A bill to authorize the Secretary of Health and Human Services to make grants to community health coalitions to assist in the development of integrated health care delivery, and for other purposes.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Community Coalitions for Access and 
Quality Improvement Act of 2009''.

SEC. 2. PURPOSE.

    The purpose of this Act is to provide assistance to community 
health coalitions as described in section 3(b) with a clearly defined 
local need to increase access to and improve the quality of health care 
services through activities which--
            (1) develop or strengthen coordination of services to allow 
        all individuals, including the uninsured and low-income, to 
        receive efficient and higher quality care and to gain entry 
        into and receive services from a comprehensive system of 
        medical, dental, pharmaceutical, and behavioral health care;
            (2) develop efficient and sustainable infrastructure for a 
        health care delivery system characterized by effective 
        collaboration, information sharing, and clinical and financial 
        coordination among all types of providers of care in the 
        community; and
            (3) develop or strengthen activities related to providing 
        coordinated care for individuals with chronic conditions.

SEC. 3. GRANTS TO STRENGTHEN THE EFFECTIVENESS, EFFICIENCY, AND 
              COORDINATION OF SERVICES.

    (a) In General.--The Secretary of Health and Human Services (in 
this Act referred to as the ``Secretary'') shall award grants to assist 
in the development of integrated health care delivery systems to serve 
defined communities of individuals--
            (1) to improve the efficiency of and coordination among the 
        providers providing services through such systems;
            (2) to assist local communities in developing programs 
        targeted toward preventing and managing chronic diseases; and
            (3) to expand and enhance the services provided through 
        such systems.
    (b) Eligible Entities.--To be eligible to receive a grant under 
this section, an entity shall be an entity that--
            (1) represents a balanced consortium--
                    (A) whose principal purpose is to ensure the 
                sustainable capacity for the provision of a broad range 
                of coordinated services for all residents within a 
                community defined in the entity's grant application as 
                described in paragraph (2); and
                    (B) that includes at least one of each of the 
                following providers that serve the community (unless 
                such provider does not exist within the community, 
                declines or refuses to participate, or places 
                unreasonable conditions on their participation)--
                            (i) a federally qualified health center (as 
                        defined in section 1861(aa) of the Social 
                        Security Act (42 U.S.C. 1395x(aa)));
                            (ii) rural health clinics and rural health 
                        networks (as defined in sections 1861(aa) and 
                        1820(d) of the Social Security Act, 
                        respectively (42 U.S.C. 1395x(aa), 1395i-
                        4(d)));
                            (iii) a hospital with a low-income 
                        utilization rate that is greater than 25 
                        percent (as defined in section 1923(b)(3) of 
                        the Social Security Act (42 U.S.C. 1396r-
                        4(b)(3))) or a critical access hospital (as 
                        defined in section 1820(c)(2) of the Social 
                        Security Act (42 U.S.C. 1395i-4(c)(2)));
                            (iv) a public health department; and
                            (v) an interested public or private sector 
                        health care provider or an organization that 
                        has traditionally served the medically 
                        uninsured and low-income individuals; and
            (2) submits to the Secretary an application, in such form 
        and manner as the Secretary shall prescribe, that--
                    (A) clearly defines the community to be served;
                    (B) identifies the providers who will participate 
                in the community coalition under the grant and 
                specifies each provider's contribution to the care of 
                individuals in the community;
                    (C) describes the activities that the applicant and 
                the community coalition propose to perform under the 
                grant to further the objectives of this section;
                    (D) demonstrates that it is an established 
                coalition with ability to build on the current system 
                for serving the community by involving providers who 
                have traditionally provided a significant volume of 
                care for uninsured and low-income individuals for that 
                community;
                    (E) demonstrates the coalition's ability to develop 
                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 pharmacy, substance abuse, behavioral health 
                and oral health services, in a manner that ensures 
                continuity of care in the community;
                    (F) provides evidence of community involvement, 
                including the business community, in the development, 
                implementation, and direction of the system of care 
                that the coalition proposes to ensure;
                    (G) demonstrates the coalition's ability to ensure 
                that participating individuals are enrolled in health 
