I 
111TH CONGRESS 
1ST SESSION H. R. 3430 
To establish a Medicare DSH pilot program under which participants shall 
establish collaborative care networks to reduce the use of emergency 
departments, inpatient and other expensive resources of hospitals and 
other providers and provide more comprehensive and coordinated care 
to low-income individuals, including those without health insurance cov-
erage, and to establish a Collaborative Care Network Center. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 30, 2009 
Ms. LINDA T. SA´NCHEZ of California (for herself, Mr. LEWIS of Georgia, and 
Mr. RUSH) introduced the following bill; which was referred to the Com-
mittee on Ways and Means, and in addition to the Committee on Energy 
and Commerce, for a period to be subsequently determined by the Speak-
er, in each case for consideration of such provisions as fall within the ju-
risdiction of the committee concerned 
A BILL 
To establish a Medicare DSH pilot program under which 
participants shall establish collaborative care networks 
to reduce the use of emergency departments, inpatient 
and other expensive resources of hospitals and other 
providers and provide more comprehensive and coordi-
nated care to low-income individuals, including those 
without health insurance coverage, and to establish a 
Collaborative Care Network Center. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘DSH Collaborative 
Care Network Pilot Program Act of 2009’’. 
SEC. 2. MEDICARE DSH PILOT PROGRAM. 
(a) ESTABLISHMENT.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services (in this Act referred to as the ‘‘Sec-
retary’’) shall carry out a Medicare DSH pilot pro-
gram (in this Act referred to as the ‘‘Pilot Pro-
gram’’) under which, for purposes of establishing 
model projects described in paragraph (2), eligible 
DSH Program participants shall, for discharges oc-
curring during a cost reporting period for which the 
participant is participating in the Pilot Program, re-
ceive an amount in accordance with paragraph (3) 
in addition to the amount the participant would oth-
erwise receive under section 1886(d)(5)(F) of the 
Social Security Act (42 U.S.C. 1395ww(d)(5)(F)). 
(2) MODEL
PROJECTS.—Model projects de-
scribed in this paragraph are projects to accomplish 
the following goals: 
(A) To reduce unnecessary use of items 
and services furnished in emergency depart-
ments of hospitals (especially to ensure that in-
dividuals without health insurance coverage or 
with inadequate health insurance coverage do 
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not use the services of such department instead 
of the services of a primary care physician) 
through methods such as— 
(i) screening individuals who seek 
emergency department services for possible 
eligibility under relevant governmental 
health programs or for subsidies under 
such programs; and 
(ii) providing such individuals refer-
rals for follow-up care and chronic condi-
tion care. 
(B) To manage chronic conditions to re-
duce their severity, negative health outcomes, 
and expense. 
(C) To encourage health care providers to 
coordinate their efforts so that the most vulner-
able patient populations seek and obtain pri-
mary care. 
(D) To provide more comprehensive and 
coordinated care to low-income vulnerable indi-
viduals and individuals without health insurance 
coverage or with inadequate coverage. 
(E) To provide mechanisms for improving 
both quality and efficiency of care for low-in-
come individuals and families, with an emphasis 
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on those most likely to remain uninsured de-
spite the existence of government programs to 
make health insurance more affordable. 
(F) To increase preventive services, includ-
ing screening and counseling, to those who 
would otherwise not receive such screening, in 
order to improve health status and reduce long 
term complications and costs. 
(G) To ensure the availability of commu-
nity-wide safety net services, including emer-
gency and trauma care. 
(3) ADDITIONAL AMOUNT.— 
(A) IN
GENERAL.—The Secretary shall 
specify the additional amount each eligible 
DSH Program participant shall receive for a 
cost reporting period from the pool established 
under subparagraph (B) for the period involved. 
Such amount shall be established, to the max-
imum extent practicable, to retain or increase 
the level of funding for such a participant from 
year to year. The total of such payments for a 
period shall not exceed the total amount of 
funds available under subparagraph (B) for 
such period. 
(B) SPENDING POOL.— 
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(i) IN
GENERAL.—Subject to clause 
(ii), the amount described in this subpara-
graph for a fiscal year is equal to 2 per-
cent of the total of all Medicare DSH pay-
ments for the fiscal year 2008 cost report-
ing period, the rate of increase (if any), for 
each succeeding fiscal year through the fis-
cal year involved, in Medicare DSH pay-
ments for the fiscal year, as estimated by 
the Secretary. 
