I 
111TH CONGRESS 
1ST SESSION H. R. 2925 
To amend the Public Health Service Act to provide for community projects 
that will reduce the number of individuals who are uninsured with respect 
to health care, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 17, 2009 
Mr. HOEKSTRA (for himself, Mr. EHLERS, Mr. HELLER, and Mr. BARRETT 
of South Carolina) introduced the following bill; which was referred to the 
Committee on Energy and Commerce 
A BILL 
To amend the Public Health Service Act to provide for 
community projects that will reduce the number of indi-
viduals who are uninsured with respect to health care, 
and for other purposes. 
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 ‘‘Communities Building 
Access Act’’. 
SEC. 2. FINDINGS. 
The Congress finds as follows: 
VerDate Nov 24 2008 
21:16 Jun 18, 2009
Jkt 079200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H2925.IH
H2925
pwalker on PROD1PC71 with BILLS
(1) Two models of community programs for the 
uninsured have emerged as effective in generating 
community support and funding in urban and rural 
areas; in providing effective care and coverage for 
the uninsured; in avoiding displacement of private 
coverage; and in avoiding duplication of other Fed-
eral programs for the uninsured. 
(2) These community models have dem-
onstrated community-wide economic benefit. Em-
ployers in the community experience less health care 
cost-shifting, in addition to increased productivity 
and employee retention. With greater emphasis on 
preventive and chronic care, a community’s unin-
sured population becomes less of a financial burden 
on State and local budgets. 
(3) These community models have dem-
onstrated potential national solutions for certain un-
insured populations, including the working unin-
sured. Such lessons learned from these models in-
clude, for example, the level of subsidy necessary to 
get small employers to purchase coverage for their 
employees, how to effectively market access pro-
grams to the uninsured, and how to effectively man-
age chronic care among lower-income populations. 
VerDate Nov 24 2008 
21:16 Jun 18, 2009
Jkt 079200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H2925.IH
H2925
pwalker on PROD1PC71 with BILLS
(4) These community models have succeeded in 
raising much of the funding necessary to function, 
but have lacked financial stability and would enjoy 
greater success with a stable partial funding stream 
from the Federal Government. 
(5) These community models, if involved in a 
Federal partnership, have the ability and willingness 
to be accountable for a return on investment for 
Federal funding, and to disseminate expertise to 
like-minded communities. 
SEC. 3. GRANTS FOR MULTI-SHARE HEALTH CARE COV-
ERAGE PROJECTS FOR UNINSURED WORKING 
INDIVIDUALS. 
Subpart I of part D of title III of the Public Health 
Service Act (42 U.S.C. 254b et seq.) is amended by adding 
at the end the following: 
‘‘SEC. 
330M. 
MULTI-SHARE 
HEALTH 
CARE 
COVERAGE 
PROJECTS FOR UNINSURED WORKING INDI-
VIDUALS. 
‘‘(a) IN GENERAL.—The Secretary shall make grants 
to public or nonprofit private entities to carry out dem-
onstration projects for the purpose of— 
‘‘(1) making available, on a cost-sharing basis 
as described in subsection (c)(2)(C), health care cov-
erage to qualifying employees through employers 
VerDate Nov 24 2008 
21:16 Jun 18, 2009
Jkt 079200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H2925.IH
H2925
pwalker on PROD1PC71 with BILLS
that have not contributed to health care benefits for 
employees during the 12-month period prior to par-
ticipating in such a project; and 
‘‘(2) making available, on such basis, health 
care coverage to qualifying self-employed individuals 
who have been without such coverage during the 12- 
month period prior to participating in such a 
project. 
‘‘(b) QUALIFYING EMPLOYEES AND SELF-EMPLOYED 
INDIVIDUALS.—For purposes of this section, the term 
‘qualifying’, with respect to an employee or self-employed 
individual, means that the employee or self-employed indi-
vidual is not eligible for health services under the program 
under title XVIII, XIX, or XXI of the Social Security Act 
(relating to the Medicare program, the Medicaid program, 
and the State children’s health insurance program, respec-
tively). 
