S.Amdt. 1029

1. Adds SEC. ____. MEDICARE COVERAGE OF CRITICAL ACCESS HEALTH CENTER SERVICES at the end of title VI

   Adds a section

   In S. 1 · Reported to Senate

   Section 13031(j)(3) of the Consolidated Omnibus Budget Reconciliation Act of 1985 (19 U.S.C. 58c(j)(3)) is amended by striking "September 30, 2003" and inserting "September 30, 2013". Amend the title so as to read: "A bill to amend title XVIII of the Social Security Act to provide for a voluntary prescription drug benefit under the medicare program and to strengthen and improve the medicare program, and for other purposes.".

   Inserted: SEC. ____. MEDICARE COVERAGE OF CRITICAL ACCESS HEALTH CENTER SERVICES.

   Inserted: (a) In General.--

   Inserted: (1) Coverage.--Section 1861(s)(2)(E) (42 U.S.C. 1395x(s)(2)(E)) is amended--

   Inserted: (A) by striking "services and" and inserting "services,"; and

   Inserted: (B) by striking "center services" and inserting "center services, and critical access health center services".

   Inserted: (2) Definitions.--Section 1861(aa) (42 U.S.C. 1395x(aa)) is amended--

   Inserted: (A) in the heading--

   Inserted: (i) by striking "Services and" and inserting "Services,"; and

   Inserted: (ii) by striking "Center Services" and inserting "Center Services, and Critical Access Health Center Services";

   Inserted: (B) in paragraph (1)(B), by striking "paragraph (5)" and inserting "paragraph (7)";

   Inserted: (C) by redesignating paragraphs (5), (6), and (7) as paragraphs (7), (8), and (9), respectively; and

   Inserted: (D) by inserting after paragraph (4) the following:

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   Inserted: "(5) The term 'critical access health center services' means--

   Inserted: "(A) services of the type described in subparagraphs (A) through (C) of paragraph (1); and

   Inserted: "(B) preventive primary health services of the type that a health center is required to provide under section 330 of the Public Health Service Act, when furnished to an individual who is an outpatient of a critical access health center and, for this purpose, any reference to a rural health clinic or a physician described in paragraph (2)(B) is deemed a reference to a critical access health center or a physician at the center, respectively.

   Inserted: "(6) The term 'critical access health center' means an entity that--

   Inserted: "(A) is sponsored by a private, nonprofit entity with a religious affiliation; and

   Inserted: "(B) based on the recommendation of the Centers for Medicare and Medicaid Services, is determined by the Secretary to meet the requirements for receiving a grant under section 330 of the Public Health Service Act (other than the requirement of subsection (n)(3)(H)(i) of such section).".

   Inserted: (3) Payments.--

   Inserted: (A) Scope of benefits.--Section 1832(a) (42 U.S.C.1395k(a)) is amended--

   Inserted: (i) in paragraph (1), by striking "subparagraphs (B) and (D)" and inserting "subparagraphs (B), (D), and (K)"; and

   Inserted: (ii) in paragraph (2)--

   Inserted: (I) by striking "and" at the end of subparagraph (I);

   Inserted: (II) by striking the period at the end of subparagraph (J) and inserting "; and"; and

   Inserted: (III) by adding at the end the following:

   Inserted: "(K) critical access health center services.".

   Inserted: (B) Payment of benefits.--Section 1833(a) (42 U.S.C.1395l(a)) is amended--

   Inserted: (i) in the matter preceding subparagraph (A) of paragraph (2), by striking "and (I)" and inserting "(I), and (K)"; and

   Inserted: (ii) in paragraph (3), by inserting "or section 1832(a)(2)(K)" after "section 1832(a)(2)(D)".

   Inserted: (C) Part b deductible not applicable.--The first sentence of section 1833(b) (42 U.S.C. 1395l(b)) is amended by inserting "or critical access health center services" after "Federally qualified health center services".