(ii) TREATMENT OF DECREASES.—If 
because of a change in law or regulation 
there is a decrease total Medicare DSH 
payments for a fiscal year, 5 percent of the 
amount of such decreased payments shall 
be added to the amount otherwise com-
puted under clause (i). 
(b) ELIGIBILITY AND PARTICIPANT SELECTION.— 
(1) ELIGIBLE DSH PROGRAM PARTICIPANT.— 
For purposes of this section, the term ‘‘eligible DSH 
Program participant’’ means a hospital described in 
section 1886(d)(5)(F)(i) of the Social Security Act 
that is to be a member of a collaborative care net-
work described in subsection (d) and selected by the 
Secretary under paragraph (3). 
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(2) APPLICATION.—An applicant representing a 
collaborative care network described in subsection 
(d) shall submit to the Secretary an application in 
such form and manner and containing such informa-
tion as specified by the Secretary. Such information 
shall at least— 
(A) identify the health care providers par-
ticipating in the collaborative care network pro-
posed by the applicant and in the case a Feder-
ally-qualified health center is not included as 
such a participant, the reason such a center is 
not so included; 
(B) include a description of how the pro-
viders plan to collaborate to provide comprehen-
sive and integrated care for low-income individ-
uals, including uninsured and underinsured in-
dividuals; 
(C) include a description of the organiza-
tional and joint governance structure of the col-
laborative care network in a manner so that it 
is clear how decisions will be made; 
(D) define the geographic areas and popu-
lations that the network intends to serve; 
(E) define the scope of services that the 
network intends to provide and identify any 
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reasons why such services would not include a 
suggested core service identified by the Sec-
retary under paragraph (4); 
(F) demonstrate the network’s ability to 
meet the requirements of this section; and 
(G) provide assurances that (and include a 
plan demonstrating how) funds received by an 
eligible DSH Program participant under section 
1886(d)(5)(F) of the Social Security Act pursu-
ant to the Pilot Program shall be appropriately 
distributed among all health care providers par-
ticipating in the collaborative care network. 
(3) SELECTION OF PARTICIPANTS.—The Sec-
retary shall select eligible DSH Program partici-
pants from applications submitted under paragraph 
(2) on the basis of quality of the proposal involved, 
geographic diversity (including different States and 
regions served and urban and rural diversity), and 
the number of low-income and uninsured individuals 
that the proposal intends to serve. The Secretary 
shall give priority to proposals from eligible DSH 
Program participants that serve a high volume a 
low-income individuals, and in applying this criteria, 
may consider whether the eligible DSH Program 
participant meets the criteria set out under section 
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1923(b)(1)(B) of the Social Security Act. Subject to 
receiving enough high quality applications under 
paragraph (2), the Secretary shall select at least 5 
such participants initially. 
(4) SUGGESTED
CORE
SERVICES.—For pur-
poses of paragraph (2)(E), the Secretary shall de-
velop a list of suggested core services to be provided 
by a collaborative care network. The Secretary may 
select an eligible DSH Program participant under 
paragraph (3), the application of which does not in-
clude all such services, if such application provides 
a reasonable explanation why such services are not 
proposed to be included, and the Secretary deter-
mines that the application is otherwise high quality. 
Unless the Secretary determines otherwise, such list 
of suggested core services should include primary 
care, maternity care, and well-baby care. 
(5) TERMINATION AUTHORITY.—The Secretary 
may terminate selection of a collaborative care net-
work under this section for good cause. Such good 
cause shall include a determination that the net-
work— 
(A) has failed to provide a comprehensive 
range of coordinated and integrated health care 
services as required under subsection (d)(3); 
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(B) had failed to meet reasonable quality 
standards; 
(C) has misappropriated funds provided 
under this section; or 
(D) has failed to make progress toward ac-
complishing goals set out in subsection (a)(2). 
(c) USE OF FUNDS.—Funds provided under the Pilot 
Program shall be available to an eligible DSH Program 
participant (or consortium of participants) to create and 
support collaborative care networks (described in sub-
section (d)) that would carry out the following activities: 
(1) Assist low-income individuals without ade-
quate health care coverage to— 
(A) access and appropriately use health 
services; 
(B) enroll in applicable public or private 
health insurance programs; 
(C) obtain referrals to and see a primary 
care provider in the case such an individual 
does not have a primary care provider; and 
(D) obtain appropriate care for chronic 
conditions. 
(2) Improve heath care by providing case man-
agement, application assistance, and appropriate re-
ferrals such as through methods to— 
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