To improve women's access to quality health care.

SA 1117. Mrs. MURRAY (for herself, Mr. Wyden, Mr. Brown, Ms. Baldwin,
Mr. Bennet, Mr. Blumenthal, Mrs. Boxer, Ms. Hirono, Ms. Mikulski, Mr.
Menendez, Mr. Murphy, Mr. Sanders, Ms. Stabenow, Mrs. Shaheen, Mr.
Franken, Mr. Reid, Mr. Whitehouse, Ms. Cantwell, Ms. Warren, and Mr.
Booker) proposed an amendment to the bill H.R. 2, to amend title XVIII
of the Social Security Act to repeal the Medicare sustainable growth
rate and strengthen Medicare access by improving physician payments and
making other improvements, to reauthorize the Children's Health
Insurance Program, and for other purposes; as follows:

At the appropriate place, insert the following:

TITLE __--WOMEN'S ACCESS TO QUALITY HEALTH CARE

SEC. _01. SHORT TITLE.

This title may be cited as the ``Women's Access to Quality
Health Care Act''.

SEC. _02. RENEWAL OF APPLICATION OF MEDICARE PAYMENT RATE
FLOOR TO PRIMARY CARE SERVICES FURNISHED UNDER
MEDICAID AND INCLUSION OF ADDITIONAL PROVIDERS.

(a) Renewal of Payment Floor; Additional Providers.--
(1) In general.--Section 1902(a)(13) of the Social Security
Act (42 U.S.C. 1396a(a)(13)) is amended by striking
subparagraph (C) and inserting the following:
``(C) payment for primary care services (as defined in
subsection (jj)) at a rate that is not less than 100 percent
of the payment rate that applies to such services and
physician under part B of title XVIII (or, if greater, the
payment rate that would be applicable under such part if the
conversion factor under section 1848(d) for the year involved
were the conversion factor under such section for 2009), and
that is not less than the rate that would otherwise apply to
such services under this title if the rate were determined
without regard to this subparagraph, and that are--
``(i) furnished on or after January 1, 2013, and before
January 1, 2015, by a physician with a primary specialty
designation of family medicine, general internal medicine, or
pediatric medicine; or
``(ii) furnished on or after January 1, 2015, and before
January 1, 2017--

``(I) by a physician with a primary specialty designation
of family medicine, general internal medicine, or pediatric
medicine, but only if the physician self-attests that the
physician is Board certified in family medicine, general
internal medicine, or pediatric medicine;
``(II) by a physician with a primary specialty designation
of obstetrics and gynecology, but only if the physician self-
attests that the physician is Board certified in obstetrics
and gynecology;
``(III) by an advanced practice clinician, as defined by
the Secretary, that works under the supervision of--

``(aa) a physician that satisfies the criteria specified in
subclause (I) or (II); or

[[Page S2179]]

``(bb) a nurse practitioner or a physician assistant (as
such terms are defined in section 1861(aa)(5)(A)) who is
working in accordance with State law, or a certified nurse-
midwife (as defined in section 1861(gg)) who is working in
accordance with State law;

``(IV) by a rural health clinic, Federally-qualified health
center, or other health clinic that receives reimbursement on
a fee schedule applicable to a physician, a nurse
practitioner or a physician assistant (as such terms are
defined in section 1861(aa)(5)(A)) who is working in
accordance with State law, or a certified nurse-midwife (as
defined in section 1861(gg)) who is working in accordance
with State law, for services furnished by a physician, nurse
practitioner, physician assistant, or certified nurse-
midwife, or services furnished by an advanced practice
clinician supervised by a physician described in subclause
(I)(aa) or (II)(aa), another advanced practice clinician, or
a certified nurse-midwife; or
``(V) by a nurse practitioner or a physician assistant (as
such terms are defined in section 1861(aa)(5)(A)) who is
working in accordance with State law, or a certified nurse-
midwife (as defined in section 1861(gg)) who is working in
accordance with State law, in accordance with procedures that
ensure that the portion of the payment for such services that
the nurse practitioner, physician assistant, or certified
nurse-midwife is paid is not less than the amount that the
nurse practitioner, physician assistant, or certified nurse-
midwife would be paid if the services were provided under
part B of title XVIII;''.

