Sec. 1. Short title; table of contents. 
Sec. 2. Rural health clinic reimbursement. 
Sec. 3. Rural health clinic quality reporting initiative. 
Sec. 4. Rural health clinic and community health center collaborative access ex-
pansion. 
Sec. 5. GAO report on diabetes education and medical nutrition therapy serv-
ices. 
Sec. 6. Rural health clinic provider retention demonstration project. 
Sec. 7. Definition of rural health clinic. 
Sec. 8. Medicare Advantage plan payments. 
Sec. 9. Sense of the Senate regarding adequacy of network-based health plans. 
SEC. 2. RURAL HEALTH CLINIC REIMBURSEMENT. 
Section 1833(f) of the Social Security Act (42 U.S.C. 
1395l(f)) is amended— 
(1) in paragraph (1), by striking ‘‘, and’’ at the 
end and inserting a semicolon; 
(2) in paragraph (2)— 
(A) by striking ‘‘in a subsequent year’’ and 
inserting ‘‘after 1988 and before 2010’’; and 
(B) by striking the period at the end and 
inserting a semicolon; and 
(3) by adding at the end the following new 
paragraphs: 
‘‘(3) in 2010, at $92 per visit; and 
‘‘(4) in a subsequent year, at the limit estab-
lished under this subsection for the previous year in-
creased 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)) fur-
nished as of the first day of that year.’’. 
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SEC. 3. RURAL HEALTH CLINIC QUALITY REPORTING INI-
TIATIVE. 
Section 1833 of the Social Security Act (42 U.S.C. 
1395l) is amended by adding at the end the following new 
subsection: 
‘‘(x) INCENTIVE PAYMENTS
FOR RURAL HEALTH 
CLINIC QUALITY REPORTING.— 
‘‘(1) IN GENERAL.—The Secretary shall imple-
ment a system to provide incentive payments for the 
satisfactory reporting of data on quality measures by 
eligible professionals, as defined in subsection 
(k)(3)(B) of section 1848, who are employed by a 
rural health clinic or provide services in a rural 
health clinic through a contractual arrangement, 
similar to the reporting system for covered profes-
sional services as established under subsections (k) 
and (m) of such section. 
‘‘(2) AMOUNT; DURATION.—Incentive payments 
in the amount of $2 per visit shall be made to rural 
health clinics with respect to eligible professionals 
who furnish rural health clinic services during the 
period beginning on January 1, 2010, and ending on 
December 31, 2013. 
‘‘(3) PAYMENT FROM TRUST FUND.—The in-
centive payments provided under this subsection 
shall be made available from the Federal Supple-
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mentary Medical Insurance Trust Fund under sec-
tion 1841. 
‘‘(4) PAYMENT
LIMITS.—Incentive payments 
made under this subsection shall not be subject to 
the payment limits established under subsection (f). 
‘‘(5) SINGLE FORM.—The Secretary shall pro-
vide rural health clinics that participate in the qual-
ity reporting system under this subsection with a 
single form for submission of data on quality meas-
ures and reimbursement claim information. 
‘‘(6) REPORTING.—Not later than December 
31, 2012, the Secretary shall prepare and submit a 
report to Congress on the quality reporting system 
established under this subsection, including— 
‘‘(A) the number and types of services in-
volved in the system; 
‘‘(B) the number of rural health clinics 
participating in the system; 
‘‘(C) the overall quality of care that was 
delivered by the rural health clinics during this 
period; 
‘‘(D) the patient outcomes under the sys-
tem; 
‘‘(E) recommendations for improving the 
system; and 
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‘‘(F) any additional related matters that 
the Secretary determines appropriate.’’. 
SEC. 4. RURAL HEALTH CLINIC AND COMMUNITY HEALTH 
CENTER COLLABORATIVE ACCESS EXPAN-
SION. 
Section 330 of the Public Health Service Act (42 
U.S.C. 254b) is amended by adding at the end the fol-
lowing: 
‘‘(s) RULE OF CONSTRUCTION WITH RESPECT TO 
RURAL HEALTH CLINICS.— 
‘‘(1) IN
GENERAL.—Nothing in this section 
shall be construed to prevent a community health 
center from contracting with a federally certified 
rural health clinic (as defined by section 1861(aa)(2) 
of the Social Security Act) for the delivery of pri-
mary health care services that are available at the 
rural health clinic to individuals who would other-
wise be eligible for free or reduced cost care if that 
individual were able to obtain that care at the com-
munity health center. Such services may be limited 
in scope to those primary health care services avail-
able in that rural health clinic. 
‘‘(2) ASSURANCES.—In order for a rural health 
clinic to receive funds under this section through a 
contract with a community health center under 
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paragraph (1), such rural health clinic shall estab-
lish policies to ensure— 
‘‘(A) nondiscrimination based upon the 
ability of a patient to pay; and 
‘‘(B) the establishment of a sliding fee 
scale for low-income patients.’’. 
SEC. 5. GAO REPORT ON DIABETES EDUCATION AND MED-
ICAL NUTRITION THERAPY SERVICES. 
Not later than July 1, 2012, the Comptroller General 
of the United States shall submit to the Committee on 
Health, Education, Labor, and Pensions of the Senate and 
the Committee on Energy and Commerce of the House 
of Representatives a report concerning the medical nutri-
tion therapy counseling services provided by federally 
qualified health clinics. Such report shall specifically ex-
amine— 
(1) the availability, health provider cost, reim-
bursement amount, and barriers to diabetes edu-
cation and medical nutrition therapy services in fed-
erally qualified health clinics; 
(2) the availability, health provider cost, reim-
bursement amount, and quality outcomes of diabetes 
education and medical nutrition therapy services in 
rural and frontier areas; 
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