race, ethnicity, service delivery system, and family
income of individuals enrolled.’’.
(2) 
ANNUAL
REPORTS.—Section
2108(b)(1)(B)(i) 
of 
such 
Act 
(42 
U.S.C.
1397hh(b)(1)(B)(i)) is amended by inserting ‘‘pri-
mary language of enrollees,’’ after ‘‘family income,’’.
(c) EMPLOYER COVERAGE WAIVER CHANGES.—Sec-
tion 2105(c)(3) of such Act (42 U.S.C. 1397ee(c)(3)) is
amended—
(1) by redesignating subparagraphs (A) and
(B) as clauses (i) and (ii) and indenting appro-
priately;
(2) by designating the matter beginning with
‘‘Payment may be made’’ as a subparagraph (A)
with the heading ‘‘IN GENERAL’’ and indenting ap-
propriately; and
(3) by adding at the end the following new sub-
paragraphs:
‘‘(B) APPLICATION OF REQUIREMENTS.—
In carrying out subparagraph (A)—
‘‘(i) the Secretary shall not require a
minimum employer contribution level that
is separate from the requirement of cost-
effectiveness under subparagraph (A)(i),
but a State shall identify a reasonable min-
imum employer contribution level that is
based on data demonstrating that such a
level is representative to the employer-
sponsored insurance market in the State
and shall monitor employer contribution
levels over time to determine whether sub-
stitution is occurring and report the find-
ings in annual reports under section
2108(a);
‘‘(ii) the State shall establish a wait-
ing period of at least 6 months without
group health coverage, but may establish
reasonable exceptions to such period and
shall not apply such a waiting period to a
child who is provided coverage under a
group health plan under section 1906;
‘‘(iii) subject to clause (iv), the State
shall provide satisfactory assurances that
the minimum benefits and cost-sharing
protections established under this title are
provided, either through the coverage
under subparagraph (A) or as a supple-
ment to such coverage; and
‘‘(iv) coverage under such subpara-
graph shall not be considered to violate
clause (iii) because it does not comply with
requirements relating to reviews of health
service decisions if the enrollee involved is
provided the option of being provided bene-
fits directly under this title.
‘‘(C) ACCESS TO EXTERNAL REVIEW PROC-
ESS.—In carrying out subparagraph (A), if a
State provides coverage under a group health
plan that does not meet the following external
review requirements, the State must give appli-
cants and enrollees (at initial enrollment and at
each redetermination of eligibility) the option to
obtain health benefits coverage other than
through that group health plan:
‘‘(i) The enrollee has an opportunity
for external review of a—
‘‘(I) delay, denial, reduction, sus-
pension, or termination of health serv-
ices, in whole or in part, including a
determination about the type or level
of services; and
‘‘(II) failure to approve, furnish,
or provide payment for health services
in a timely manner.
‘‘(ii) The external review is conducted
by the State or a impartial contractor
other than the contractor responsible for
the matter subject to external review.
‘‘(iii) The external review decision is
made on a timely basis in accordance with
the medical needs of the patient. If the
medical needs of the patient do not dictate
a shorter time frame, the review must be
completed—
‘‘(I) within 90 calendar days of
the date of the request for internal or
external review; or
‘‘(II) within 72 hours if the en-
rollee’s physician or plan determines
that the deadline under subclause (I)
could seriously jeopardize the enroll-
ee’s life or health or ability to attain,
maintain, or regain maximum func-
tion (except that a State may extend
the 72-hour deadline by up to 14 days
if the enrollee requests an extension).
‘‘(iv) The external review decision
shall be in writing.
‘‘(v) Applicants and enrollees have an
opportunity—
‘‘(I) to represent themselves or
have representatives of their choosing
in the review process;
‘‘(II) timely review their files and
other applicable information relevant
to the review of the decision; and
‘‘(III) fully participate in the re-
view process, whether the review is
conducted in person or in writing, in-
cluding by presenting supplemental
information during the review proc-
ess.’’.
(d) EFFECTIVE DATE.—The amendments made by
this section apply as of October 1, 2001, whether or not
regulations implementing such amendments have been
issued.
SEC. 16. CREATION OF COMMUNITY ACCESS PROGRAM.
Part D of title III of the Public Health Service Act
(42 U.S.C. 254b et seq.) is amended by inserting after
subpart IV the following new subpart:
‘‘Subpart V—Community Access Program
‘‘SEC. 340. GRANTS TO STRENGTHEN THE EFFECTIVENESS,
EFFICIENCY, AND COORDINATION OF SERV-
ICES FOR THE UNINSURED AND UNDER-
INSURED.
‘‘(a) IN GENERAL.—The Secretary may make grants
for the purpose of assisting the development of integrated
health care delivery systems—
‘‘(1) to serve communities of individuals who
are uninsured and individuals who are underinsured;
‘‘(2) to expand the scope of services provided;
and
‘‘(3) to improve the efficiency and coordination
among the providers of such services.
‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive
a grant under this section, an entity must—
‘‘(1) be a public or nonprofit private entity such
as—
‘‘(A) a Federally qualified health center
(as defined under section 1861(aa)(4) of the
Social Security Act);
‘‘(B) a hospital that meets the require-
ments of section 340B(a)(4)(L) (or, if none are
available in the area, a hospital that is a pro-
vider of a substantial volume of non-emergency
health services to uninsured individuals and
families without regard to their ability to pay)
without regard to 340B(a)(4)(L)(iii); or
‘‘(C) a public health department; and
‘‘(2) represent a consortium of providers and,
as appropriate, related agencies or entities—
‘‘(A) whose principal purpose is to provide
a broad range of coordinated health care serv-
ices for a community defined in the entity’s
grant application (which may be a special popu-
lation group such as migrant and seasonal farm
workers, homeless persons or individuals with
disabilities);
‘‘(B) that includes all health care providers
that serve the community and that have tradi-
tionally provided care (beyond emergency serv-
ices) to uninsured and underinsured individuals
without regard to the individuals’ ability to pay
(if there are any such providers) unless any
such provider or providers declines to partici-
pate; and
‘‘(C) that may include other health care
providers and related agencies and organiza-
tions;
except that preference shall be given to applicants that
are health care providers identified in paragraph (1).
‘‘(c) APPLICATIONS.—To be eligible to receive a grant
under this section, an eligible entity shall submit to the
Secretary an application, in such form and manner as the
Secretary shall prescribe, that shall—
‘‘(1) define a community of uninsured and
underinsured individuals that consists of all such
individuals—
‘‘(A) in a specified geographical area; or
‘‘(B) in a specified population within such
an area;
‘‘(2) identify the providers who will participate
in the consortium’s program under the grant, and
specify each one’s contribution to the care of unin-
sured and underinsured individuals in the commu-
nity, including the volume of care it provides to
medicare and medicaid beneficiaries and to privately
paid patients;
‘‘(3) describe the activities that the applicant
and the consortium propose to perform under the
grant to further the purposes of this section;
‘‘(4) demonstrate the consortium’s ability to
build on the current system for serving uninsured
and underinsured individuals by involving providers
who have traditionally provided a significant volume
of care for that community;
‘‘(5) demonstrate the consortium’s ability to de-
velop 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, secondary, and tertiary
services, as well as substance abuse treatment and
mental health services in a manner which assures
continuity of care in the community;
‘‘(6) provide evidence of community involvement
in the development, implementation, and direction of
the program that it proposes to operate;
‘‘(7) demonstrate the consortium’s ability to en-
sure that individuals participating in the program
are enrolled in public insurance programs for which
they are eligible;
‘‘(8) present 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 way
to assure long-term sustainability;
‘‘(9) describe a plan for evaluation of the activi-
ties carried out under the grant, including measure-
ment of progress toward the goals and objectives of
the program;
‘‘(10) demonstrate fiscal responsibility through
the use of appropriate accounting procedures and
appropriate management systems;
‘‘(11) include such other information as the
Secretary may prescribe; and
‘‘(12) demonstrate the commitment to serve the
community without regard to the ability of the indi-
vidual or family to pay by arranging for or providing
free or reduced charge care for the poor.
‘‘(d) PRIORITIES.—In awarding grants under this
section, the Secretary may accord priority to applicants—
‘‘(1) whose consortium includes public hospitals,
Federally qualified health centers (as defined in sec-
tion 1905(l)(2)(B) of the Social Security Act), and
other providers that are covered entities as defined
by section 340B(a)(4) of this Act (or that would be
covered entities as so defined but for subparagraph
(L)(iii) of such section);
‘‘(2) that identify a community whose geo-
graphical area has a high or increasing percentage
of individuals who are uninsured;
‘‘(3) whose consortium includes other health
care providers that have a tradition of serving unin-
sured individuals and underinsured individuals in
the community;
‘‘(4) who show evidence that the program would
expand utilization of preventive and primary care
services for uninsured and underinsured individuals
and families in the community, including mental
health services or substance abuse services;
‘‘(5) whose proposed program would improve
coordination between health care providers and ap-
propriate social service providers, including local and
regional human services agencies, school systems,
and agencies on aging;
‘‘(6) that demonstrate collaboration with State
and local governments;
‘‘(7) that make use of non-Federal contribu-
tions to the greatest extent possible; or
‘‘(8) that demonstrate a likelihood that the pro-
posed program will continue after support under this
section ceases.
‘‘(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
planning, developing, and operating the
greater integration of a health care deliv-
ery system so that it either directly pro-
vides or ensures the provision of a broad
range of services, as appropriate, including
primary, secondary, and tertiary services,
as well as substance abuse treatment and
mental health services; and
‘‘(ii) direct patient care and service
expansions to fill identified or documented
gaps within an integrated delivery system.
‘‘(B) SPECIFIC USES.—The following are
examples of purposes for which a grantee may
use grant funds, when such use meets the con-
ditions stated in subparagraph (A):
‘‘(i) Increase in outreach activities.
‘‘(ii) Improvements to case manage-
ment.
‘‘(iii) Improvements to coordination of
transportation to health care facilities.
‘‘(iv) Development of provider net-
works.
‘‘(v) Recruitment, training, and com-
pensation of necessary personnel.
‘‘(vi) Acquisition of technology.
‘‘(vii) Identifying and closing gaps in
services being provided.
‘‘(viii) Improvements to provider com-
munication, including implementation of
shared information systems or shared clin-
ical systems.
‘‘(ix) Other activities that may be ap-
propriate to a community that would in-
crease access to the uninsured.
‘‘(2) DIRECT PATIENT CARE LIMITATION.—No
more than 15 percent of the funds provided under
a grant 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 3 percent of funds appropriated to carry
out this section for technical assistance to grantees,
obtaining assistance of experts and consultants,
meetings, dissemination of information, evaluation,
and activities that will extend the benefits of funded
programs to communities other than the one funded.
‘‘(f) MAINTENANCE OF EFFORT.—With respect to
activities for which a grant under this section is author-
ized, the Secretary may award such a grant only if the