                care coverage programs, both public and private, for 
                which the individuals are eligible;
                    (H) presents 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 manner to ensure 
                long-term sustainability of the system of care;
                    (I) describes a plan for evaluation of the 
                activities carried out under the grant, including 
                measurement of progress toward the goals and objectives 
                of the program and the use of evaluation findings to 
                improve system performance;
                    (J) demonstrates fiscal responsibility through the 
                use of appropriate accounting procedures and management 
                systems;
                    (K) demonstrates commitment to serve the community 
                without regard to the ability of an individual or 
                family to pay by arranging for or providing free or 
                reduced charge care for the poor; and
                    (L) includes such other information as the 
                Secretary may prescribe.
    (c) Limitations.--
            (1) In general.--An eligible entity may receive a grant 
        under this section for 3 consecutive fiscal years and may 
        receive such a grant award for 2 additional years if--
                    (A) the eligible entity submits to the Secretary a 
                request for a grant for such additional years;
                    (B) the Secretary determines that current 
                performance justifies the granting of such a request; 
                and
                    (C) the Secretary determines that granting such 
                request is necessary to further the objectives 
                described in subsection (a).
    (d) Priorities.--In awarding grants under this section, the 
Secretary--
            (1) may accord priority to applicants that demonstrate the 
        greatest extent of unmet need in the community for a more 
        coordinated system of care; and
            (2) shall accord priority to applicants that best promote 
        the objectives of this section, taking into consideration the 
        extent to which the applicant--
                    (A) identifies a community whose geographical area 
                has a high or increasing percentage of individuals who 
                are uninsured or low-income;
                    (B) demonstrates that the applicant has included in 
                its community coalition providers, support systems, and 
                programs that have a tradition of serving individuals 
                and families in the community who are uninsured or earn 
                below 200 percent of the Federal poverty level;
                    (C) shows evidence that the proposed coalition 
                activities would expand utilization of preventive and 
                primary care services for uninsured and underinsured 
                individuals and families in the community, including 
                pharmaceuticals, behavioral and mental health services, 
                oral health services, or substance abuse services;
                    (D) proposes approaches that would improve 
                coordination between health care providers and 
                appropriate social service providers;
                    (E) demonstrates collaboration with State and local 
                governments;
                    (F) demonstrates that the applicant makes use of 
                non-Federal contributions to the greatest extent 
                possible; or
                    (G) demonstrates likelihood that the proposed 
                activities will lead to sustainable integrated delivery 
                system as additional efforts of health systems 
                development evolve.
    (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 
                        achieving the greater integration of a health 
                        care delivery system so that the system either 
                        directly provides or ensures the provision of a 
                        broad range of culturally competent services, 
                        including as appropriate primary, secondary, 
                        and tertiary care and oral health, substance 
                        abuse, behavioral and mental health, and 
                        pharmaceutical 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 under 
                this section, when such use meets the conditions stated 
                in subparagraph (A):
                            (i) Increases in outreach activities and 
                        closing gaps in health care service, including 
                        referral to specialty services and prescription 
                        drugs and conducting ongoing outreach to health 
                        disparity populations.
                            (ii) Improvements to care management and 
                        delivery of patient-centered care, including 
                        patient navigation services.
                            (iii) Improvements to coordination of 
                        transportation to health care facilities.
                            (iv) Development of provider networks and 
                        other innovative models to engage physicians in 
                        voluntary efforts to serve the medically 
                        underserved within a community.
                            (v) Recruitment, training, and compensation 
                        of necessary personnel.
                            (vi) Coordinate the acquisition or 
                        interconnected use of technology within a 
                        community for the purpose of coordinating care 