‘‘(c) REQUIREMENTS FOR GRANT.— 
‘‘(1) IN
GENERAL.—A grant may be made 
under subsection (a) for a project only if the appli-
cant involved— 
‘‘(A) has defined a service area for the 
project; 
‘‘(B) has formed a consortium of entities 
in such service area, which consortium is com-
VerDate Nov 24 2008 
21:16 Jun 18, 2009
Jkt 079200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H2925.IH
H2925
pwalker on PROD1PC71 with BILLS
posed of employers whose employees may or 
may not be served by the project, health care 
providers who will provide services through the 
project, and other appropriate entities; 
‘‘(C) has ensured that the consortium has 
established a set of unified goals for the project; 
‘‘(D) has conducted a basic level of demo-
graphic research to obtain data on the unin-
sured businesses, working uninsured, and pro-
vider community within the service area in 
order to determine the potential value and ef-
fectiveness of operating such a project, which 
data includes— 
‘‘(i) the rate of uncompensated care; 
‘‘(ii) the number of women lacking 
prenatal services; 
‘‘(iii) immunization rates; and 
‘‘(iv) the number of employers that do 
not provide health insurance to their em-
ployees; and 
‘‘(E) has conducted a basic evaluation of 
State health insurance and local laws that 
might impact the implementation of the project. 
VerDate Nov 24 2008 
21:16 Jun 18, 2009
Jkt 079200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H2925.IH
H2925
pwalker on PROD1PC71 with BILLS
‘‘(2) AGREEMENTS.—A grant may be made 
under subsection (a) for a project only if the appli-
cant involved agrees as follows: 
‘‘(A) Eligibility criteria will be established 
for employers to participate in the project, in-
cluding the requirement that the employers be 
located within the service area defined under 
paragraph (1)(A) for the project, which may in-
clude— 
‘‘(i) a maximum average income 
earned by the employees of the business; 
‘‘(ii) criteria, in addition to the 12- 
month periods under subsection (a), to 
avoid creating any incentive for an em-
ployer or self-employed individual to dis-
continue health plans or health insurance 
policies; and 
‘‘(iii) such other criteria as the con-
sortium under paragraph (1)(B) considers 
to be appropriate. 
‘‘(B) A network of health care providers 
will be formed to provide services to qualifying 
employees and self-employed individuals who 
participate in the project, which services will be 
VerDate Nov 24 2008 
21:16 Jun 18, 2009
Jkt 079200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H2925.IH
H2925
pwalker on PROD1PC71 with BILLS
provided according to a schedule of fees and co-
payments negotiated by the project. 
‘‘(C) Of the cost of providing health care 
coverage through the project— 
‘‘(i) not more than 30 percent will be 
paid by the project with funds from the 
grant; and 
‘‘(ii) not less than 70 percent will be 
paid by the employer, the employee, and 
any additional sources of funds (such as 
the community in which the project is lo-
cated) that may be available pursuant to 
arrangements with the project. 
‘‘(D) A minimum benefit package will be 
selected that includes— 
‘‘(i) physicians services; 
‘‘(ii) prescription drug benefits; 
‘‘(iii) in-patient hospital services; 
‘‘(iv) out-patient services; 
‘‘(v) emergency room visits; 
‘‘(vi) emergency ambulance services; 
and 
‘‘(vii) diagnostic laboratory tests and 
x-rays. 
VerDate Nov 24 2008 
21:16 Jun 18, 2009
Jkt 079200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H2925.IH
H2925
pwalker on PROD1PC71 with BILLS
With respect to compliance with the agreement 
under this subparagraph, the project is not re-
quired to provide coverage for any service per-
formed outside the service area of the project, 
except to the extent that a service specified in 
any of clauses (i) through (vii) is not reasonably 
available within the service area. 
‘‘(E) The minimum benefit package will 
not exclude coverage of a medical condition on 
the basis that it is a pre-existing condition. 
