I 
111TH CONGRESS 
1ST SESSION H. R. 3665 
To amend title XIX of the Social Security Act to provide for payment 
for Medicaid services furnished by Ryan White part C grantees under 
a cost-based prospective payment system. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 29, 2009 
Ms. BALDWIN (for herself, Mrs. CAPPS, Ms. MATSUI, and Ms. MOORE of Wis-
consin) introduced the following bill; which was referred to the Committee 
on Energy and Commerce 
A BILL 
To amend title XIX of the Social Security Act to provide 
for payment for Medicaid services furnished by Ryan 
White part C grantees under a cost-based prospective 
payment system. 
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 ‘‘Ryan White Grantee 
Medicaid Payment Equity Act of 2009’’. 
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SEC. 2. MEDICAID PAYMENT FOR SERVICES FURNISHED BY 
RYAN WHITE PART C GRANTEES ON A COST- 
BASED PROSPECTIVE PAYMENT SYSTEM. 
(a) IN GENERAL.—Section 1902 of the Social Secu-
rity Act (42 U.S.C. 1396a) is amended— 
(1) in subsection (a)(15), by inserting before 
the semicolon at the end the following: ‘‘and provide 
for payment for services described in section 1905(a) 
provided by a recipient of a grant under part C of 
title XXVI of the Public Health Service Act in ac-
cordance with subsection (gg)’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(gg) PAYMENT FOR SERVICES PROVIDED BY RYAN 
WHITE PART C GRANTEES.— 
‘‘(1) IN GENERAL.—Beginning with fiscal year 
2010 with respect to services furnished on or after 
January 1, 2010, and each succeeding fiscal year, 
the State plan shall provide for payment for services 
described in section 1905(a) (in this subsection re-
ferred to as ‘Medicaid covered services’) furnished by 
a recipient of a grant under part C of title XXVI 
of the Public Health Service Act (in the subsection 
referred to as a ‘grantee’) in accordance with the 
provisions of this subsection. 
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‘‘(2) FISCAL YEAR 2010.—Subject to paragraph 
(4), for services furnished on and after January 1, 
2010, during fiscal year 2010, the State plan shall 
provide for payment for such services in an amount 
(calculated on a per visit or similar basis as specified 
by the Secretary) that is equal to 100 percent of the 
average of the costs of the grantee of furnishing 
such services during fiscal years 2008 and 2009 
which are reasonable and related to the cost of fur-
nishing such services, or based on such other tests 
of reasonableness as the Secretary prescribes in reg-
ulations under section 1833(a)(3), or, in the case of 
services to which such regulations do not apply, the 
same methodology used under section 1833(a)(3), 
adjusted to take into account any increase or de-
crease in the scope of such services furnished by the 
grantee during fiscal year 2010. 
‘‘(3) FISCAL YEAR 2011 AND SUCCEEDING FIS-
CAL YEARS.—Subject to paragraph (4), for services 
furnished during fiscal year 2011 or a succeeding 
fiscal year, the State plan shall provide for payment 
for such services in an amount (calculated on a per 
visit or similar basis) that is equal to the amount 
calculated for such services under this subsection for 
the preceding fiscal year— 
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‘‘(A) increased 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 that fiscal year; and 
‘‘(B) adjusted to take into account any in-
crease or decrease in the scope of such services 
furnished by the grantee during that fiscal year. 
‘‘(4) ESTABLISHMENT OF INITIAL YEAR PAY-
MENT AMOUNT FOR NEW GRANTEES.—In any case 
in which an entity first becomes a grantee after fis-
cal year 2009, the State plan shall provide for pay-
ment for Medicaid covered services furnished by the 
entity in the first fiscal year in which the entity so 
qualifies in an amount (calculated on a per visit or 
similar basis) that is equal to 100 percent of the 
costs of furnishing such services during such fiscal 
year based on the rates established under this sub-
section for the fiscal year for other such grantees lo-
cated in the same or adjacent area with a similar 
case load or, in the absence of such a grantee, in ac-
cordance with the regulations and methodology re-
ferred to in paragraph (2) or based on such other 
tests of reasonableness as the Secretary may specify. 
For each fiscal year following the fiscal year in 
which the entity first qualifies, the State plan shall 
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provide for the payment amount to be calculated in 
accordance with paragraph (3). 
‘‘(5) ADMINISTRATION IN THE CASE OF MAN-
AGED CARE.— 
‘‘(A) IN GENERAL.—In the case of services 
furnished by a grantee pursuant to a contract 
between the grantee and a managed care entity 
(as defined in section 1932(a)(1)(B)), the State 
plan shall provide for payment to the grantee 
by the State of a supplemental payment equal 
to the amount (if any) by which the amount de-
termined under paragraphs (2), (3), and (4) ex-
ceeds the amount of the payments provided 
under the contract. 
‘‘(B) PAYMENT SCHEDULE.—The supple-
mental payment required under subparagraph 
(A) shall be made pursuant to a payment 
schedule agreed to by the State and the grant-
ee, but in no case less frequently than every 4 
months. 
‘‘(6) ALTERNATIVE
PAYMENT
METHODOLO-
GIES.—Notwithstanding any other provision of this 
section, the State plan may provide for payment in 
any fiscal year to a grantee for Medicaid covered 
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