
(A) identifies a community whose geo-
graphical area has a high or increasing percent-
age of individuals who are uninsured or low-in-
come; 
(B) demonstrates that the applicant has 
included in its community coalition providers, 
support systems, and programs that have a tra-
dition of serving individuals and families in the 
community who are uninsured or earn below 
200 percent of the Federal poverty level; 
(C) shows evidence that the proposed coali-
tion activities would expand utilization of pre-
ventive and primary care services for uninsured 
and underinsured individuals and families in 
the community, including pharmaceuticals, be-
havioral and mental health services, oral health 
services, or substance abuse services; 
(D) proposes approaches that would im-
prove coordination between health care pro-
viders and appropriate social service providers; 
(E) demonstrates collaboration with State 
and local governments; 
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(F) demonstrates that the applicant makes 
use of non-Federal contributions to the greatest 
extent possible; or 
(G) demonstrates likelihood that the pro-
posed activities will lead to sustainable inte-
grated delivery system as additional efforts of 
health systems development evolve. 
(e) USE OF FUNDS.— 
(1) USE BY GRANTEES.— 
(A) IN GENERAL.—Except as provided in 
paragraphs (2) and (3), a grantee may use 
amounts provided under this section only for— 
(i) direct expenses associated with 
achieving the greater integration of a 
health care delivery system so that the sys-
tem either directly provides or ensures the 
provision of a broad range of culturally 
competent services, including as appro-
priate primary, secondary, and tertiary 
care and oral health, substance abuse, be-
havioral and mental health, and pharma-
ceutical services; and 
(ii) direct patient care and service ex-
pansions to fill identified or documented 
gaps within an integrated delivery system. 
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(B) SPECIFIC USES.—The following are ex-
amples of purposes for which a grantee may use 
grant funds under this section, when such use 
meets the conditions stated in subparagraph 
(A): 
(i) Increases in outreach activities and 
closing gaps in health care service, includ-
ing referral to specialty services and pre-
scription drugs and conducting ongoing 
outreach to health disparity populations. 
(ii) Improvements to care manage-
ment and delivery of patient-centered care, 
including patient navigation services. 
(iii) Improvements to coordination of 
transportation to health care facilities. 
(iv) Development of provider networks 
and other innovative models to engage phy-
sicians in voluntary efforts to serve the 
medically underserved within a community. 
(v) Recruitment, training, and com-
pensation of necessary personnel. 
(vi) Coordinate the acquisition or 
interconnected use of technology within a 
community for the purpose of coordinating 
care and improving provider communica-
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tion, including implementation of shared 
information systems or shared clinical sys-
tems to improve the quality of health care. 
(vii) Development of common proc-
esses such as mechanisms for determining 
eligibility 
for 
the 
programs 
provided 
through the system, common identification 
cards, sliding scale discounts, and moni-
toring and tracking of outcomes. 
(viii) Development of specific preven-
tion and disease management tools and 
processes. 
(ix) Language access services. 
(x) Facilitating the involvement of 
community organizations to provide better 
access to high-quality health care services 
to individuals at risk for or who have 
chronic diseases or cancer. 
(xi) Helping patients overcome bar-
riers within the health care system to en-
sure prompt diagnostic and treatment res-
olution of an abnormal finding of cancer or 
chronic disease. 
(2) DIRECT PATIENT CARE LIMITATION.—Not 
more than 20 percent of the funds provided under 
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a grant awarded under this section may be used for 
providing direct patient care and services. 
(3) RESERVATION
OF
FUNDS
FOR
NATIONAL 
PROGRAM PURPOSES.—The Secretary may use not 
more than 7 percent of funds appropriated to carry 
out this section for providing technical assistance to 
grantees, obtaining assistance of experts and con-
sultants, holding meetings, developing of tools, dis-
seminating of information, and evaluation. 
(f) REPORTING BY GRANTEE.—A grantee under this 
section shall report to the Secretary annually regarding— 
(1) progress in meeting the goals and measur-
able objectives set forth in the grant application sub-
mitted by the grantee under subsection (b); and 
(2) the extent to which activities conducted by 
such grantee have— 
(A) improved the effectiveness, efficiency, 
and coordination of services for uninsured and 
low-income individuals in the community served 
by such grantee, using commonly accepted out-
come measures; 
(B) resulted in the provision of better qual-
ity health care for individuals and families in 
the community served; and 
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(C) resulted in the provision of health care 
to such individuals at lower cost than would 
have been possible in the absence of the activi-
ties conducted by such grantee. 
(g) MAINTENANCE OF EFFORT.—With respect to ac-
tivities for which a grant under this section is authorized, 
the Secretary may award such a grant only if the applicant 
and each of the participating providers agree that the 
grantee and each such provider will maintain its expendi-
tures of non-Federal funds for such activities at a level 
that is not less then the level of such expenditures during 
the fiscal year immediately preceding the fiscal year for 
which the applicant is applying to receive such grant. 
(h) TECHNICAL ASSISTANCE.—The Secretary may 
provide any entity that receives a grant under this section 
with technical and other nonfinancial assistance necessary 
to meet the requirements of this section. The Secretary 
may choose to provide such assistance by awarding a grant 
to, or entering into a contract with, a State or national 
not-for-profit organization with expertise in building suc-
cessful community coalitions. 
(i) EVALUATION OF PROGRAM.—Not later than Sep-
tember 30, 2014, the Secretary shall prepare and submit 
to the appropriate committees of Congress a report that 
describes the extent to which projects funded under this 
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section have been successful in improving the effective-
ness, efficiency, and coordination of services in the com-
munities served by such projects, including whether the 
projects resulted in the provision of better quality health 
care for such individuals, and whether such care was pro-
vided at lower costs than would have been provided in the 
absence of such projects. 
(j) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this sec-
tion— 
(1) $75,000,000 for fiscal year 2010; 
(2) $100,000,000 for fiscal year 2011; 
(3) $125,000,000 for fiscal year 2012; 
(4) $150,000,000 for fiscal year 2013; and 
(5) $175,000,000 for fiscal year 2014. 
Æ 
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