‘‘(F) An entity will be selected by the con-
sortium under paragraph (1)(B) to carry out 
administrative and accounting functions with 
respect to the health care coverage to be offered 
by the project, including monthly billings, 
verification and enrollment of eligible employers 
and employees, maintenance of membership ros-
ters, operation of the utilization management 
program under subparagraph (G), and develop-
ment of a marketing plan. 
‘‘(G) A utilization management program 
will be selected that ensures delivery of care in 
the appropriate setting, using appropriate re-
sources and clinical practice guidelines. 
VerDate Nov 24 2008 
21:16 Jun 18, 2009
Jkt 079200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H2925.IH
H2925
pwalker on PROD1PC71 with BILLS
‘‘(H) A plan will be implemented for meas-
uring quality and efficiency of care provided 
through the project within 2 years after the 
project begins operation. 
‘‘(I) A plan will be implemented for man-
aging care for enrollees with chronic illness, as 
well as additional cost-control initiatives that 
will be employed by the project within 2 years 
after the project begins operation. 
‘‘(J) A plan will be implemented for pro-
tecting the project from high risks, which may 
include affiliation with State high-risk pool or 
local safety net program, and purchase of rein-
surance. 
‘‘(K) A plan will be implemented for evalu-
ating the project on an interim basis, not less 
frequently than annually. 
‘‘(d) APPLICATION FOR GRANT.—A grant may be 
made under subsection (a) only if an application for the 
grant is submitted to the Secretary and the application 
is in such form, is made in such manner, and contains 
such agreements, assurances, and information as the Sec-
retary determines to be necessary to carry out this section. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose of making grants under subsection (a), there is 
VerDate Nov 24 2008 
22:15 Jun 18, 2009
Jkt 079200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H2925.IH
H2925
pwalker on PROD1PC71 with BILLS
authorized to be appropriated $36,000,000 in the aggre-
gate for the fiscal years 2010 through 2016, of which 
there are authorized to be appropriated amounts as fol-
lows: 
‘‘(1) For fiscal year 2010, $2,000,000. 
‘‘(2) For each of the fiscal years 2011 and 
2012, $5,000,000. 
‘‘(3) For each of the fiscal years 2013 through 
2016, $6,000,000. 
‘‘SEC. 330N. GRANTS FOR VOLUNTEER SPECIALTY PRO-
VIDER NETWORKS. 
‘‘(a) IN GENERAL.—The Secretary shall make grants 
to public or nonprofit private entities to carry out dem-
onstration projects for the purpose of forming and main-
taining networks composed of health care specialists who 
volunteer health services to eligible individuals. 
‘‘(b) ELIGIBLE INDIVIDUALS.—For purposes of this 
section, the term ‘eligible individual’ means an individual 
who has been enrolled by a project under subsection (a) 
and— 
‘‘(1) whose employer does not provide health 
care coverage; 
‘‘(2) is unable to obtain health care coverage 
through a family member or common law partner; 
VerDate Nov 24 2008 
21:16 Jun 18, 2009
Jkt 079200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H2925.IH
H2925
pwalker on PROD1PC71 with BILLS
‘‘(3) is at or below a poverty level specified by 
the Secretary; and 
‘‘(4) is not eligible for health services under the 
program under title XVIII, XIX, or XXI of the So-
cial Security Act (relating to the Medicare program, 
the Medicaid program, and the State children’s 
health insurance program, respectively). 
‘‘(c) QUALIFIED GRANT EXPENDITURES.—A grant 
may be made under subsection (a) for a project only if 
the applicant involved agrees that the grant will be ex-
pended to assist specialists that are participants in the 
network involved through any or all of the following 
means: 
‘‘(1) Paying nominal administrative fees to the 
participants for the costs of providing services to eli-
gible individuals. 
‘‘(2) Assisting with the cost of training primary 
care practitioners to manage the chronic conditions 
that are most often treated by the network special-
ists. 
