I
106TH CONGRESS
1ST SESSION
H. R. 1860
To require managed care organizations to contract with providers in medically
underserved areas, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
MAY 19, 1999
Mrs. CHRISTENSEN (for herself, Mrs. JONES of Ohio, Mr. RUSH, Ms. EDDIE
BERNICE JOHNSON of Texas, Mr. CLYBURN, Mr. WYNN, Mr. THOMPSON
of Mississippi, Ms. KILPATRICK, Mrs. MEEK of Florida, Mr. MENENDEZ,
Mrs. CLAYTON, Ms. CARSON, Ms. MILLENDER-MCDONALD, Mr. WATT of
North Carolina, Mr. JEFFERSON, Ms. LEE, Mr. BISHOP, Mr. OWENS,
Mr. HILLIARD, Mr. PAYNE, Mr. DAVIS of Illinois, Ms. NORTON, Mr.
MEEKS of New York, Ms. BROWN of Florida, Mr. SCOTT, Mr. FATTAH,
Mr. CLAY, Mr. LEWIS of Georgia, Ms. JACKSON-LEE of Texas, Mr.
TOWNS, Mr. CUMMINGS, Ms. WATERS, Ms. MCKINNEY, Mr. DIXON, Mr.
CONYERS, Mr. HASTINGS of Florida, Mr. JACKSON of Illinois, Mr. FORD,
and Mr. RANGEL) introduced the following bill; which was referred to the
Committee on Commerce, and in addition to the Committees on Edu-
cation and the Workforce, and Ways and Means, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such
provisions as fall within the jurisdiction of the committee concerned
A BILL
To require managed care organizations to contract with pro-
viders in medically underserved areas, and for other pur-
poses.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; FINDINGS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Medically Underserved Access to Care Act of 1999’’.
(b) FINDINGS.—Congress finds the following:
(1) Minority individuals living in medically un-
derserved 
areas 
are 
generally 
less 
well-off
socioeconomically, and are often sicker than the pop-
ulation that managed care organizations tradition-
ally serve.
(2) Many managed care organizations are not
equipped to deal effectively with minorities in under-
served areas and consequently may offer lower qual-
ity health care in such areas.
(3) Often managed care organizations do not
contract with physicians and other community-based
service providers who traditionally serve medically
underserved areas.
(4) There is a concern among minority physi-
cians that selective marketing practices and referral
processes may keep minority and community-based
physicians out of some managed care organizations.
(5) Managed care organizations sometimes ex-
clude physicians and other community-based health
care providers who traditionally provide service to
underserved areas; this is particularly the case
among minority physicians who may be well estab-
lished in their community based practices but are
not board certified.
SEC. 2. REQUIREMENT FOR SERVICE TO AREAS THAT IN-
CLUDE A MEDICALLY UNDERSERVED POPU-
LATION.
(a) REQUIREMENT.—
(1) IN GENERAL.—A managed care organiza-
tion offering a managed care plan shall establish and
maintain adequate arrangements, as defined under
regulations of the Secretary, with a sufficient num-
ber, mix, and distribution of health care profes-
sionals and providers to assure that covered items
and services are available and accessible to each en-
rollee under the plan—
(A) in the service area of the organization;
(B) in a variety of sites of service;
(C) with reasonable promptness (including
reasonable hours of operation and after-hours
services);
(D) with reasonable proximity to the resi-
dences and workplaces of enrollees; and
(E) in a manner that—
(i) takes into account the diverse
needs of enrollees; and
(ii) reasonably assures continuity of
care.
(2) TREATMENT OF ORGANIZATIONS SERVING
CERTAIN AREAS.—For a managed care organization
that serves a medically underserved area, the organi-
zation shall be treated as meeting the requirement
of paragraph (1) if the organization has arrange-
ments with a sufficient number, mix, and distribu-
tion of health care professionals and providers hav-
ing a history of serving such areas.
(b) ENFORCEMENT OF REQUIREMENTS.—
(1) APPLICATION TO GROUP HEALTH PLANS.—
(A) PUBLIC HEALTH SERVICE ACT.—For
purposes of applying title XXVII of the Public
Health Service Act, the requirements of sub-
section (a) shall be treated as though they were
included in subpart 2 of part A of such title (42
U.S.C. 300gg–4 et seq.).
(B) EMPLOYEE RETIREMENT INCOME SE-
CURITY ACT OF 1974.—For purposes of applying
part 7 of subtitle B of title I of the Employee
Retirement Income Security Act of 1974, the
requirements of subsection (a) shall be treated
as though they were included in subpart B of
such part (29 U.S.C. 1185 et seq.).
