I 
111TH CONGRESS 
1ST SESSION H. R. 1643 
To amend title XVIII of the Social Security Act to establish a prospective 
payment system instead of the reasonable cost-based reimbursement 
method for Medicare-covered services provided by Federally qualified 
health centers and to expand the scope of such covered services to 
account for expansions in the scope of services provided by Federally 
qualified health centers since the inclusion of such services for coverage 
under the Medicare Program. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 19, 2009 
Mr. LEWIS of Georgia (for himself and Mrs. EMERSON) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration 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 establish 
a prospective payment system instead of the reasonable 
cost-based reimbursement method for Medicare-covered 
services provided by Federally qualified health centers 
and to expand the scope of such covered services to 
account for expansions in the scope of services provided 
by Federally qualified health centers since the inclusion 
of such services for coverage under the Medicare Pro-
gram. 
VerDate Nov 24 2008 
02:02 Mar 21, 2009
Jkt 079200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6652
E:\BILLS\H1643.IH
H1643
jbell on PROD1PC69 with BILLS
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 ‘‘Medicare Access to 
Community Health Centers (MATCH) Act of 2009’’. 
SEC. 2. FINDINGS. 
(a) FINDINGS.—Congress makes the following find-
ings regarding community health centers: 
(1) 
NATIONAL
IMPORTANCE.—Community 
health centers serve as the medical home and family 
physician to over 16 million people nationally. Their 
patients represent one in seven low-income persons, 
one in eight uninsured Americans, one in nine Med-
icaid beneficiaries, one in ten minorities, and one in 
ten rural residents. 
(2) HEALTH CARE SAFETY NET.—Because Fed-
erally qualified health centers (FQHCs) are gen-
erally located in medically underserved areas, FQHC 
patients are disproportionately low income, unin-
sured or publicly insured, and minority, and they 
frequently have poorer health and more complicated, 
costly medical needs than patients nationally. As a 
chief component of the health care safety net, 
FQHCs are required by regulation to serve all pa-
VerDate Nov 24 2008 
02:02 Mar 21, 2009
Jkt 079200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H1643.IH
H1643
jbell on PROD1PC69 with BILLS
tients, regardless of insurance status or ability to 
pay. 
(3) 
MEDICARE
BENEFICIARIES.—Medicare 
beneficiaries are typically less healthy and, therefore, 
costlier to treat than other FQHC patients. Medi-
care beneficiaries tend to have more complex health 
care needs as— 
(A) more than half of Medicare patients 
have at least two chronic conditions; 
(B) 45 percent take five or more medica-
tions; and 
(C) over half of Medicare beneficiaries 
have more than one prescribing physician. 
(4) NEED TO IMPROVE FQHC PAYMENT.—While 
the Centers for Medicare & Medicaid Services have 
nearly 15 years’ worth of FQHC cost report data, 
which would equip the agency to develop a new 
Medicare reimbursement system, the agency has 
failed to update and improve the Medicare FQHC 
payment system. 
VerDate Nov 24 2008 
02:02 Mar 21, 2009
Jkt 079200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H1643.IH
H1643
jbell on PROD1PC69 with BILLS
SEC. 3. EXPANSION OF MEDICARE-COVERED PRIMARY AND 
PREVENTIVE 
SERVICES 
AT 
FEDERALLY 
QUALIFIED HEALTH CENTERS. 
(a) IN GENERAL.—Section 1861(aa)(3) of the Social 
Security Act (42 U.S.C. 1395w(aa)(3) is amended to read 
as follows: 
‘‘(3) The term ‘Federally qualified health center serv-
ices’ means— 
‘‘(A) services of the type described in subpara-
graphs (A) through (C) of paragraph (1), and such 
other ambulatory services furnished by a Federally 
qualified health center for which payment may oth-
erwise be made under this title if such services were 
furnished by a health care provider or health care 
professional other than a Federally qualified health 
center; and 
‘‘(B) preventive primary health services that a 
center is required to provide under section 330 of 
the Public Health Service Act, 
when furnished to an individual as a patient of a Federally 
qualified health center and such services when provided 
by a health care provider or health care professional em-
ployed by or under contract with a Federally qualified 
health center and for this purpose, any reference to a rural 
health clinic or a physician described in paragraph (2)(B) 
is deemed a reference to a Federally qualified health cen-
VerDate Nov 24 2008 
02:02 Mar 21, 2009
Jkt 079200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H1643.IH
H1643
jbell on PROD1PC69 with BILLS
ter or a physician at the center, respectively. Services de-
scribed in the previous sentence shall be treated as billable 
visits for purposes of payment to the Federally qualified 
health center.’’. 
(b) CONFORMING AMENDMENT TO PERMIT PAY-
MENT
FOR
HOSPITAL-BASED
SERVICES.—Section 
1862(a)(14) of such Act (42 U.S.C. 1395y(a)(14)) is 
amended by inserting ‘‘Federally qualified health center 
services,’’ after ‘‘qualified psychologist services,’’. 
(c) EFFECTIVE DATES.—The amendments made by 
subsections (a) and (b) shall apply to services furnished 
on or after January 1, 2010. 
SEC. 4. ESTABLISHMENT OF A MEDICARE PROSPECTIVE 
PAYMENT SYSTEM FOR FEDERALLY QUALI-
FIED HEALTH CENTER SERVICES. 