   Inserted: (D) Exception to exclusions from coverage.--Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is amended--

   Inserted: (i) in paragraph (2), by inserting "or critical access health center services (as defined in section 1861(aa)(5))" after "Federally qualified health center services";

   Inserted: (ii) in paragraph (3), by inserting "in the case of critical access health center services (as defined in section 1861(aa)(5))," after "section 1880(e),"; and

   Inserted: (iii) in the second sentence, by inserting "or critical access health center services described in section 1861(aa)(5)(B)" after "section 1861 (aa)(3)(B)".

   Inserted: (E) Exception to anti-kickback law for waiver of coinsurance.--Section 1128B(b)(3)(D) (42 U.S.C. 13206-7b(b)(3)(D)) is amended--

   Inserted: (i) by inserting "(i)" before "a waiver";

   Inserted: (ii) by inserting "and" after "Act;"; and

   Inserted: (iii) by adding at the end the following:

   Inserted: "(ii) a waiver of--

   Inserted: "(I) any coinsurance under part B of title XVIII by a critical access health center with respect to an individual who qualifies for subsidized services under a provision of section 330 of the Public Health Service Act (as made applicable to such centers by section 1861(aa)(6)); and

   Inserted: "(II) the deductible and any coinsurance under such part by any provider of services, physician, or supplier to which such an individual is referred by a critical access health center for the provision of services that are not critical access health center services;".

   Inserted: (F) Conforming amendments.--

   Inserted: (i) Section 1842(b)(18)(C)(1) (42 U.S.C. 1395u(b)(18)(C)(1)) is amended by striking "section 1861(aa)(5)" and inserting "section 1861(aa)(7)".

   Inserted: (ii) Section 1861(s)(2) (42 U.S.C. 1395x(s)(2)) is amended in subparagraph (H)(i), by striking "subsection (aa)(5)" and inserting "subsection (aa)(7)".

   Inserted: (iii) Section 1861(s)(2) (42 U.S.C. 1395x(s)(2)) is amended in subparagraph (K)--

   Inserted: (I) by striking "subsection (aa)(5)" each place it appears and inserting "subsection (aa)(7)"; and

   Inserted: (II) by striking "subsection (aa)(6)" and inserting "subsection (aa)(8)".

   Inserted: (b) Effective Date.--The amendments made this section shall apply to items and services furnished on or after October 1, 2004.

   Inserted: SEC. ____ . DEMONSTRATION TO IMPROVE ACCESS AND CONTINUITY OF CARE FOR LOW-INCOME BENEFICIARIES.

   Inserted: (a) In General.--The Secretary shall--

   Inserted: (1) conduct a demonstration project to test the use of alternative payment methodologies to health care providers to improve access to ambulatory health care services and continuity of care for vulnerable populations such as low-income beneficiaries under title XVIII; and

   Inserted: (2) waive any provisions of the Social Security Act that are necessary to implement such demonstration.

   Inserted: (b) Duration.--The demonstration project conducted pursuant to subsection (a) shall be for a term of at least 3 years and shall begin operation not later than 1 year after the date of the enactment of this Act.

   Inserted: (c) Reports.--

   Inserted: (1) Interim and final reports required.--The Secretary shall submit interim and final reports on the demonstration project conducted pursuant to subsection (a) to the Committee on Finance of the Senate and the Committee on Ways and Means and the Committee on Commerce of the House of Representatives. Such reports shall describe--

   Inserted: (A) the alternative payment methodologies in use under the demonstration;

   Inserted: (B) the provisions of law waived by the Secretary in order to conduct the demonstration; and

   Inserted: (C) the extent to which the demonstration has achieved the objectives described in subsection (a).

   Inserted: (2) Timing of reports.--The Secretary shall submit the interim report required by paragraph (1) not later than 2 years after the commencement of the demonstration and the final report not later than 6 months after the termination the demonstration.

   Original wording

   At the end of title VI, insert the following:

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As printed