To provide reimbursement for Federally qualified health centers participating in Medicare managed care.

1. Adds SEC. ____. REIMBURSEMENT FOR FEDERALLY QUALIFIED HEALTH CENTERS PARTICIPATING IN MEDICARE MANAGED CARE 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. ____. REIMBURSEMENT FOR FEDERALLY QUALIFIED HEALTH CENTERS PARTICIPATING IN MEDICARE MANAGED CARE.

   Inserted: (a) Reimbursement.--

   Inserted: (1) In general.--Section 1833(a)(3) (42 U.S.C. 1395l(a)(3)) is amended to read as follows:

   Inserted: "(3) in the case of services described in section 1832(a)(2)(D)--

   Inserted: "(A) except as provided in subparagraph (B), the costs which are reasonable and related to the cost of furnishing such services or which are based on such other tests of reasonableness as the Secretary may prescribe in regulations, including those authorized under section 1861(v)(1)(A), less the amount a provider may charge as described in clause (ii) of section 1866(a)(2)(A), but in no case may the payment for such services (other than for items and services described in section 1861(s)(10)(A)) exceed 80 percent of such costs; or

   Inserted: "(B) with respect to the services described in clause (ii) of section 1832(a)(2)(D) that are furnished to an individual enrolled with a MedicareAdvantage plan under part C pursuant to a written agreement described in section 1853(j), the amount by which--

   Inserted: "(i) the amount of payment that would have otherwise been provided under subparagraph (A) (calculated as if '100 percent' were substituted for '80 percent' in such subparagraph) for such services if the individual had not been so enrolled; exceeds

   Inserted: "(ii) the amount of the payments received under such written agreement for such services (not including any financial incentives provided for in such agreement such as risk pool payments, bonuses, or withholds), less the amount the Federally qualified health center may charge as described in section 1857(e)(3)(C);".

   Inserted: (b) Continuation of MedicareAdvantage Monthly Payments.--

   Inserted: (1) In general.--Section 1853 (42 U.S.C. 1395w-23), as amended by this Act, is amended by adding at the end the following new subsection:

   Inserted: "(j) Payment Rule for Federally Qualified Health Center Services.--If an individual who is enrolled with a MedicareAdvantage plan under this part receives a service from a Federally qualified health center that has a written agreement with such plan for providing such a service (including any agreement required under section 1857(e)(3))--

   Inserted: "(1) the Secretary shall pay the amount determined under section 1833(a)(3)(B) directly to the Federally qualified health center not less frequently than quarterly; and

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   Inserted: "(2) the Secretary shall not reduce the amount of the monthly payments to the MedicareAdvantage plan made under section 1853(a) as a result of the application of paragraph (1).".

   Inserted: (2) Conforming amendments.--

   Inserted: (A) Paragraphs (1) and (2) of section 1851(i) (42 U.S.C. 1395w-21(i)(1)), as amended by this Act, are each amended by inserting "1853(j)," after "1853(i),".

   Inserted: (B) Section 1853(c)(5) is amended by striking "subsections (a)(3)(C)(iii) and (i)" and inserting "subsections (a)(3)(C)(iii), (i), and (j)(1)".

   Inserted: (c) Additional MedicareAdvantage Contract Requirements.--Section 1857(e) (42 U.S.C. 1395w-27(e)) is amended by adding at the end the following new paragraph:

   Inserted: "(3) Agreements with federally qualified health centers.--

   Inserted: "(A) Payment levels and amounts.--A contract under this part shall require the MedicareAdvantage plan to provide, in any contract between the plan and a Federally qualified health center, for a level and amount of payment to the Federally qualified health center for services provided by such health center that is not less than the level and amount of payment that the plan would make for such services if the services had been furnished by a provider of services that was not a Federally qualified health center.

   Inserted: "(B) Cost-sharing.--Under the written agreement described in subparagraph (A), a Federally qualified health center must accept the MedicareAdvantage contract price plus the Federal payment provided for in section 1833(a)(3)(B) as payment in full for services covered by the contract, except that such a health center may collect any amount of cost-sharing permitted under the contract under this part, so long as the amounts of any deductible, coinsurance, or copayment comply with the requirements under section 1854(e).".

   Inserted: (d) Safe Harbor From Antikickback Prohibition.--Section 1128B(b)(3) (42 U.S.C. 1320a-7b(b)(3)) is amended--

   Inserted: (1) in subparagraph (E), by striking "and" after the semicolon at the end;

   Inserted: (2) in subparagraph (F), by striking the period at the end and inserting "; and"; and

   Inserted: (3) by adding at the end the following new subparagraph:

   Inserted: "(G) any remuneration between a Federally qualified health center (or an entity controlled by such a health center) and a MedicareAdvantage plan pursuant to the written agreement described in section 1853(j).".

   Inserted: (e) Effective Date.--The amendments made by this section shall apply to services provided on or after January 1, 2006, and contract years beginning on or after such date.

   Original wording

   At the end of title VI, insert the following:

Read automatically from the Congressional Record. Check the original before relying on it.

As printed