(a) IN GENERAL.—Paragraph (3) section 1833(a) of 
the Social Security Act (42 U.S.C. 1395l(a)) is amended 
to read as follows: 
‘‘(3)(A) in the case of services described in sec-
tion 1832(a)(2)(D)(i) the costs which are reasonable 
and related to the furnishing of such services or 
which are based on such other tests of reasonable-
ness as the Secretary may prescribe in regulations 
including 
those 
authorized 
under 
section 
1861(v)(1)(A), less the amount a provider may 
VerDate Nov 24 2008 
02:02 Mar 21, 2009
Jkt 079200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H1643.IH
H1643
jbell on PROD1PC69 with BILLS
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 services de-
scribed in 1861(s)(10)(A)) exceed 80 percent of such 
costs; and 
‘‘(B) in the case of services described in section 
1832(a)(2)(D)(ii) furnished by a Federally qualified 
health center— 
‘‘(i) subject to clauses (iii) and (iv), for 
services furnished on and after January 1, 
2010, during the center’s fiscal year that ends 
in 2010, an amount (calculated on a per visit 
basis) that is equal to 100 percent of the aver-
age of the costs of the center of furnishing such 
services during such center’s fiscal years ending 
during 2008 and 2009 which are reasonable 
and related to the cost of furnishing such serv-
ices, or which are based on such other tests of 
reasonableness as the Secretary prescribes in 
regulations including those authorized under 
section 1861(v)(1)(A) (except that in calcu-
lating such cost in a center’s fiscal years ending 
during 2008 and 2009 and applying the aver-
age of such cost for a center’s fiscal year end-
ing during fiscal year 2010, the Secretary shall 
VerDate Nov 24 2008 
02:02 Mar 21, 2009
Jkt 079200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H1643.IH
H1643
jbell on PROD1PC69 with BILLS
not apply a per visit payment limit or produc-
tivity screen), 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 or serv-
ices described in section 1861(s)(10)(A)) exceed 
80 percent of such average of such costs; 
‘‘(ii) subject to clauses (iii) and (iv), for 
services furnished during the center’s fiscal 
year ending during 2011 or a succeeding fiscal 
year, an amount (calculated on a per visit basis 
and without the application of a per visit limit 
or productivity screen) that is equal to the 
amount determined under this subparagraph 
for the center’s preceding fiscal year (without 
regard to any copayment)— 
‘‘(I) increased for a center’s fiscal 
year ending during 2011 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 2011 and increased for a center’s fiscal 
year ending during 2012 or any succeeding 
fiscal year by the percentage increase for 
such year of a market basket of Federally 
VerDate Nov 24 2008 
02:02 Mar 21, 2009
Jkt 079200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H1643.IH
H1643
jbell on PROD1PC69 with BILLS
qualified health center costs as developed 
and promulgated through regulations by 
the Secretary; and 
‘‘(II) adjusted to take into account 
any increase or decrease in the scope of 
services, including a change in the type, in-
tensity, duration, or amount of services, 
furnished by the center during the center’s 
fiscal year, 
less the amount a provider may charge as de-
scribed in clause (ii) of section 1866(a)(2)(A), 
but in no case may the payment for such serv-
ices (other than for items or services described 
in section 1861(s)(10)(A)) exceed 80 percent of 
the amount determined under this clause (with-
out regard to any copayment); 
‘‘(iii) subject to clause (iv), in the case of 
an entity that first qualifies as a Federally 
qualified health center in a center’s fiscal year 
ending after 2009— 
‘‘(I) for the first such center fiscal 
year, an amount (calculated on a per visit 
basis and without the application of a per 
visit payment limit or productivity screen) 
that is equal to 100 percent of the costs of 
VerDate Nov 24 2008 
02:02 Mar 21, 2009
Jkt 079200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H1643.IH
H1643
jbell on PROD1PC69 with BILLS
furnishing such services during such center 
fiscal year based on the per visit payment 
rates established under clause (i) or (ii) for 
a comparable period for other such centers 
located in the same or adjacent areas with 
a similar caseload or, in the absence of 
such a center, in accordance with the regu-
lations and methodology referred to in 
clause (i) or based on such other tests of 
reasonableness (without the application of 
a per visit payment limit or productivity 
screen) as the Secretary may specify, less 
the amount a provider may charge as de-
scribed in clause (ii) of section 1866 
(a)(2)(A), but in no case may the payment 
for such services (other than for items and 
services 
described 
in 
section 
1861(s)(10)(A)) exceed 80 percent of such 
costs; and 
‘‘(II) for each succeeding center fiscal 
year, the amount calculated in accordance 
with clause (ii); and 
‘‘(iv) with respect to Federally qualified 
health center services that are furnished to an 
individual enrolled with a MA plan under part 
VerDate Nov 24 2008 
02:02 Mar 21, 2009
Jkt 079200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H1643.IH
H1643
jbell on PROD1PC69 with BILLS
C pursuant to a written agreement described in 
section 1853(a)(4) (or, in the case of MA pri-
vate fee for service plan, without such written 
agreement) the amount (if any) by which— 
‘‘(I) the amount of payment that 
would have otherwise been provided under 
clauses (i), (ii), or (iii) (calculated as if 
‘100 percent’ were substituted for ‘80 per-
cent’ in such clauses) for such services if 
the individual had not been enrolled; ex-
ceeds 
‘‘(II) the amount of the payments re-
ceived under such written agreement (or, 
in the case of MA private fee for service 
plans, without 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 de-
scribed in section 1857(e)(3)(B);’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to services furnished on or after 
January 1, 2010. 
Æ 
VerDate Nov 24 2008 
02:02 Mar 21, 2009
Jkt 079200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6301
E:\BILLS\H1643.IH
H1643
jbell on PROD1PC69 with BILLS