‘‘(3) Assisting participants with the costs of 
providing fees to recruit specialists to practice in the 
service area of the project. 
VerDate Nov 24 2008 
21:16 Jun 18, 2009
Jkt 079200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H2925.IH
H2925
pwalker on PROD1PC71 with BILLS
‘‘(4) Assisting with the costs of operating a 
community clinic staffed by volunteer network spe-
cialists. 
‘‘(5) Assisting participants with the costs of in-
stalling or operating information technology that is 
of benefit to patients, such as technology to avoid 
medical errors or to facilitate the authorized elec-
tronic transfer of the health records of eligible indi-
viduals. 
‘‘(6) Paying for necessary prescription drug 
costs for necessary treatment prescribed by network 
specialists. 
‘‘(7) Such additional means as the Secretary 
may authorize. 
‘‘(d) CERTAIN
REQUIREMENTS
FOR
GRANT.—A 
grant may be made under subsection (a) for a project only 
if the applicant involved— 
‘‘(1) has defined a service area for the project; 
‘‘(2) has formed a consortium of various com-
munity members, leaders, and organizations in such 
area; 
‘‘(3) has ensured that the consortium has estab-
lished a set of unified goals for the project; 
VerDate Nov 24 2008 
21:16 Jun 18, 2009
Jkt 079200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H2925.IH
H2925
pwalker on PROD1PC71 with BILLS
‘‘(4) has conducted the basic level of demo-
graphic 
research 
described 
in 
section 
330M(c)(1)(D); 
‘‘(5) has a plan for managing the care of eligi-
ble individuals with chronic illness; and 
‘‘(6) has a plan for evaluating the project on an 
interim basis, not less frequently than once each 
year. 
‘‘(e) MATCHING FUNDS.— 
‘‘(1) IN GENERAL.—With respect to the costs of 
the project to be carried out under subsection (a) by 
an applicant, a grant under such subsection may be 
made only if the applicant agrees to make available 
(directly or through donations from public or private 
entities) non-Federal contributions toward such 
costs in an amount that is not less than 1⁄3 of such 
costs ($1 for each $2 provided in the grant). 
‘‘(2) DETERMINATION
OF
AMOUNT
CONTRIB-
UTED.—Non-Federal contributions required in para-
graph (1) may be in cash or in kind, fairly evalu-
ated, including plant, equipment, or services. 
Amounts provided by the Federal Government, or 
services assisted or subsidized to any significant ex-
tent by the Federal Government, may not be in-
VerDate Nov 24 2008 
21:16 Jun 18, 2009
Jkt 079200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H2925.IH
H2925
pwalker on PROD1PC71 with BILLS
cluded in determining the amount of such non-Fed-
eral contributions. 
‘‘(f) APPLICATION FOR GRANT.—A grant may be 
made under subsection (a) only if an application for the 
grant is submitted to the Secretary and the application 
is in such form, is made in such manner, and contains 
such agreements, assurances, and information as the Sec-
retary determines to be necessary to carry out this section. 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose of making grants under subsection (a), there is 
authorized to be appropriated $9,000,000 in the aggregate 
for the fiscal years 2010 through 2016, of which there 
are authorized to be appropriated amounts as follows: 
‘‘(1) For each of the fiscal years 2010 and 
2011, $500,000. 
‘‘(2) For each of the fiscal years 2012 and 
2013, $1,000,000. 
‘‘(3) For each of the fiscal years 2014 through 
2016, $2,000,000. 
‘‘SEC. 330O. CLEARINGHOUSE FOR INFORMATION ON COM-
MUNITY-INITIATED PROJECTS TO PROVIDE 
HEALTH CARE COVERAGE TO UNINSURED IN-
DIVIDUALS. 
‘‘(a) IN GENERAL.—The Secretary shall make an 
award of a grant or contract for the establishment and 
VerDate Nov 24 2008 
21:16 Jun 18, 2009
Jkt 079200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H2925.IH
H2925
pwalker on PROD1PC71 with BILLS