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(2) TRADITIONAL COMMUNITY PROVIDERS.—A
health access plan shall, to the extent feasible, draw
upon health care providers currently serving the
community, including community health centers (as
defined in section 330(a) of the Public Health Serv-
ice Act) and hospitals operated by units of local gov-
ernment, in developing its service network.
(3) DEVELOPMENT
OF
NEW
HEALTH
RE-
SOURCES.—A health access plan shall develop new
health resources in the community (such as school-
based clinics, mobile screening programs, and clinics
based in public housing) to meet needs that are not
met by existing community resources.
(d) ACCESS STANDARDS.—A health access plan shall
insure that each individual enrolled in it—
(1) is linked with the primary care physician
within the health access plan’s provider network of
the individual’s choice and has access to that doctor
on a 24-hour a day, 7-day a week basis;
(2) has round-the-clock telephone access to a
central program office for information purposes as
well as to voice grievances; and
(3) has access to interpreter services as nec-
essary (where a significant proportion of the popu-
lation in the community health access district is non-
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English speaking, the health access plan shall insure
that a corresponding proportion of its health care
providers have a multilingual capability).
(e) QUALITY ASSURANCE STANDARDS.—A health ac-
cess plan shall establish and maintain a quality assurance
program that includes at least the following activities:
(1) TREATMENT STANDARDS.—A health access
plan shall establish—
(A) minimum standards for treating pa-
tients that participating providers must satisfy;
(B) a program of ongoing medical record
reviews and other provider audits to insure
compliance with the plan’s treatment standards;
and
(C) a system of sanctions to insure that
providers who do not comply with the plan’s
treatment standards will be penalized and, if
found to be repeatedly out of compliance, termi-
nated from participation in the health access
plan service network.
(2) DATA COLLECTION.—A health access plan
shall monitor morbidity and mortality within the
comprehensive health access district and identify the
leading causes of death and disease.
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(3) MEMBER SURVEYS.—A health access plan
shall survey its enrollees on a regular basis to deter-
mine their satisfaction with the quality of services
received.
(4) INDEPENDENT QUALITY AUDITS.—A health
access plan shall be evaluated on a regular basis by
an independent health care accrediting organization.
(f) EFFECTIVE GRIEVANCE PROCEDURES.—A health
access plan must provide for effective procedures for hear-
ing and resolving grievances between the plan and individ-
uals enrolled in the plan.
(g) CONFIDENTIALITY OF ENROLLEE RECORDS.—
(1) A health access plan shall ensure that infor-
mation concerning its enrollees is protected from un-
authorized disclosure by the plan, its employees or
its providers.
(2) To promote the coordination of benefits to
health plan enrollees, a health access plan may dis-
close information about its enrollees to the extent
necessary to facilitate the enrollee’s receipt of serv-
ices and assistance from other entities.
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SEC. 6. DESIGNATION OF COMPREHENSIVE HEALTH AC-
CESS DISTRICTS AND CERTIFICATION OF
COMPREHENSIVE 
COMMUNITY-BASED
HEALTH ACCESS PLANS.
The Secretary shall designate a community that
meets the criteria set forth in section 2(a) of this Act a
comprehensive health access district and shall certify an
entity that meets the criteria set forth in section 5 of this
Act as a comprehensive health access plan. Each such cer-
tification and designation shall be reviewed every five
years. The Secretary may delegate all or part of the cer-
tification function to the State in which the health access
plan operates.
SEC. 7. NATIONAL HEALTH OUTCOMES RESEARCH AND
EVALUATION.
(a) PROVISION OF INFORMATION.—In order to evalu-
ate the performance of health access plans in improving
the health status of persons living in comprehensive health
access districts, each health access plan shall provide the
Secretary, at a time and in a manner specified by the Sec-
retary, at least the following information:
(1) Information on the characteristics of enroll-
ees that may affect their need for or use of health
services.
(2) Information on the types of treatments and
services and outcomes of treatments with respect to
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the clinical health, functional status and well-being
of enrollees.
(3) Information on enrollee satisfaction.
(4) Information on health care expenditures,
volume and prices of procedures, and use of special-
ized services.
(b) ANALYSIS
OF INFORMATION.—The Secretary
shall analyze the information reported by health access
plans in order to report to Congress, the plans and the
public, no less than annually, on the following:
(1) The health status of persons living in com-
prehensive health access districts (particularly those
indicators listed in section 2(a) of this Act).
(2) The level and rate of expenditures by health
access plans on medical services and other programs
to improve health status.
(3) The effectiveness of health access plans in
improving health outcomes (particularly outcomes
related to health indicators listed in section 2(a) of
this Act).
(c) RESEARCH.—
(1) The Secretary shall examine the relation-
ship between socioeconomic factors and health status
and, based on his findings, suggest interventions ap-
propriate to comprehensive health access districts.
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(2) The Secretary may contract with non-
governmental entities to perform this research. Per-
sons undertaking this work shall have access to the
information provided by the health access plans to
the Secretary.
SEC. 8. CHANGES TO THE MEDICAID STATUTE TO FACILI-
TATE STATE CONTRACTS WITH COMPREHEN-
SIVE COMMUNITY-BASED HEALTH ACCESS
PLANS.
(a) Section 1903(m)(2) of the Social Security Act (42
U.S.C. 1396b(m)(2)) is amended by adding after subpara-
graph (H) the following new subparagraph:
‘‘(I) Clause (ii) of subparagraph (A) does not
apply to any entity certified as a comprehensive
health access plan pursuant to section 6 of the Com-
prehensive Health Access District Act.’’
(b) This amendment shall apply to payments for med-
ical assistance for calendar quarters beginning on or after
July 1, 1995.
SEC. 9. REGULATIONS AND EFFECTIVE DATE.
(a) The Secretary shall promulgate regulations nec-
essary to implement this Act.
(b) This Act shall take effect on July 1, 1995, with-
out regard to whether or not final regulations to carry out
this Act have been promulgated by such date.