                        and improving provider communication, including 
                        implementation of shared information systems or 
                        shared clinical systems to improve the quality 
                        of health care.
                            (vii) Development of common processes such 
                        as mechanisms for determining eligibility for 
                        the programs provided through the system, 
                        common identification cards, sliding scale 
                        discounts, and monitoring and tracking of 
                        outcomes.
                            (viii) Development of specific prevention 
                        and disease management tools and processes.
                            (ix) Language access services.
                            (x) Facilitating the involvement of 
                        community organizations to provide better 
                        access to high-quality health care services to 
                        individuals at risk for or who have chronic 
                        diseases or cancer.
                            (xi) Helping patients overcome barriers 
                        within the health care system to ensure prompt 
                        diagnostic and treatment resolution of an 
                        abnormal finding of cancer or chronic disease.
            (2) Direct patient care limitation.--Not more than 20 
        percent of the funds provided under a grant awarded under this 
        section 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 7 percent of funds 
        appropriated to carry out this section for providing technical 
        assistance to grantees, obtaining assistance of experts and 
        consultants, holding meetings, developing of tools, 
        disseminating of information, and evaluation.
    (f) Reporting by Grantee.--A grantee under this section shall 
report to the Secretary annually regarding--
            (1) progress in meeting the goals and measurable objectives 
        set forth in the grant application submitted by the grantee 
        under subsection (b); and
            (2) the extent to which activities conducted by such 
        grantee have--
                    (A) improved the effectiveness, efficiency, and 
                coordination of services for uninsured and low-income 
                individuals in the community served by such grantee, 
                using commonly accepted outcome measures;
                    (B) resulted in the provision of better quality 
                health care for individuals and families in the 
                community served; and
                    (C) resulted in the provision of health care to 
                such individuals at lower cost than would have been 
                possible in the absence of the activities conducted by 
                such grantee.
    (g) Maintenance of Effort.--With respect to activities for which a 
grant under this section is authorized, the Secretary may award such a 
grant only if the applicant and each of the participating providers 
agree that the grantee and each such provider will maintain its 
expenditures of non-Federal funds for such activities at a level that 
is not less then the level of such expenditures during the fiscal year 
immediately preceding the fiscal year for which the applicant is 
applying to receive such grant.
    (h) Technical Assistance.--The Secretary may provide any entity 
that receives a grant under this section with technical and other 
nonfinancial assistance necessary to meet the requirements of this 
section. The Secretary may choose to provide such assistance by 
awarding a grant to, or entering into a contract with, a State or 
national not-for-profit organization with expertise in building 
successful community coalitions.
    (i) Evaluation of Program.--Not later than September 30, 2014, the 
Secretary shall prepare and submit to the appropriate committees of 
Congress a report that describes the extent to which projects funded 
under this section have been successful in improving the effectiveness, 
efficiency, and coordination of services in the communities served by 
such projects, including whether the projects resulted in the provision 
of better quality health care for such individuals, and whether such 
care was provided at lower costs than would have been provided in the 
absence of such projects.
    (j) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section--
            (1) $75,000,000 for fiscal year 2010;
            (2) $100,000,000 for fiscal year 2011;
            (3) $125,000,000 for fiscal year 2012;
            (4) $150,000,000 for fiscal year 2013; and
            (5) $175,000,000 for fiscal year 2014.

Summary: Community Coalitions for Access and Quality Improvement Act of 2009 - Directs the Secretary of Health and Human Services to award grants to assist in developing integrated health care delivery systems to serve defined communities of individuals to: (1) improve efficiency and coordination among providers; (2) assist local communities in developing programs targeted toward preventing and managing chronic diseases; and (3) expand and enhance services provided.

Authorizes the Secretary, in awarding grants, to accord priority to: (1) applicants that demonstrate the greatest unmet need for a more coordinated system of care; and (2) applicants that best promote the objectives of this Act.

Authorizes a grantee to use amounts provided only for: (1) direct expenses associated with achieving greater integration of a health care delivery system to directly provide or ensure the provision of a broad range of culturally competent services; and (2) direct patient care and service expansions to fill identified or documented gaps within an integrated delivery system.