(C) INTERNAL REVENUE CODE OF 1986.—
For purposes of applying chapter 100 of the In-
ternal Revenue Code of 1986, the requirements
of subsection (a) shall be treated as though
they were included in subchapter B of such
chapter.
(2) APPLICATION TO INDIVIDUAL HEALTH IN-
SURANCE
COVERAGE.—For purposes of applying
title XXVII of the Public Health Service Act, the re-
quirements of subsection (a) also shall be treated as
though they were part of subpart 2 of part B of
such title (42 U.S.C. 300gg–51 et seq.).
(3) MEDICARE.—The Secretary may not enter
into a contract under section 1857 of the Social Se-
curity 
Act 
(42 
U.S.C. 
1395w–27) 
with 
a
Medicare+Choice organization that is a managed
care organization unless the contract contains assur-
ances satisfactory to the Secretary that the organi-
zation will comply with the applicable requirements
of subsection (a) of this Act.
(4) MEDICAID.—Notwithstanding any other
provision of law, no funds shall be paid to a State
under section 1903(a)(1) of the Social Security Act
(42 U.S.C. 1396b(a)(1)) with respect to medical as-
sistance provided through payment to a medicaid
managed care organization (as defined in section
1903(m)(1)(A) 
of 
such 
Act, 
U.S.C.
1396b(m)(1)(A)) unless the contract with such orga-
nization contains assurances satisfactory to the Sec-
retary that the organization will comply with the ap-
plicable requirements of subsection (a) of this Act.
SEC. 3. ESTABLISHMENT OF GRANT PROGRAM.
(a) IN GENERAL.—The Secretary shall establish a
program in the Office of Minority Health of the Depart-
ment of Health and Human Services to award competitive
grants to eligible nongovernmental agencies to enable such
agencies to develop outreach programs to—
(1) inform individuals in medically underserved
areas how to access managed care organizations in
their communities; and
(2) assist physicians and other health care pro-
fessionals who serve in medically underserved areas
to enroll as providers in managed care organizations
in their communities.
(b) ELIGIBILITY AND AMOUNT.—
(1) ELIGIBILITY.—The criteria necessary to re-
ceive a grant under this section shall be determined
by the Secretary.
(2) AMOUNT.—The amount of a grant awarded
to an agency under this section shall be determined
by the Secretary.
SEC. 4. DEFINITIONS.
For purposes of this Act:
(1) ENROLLEE.—The term ‘‘enrollee’’ means,
with respect to a managed care plan offered by a
managed care organization, an individual enrolled
with the organization for coverage under such a
plan.
(2) HEALTH CARE PROFESSIONAL.—The term
‘‘health care professional’’ means a physician or
other health care practitioner who is licensed under
State law with respect to the health care services the
practitioner furnishes.
(3) HEALTH PLAN.—The term ‘‘health plan’’
means a group health plan or health insurance cov-
erage offered by a health insurance issuer.
(4) MANAGED CARE ORGANIZATION.—The term
‘‘managed care organization’’ means any entity, in-
cluding a group health plan, health maintenance or-
ganization, or provider-sponsored organization, in re-
lation to its offering of a managed care plan, and in-
cludes any other entity that provides or manages the
coverage under such a plan under a contract or ar-
rangement with the entity.
(5) MANAGED CARE PLAN.—The term ‘‘man-
aged care plan’’ means a health plan offered by an
entity if the entity—
(A) provides or arranges for the provision
of health care items and services to enrollees in
the plan through participating health care pro-
fessionals and providers; or
(B) provides financial incentives (such as
variable copayments and deductibles) to induce
enrollees to obtain benefits through partici-
pating health care professionals and providers,
or both.
(6) MEDICALLY
UNDERSERVED
AREA.—The
term ‘‘medically underserved area’’ means an area
that is designated as a health professional shortage
area under section 332 of the Public Health Service
Act (42 U.S.C. 254e) or as a medically underserved
area for purposes of section 330 or 1302(7) of such
Act (42 U.S.C. 254c, 300e–1(7)).
(7) PARTICIPATING.—The term ‘‘participating’’
means, with respect to a health care professional or
provider in relation to a health plan offered by an
entity, a physician or provider that furnishes health
care items and services to enrollees of the entity
under an agreement with the entity.
(8) PRIMARY CARE PROVIDER.—The term ‘‘pri-
mary care provider’’ means a health care profes-
sional who acts as a gatekeeper for the overall care
of an enrollee.
(9) SECRETARY.—The term ‘‘Secretary’’ means
the Secretary of Health and Human Services .
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