(2) Conforming amendment.--Section 1905(dd) of the Social
Security Act (42 U.S.C. 1396d(dd)) is amended by striking
``January 1, 2015'' and inserting ``January 1, 2017''.
(b) Ensuring Payment by Managed Care Entities.--
(1) In general.--Section 1903(m)(2)(A) of the Social
Security Act (42 U.S.C. 1396b(m)(2)(A)) is amended--
(A) in clause (xii), by striking ``and'' after the
semicolon;
(B) by realigning the left margin of clause (xiii) so as to
align with the left margin of clause (xii) and by striking
the period at the end of clause (xiii) and inserting ``;
and''; and
(C) by inserting after clause (xiii) the following:
``(xiv) such contract provides that (I) payments to
providers specified in section 1902(a)(13)(C) for primary
care services defined in section 1902(jj) that are furnished
during a period specified in section 1902(a)(13)(C) and
section 1905(dd) are at least equal to the amounts set forth
and required by the Secretary by regulation, (II) the entity
shall, upon request, provide documentation to the State,
sufficient to enable the State and the Secretary to ensure
compliance with subclause (I), and (III) the Secretary shall
approve payments described in subclause (I) that are
furnished through an agreed upon capitation, partial
capitation, or other value-based payment arrangement if the
capitation, partial capitation, or other value-based payment
arrangement is based on a reasonable methodology and the
entity provides documentation to the State sufficient to
enable the State and the Secretary to ensure compliance with
subclause (I).''.
(2) Conforming amendment.--Section 1932(f) of the Social
Security Act (42 U.S.C. 1396u-2(f)) is amended by inserting
``and clause (xiv) of section 1903(m)(2)(A)'' before the
period.

SEC. _03. INCREASING ACCESS TO SAFETY-NET PROVIDERS.

Title X of the Public Health Service Act (42 U.S.C. 300 et
seq.) is amended by inserting after section 1003 the
following:

``SEC. 1003A. GRANTS FOR FACILITIES IMPROVEMENTS.

``(a) In General.--The Secretary is authorized to award
grants to, and enter into contracts with, public or nonprofit
private entities to plan, develop, or make improvements to
facilities carrying out family planning service projects, and
to expand preventive health services, under section 1001.
``(b) Funding.--There is authorized to be appropriated, and
there is appropriated, out of any monies in the Treasury not
otherwise appropriated, $500,000,000 for each of fiscal years
2016 through 2019, to enable the Secretary to expand access
to family planning services and to provide enhanced funding
for the family planning program under section 1001.''.

SEC. _04. STRENGTHENING AND IMPROVING COMMUNITY HEALTH
CENTERS, THE NATIONAL HEALTH SERVICE CORPS, AND
TEACHING HEALTH CENTERS.

(a) In General.--The Medicare Access and CHIP
Reauthorization Act of 2015 is amended by striking section
221.
(b) Funding for Community Health Centers and the National
Health Service Corps.--
(1) Community health centers.--Section 10503(b)(1)(E) of
the Patient Protection and Affordable Care Act (42 U.S.C.
254b-2(b)(1)(E)) is amended by striking ``for fiscal year
2015'' and inserting ``for each of fiscal years 2015 through
2019''.
(2) National health service corps.--Section 10503(b)(2)(E)
of the Patient Protection and Affordable Care Act (42 U.S.C.
254b-2(b)(2)(E)) is amended by striking ``for fiscal year
2015'' and inserting ``for each of fiscal years 2015 through
2019''.
(c) Extension of Teaching Health Centers Program.--Section
340H(g) of the Public Health Service Act (42 U.S.C. 256h(g))
is amended by inserting ``, and $100,000,000 for each of
fiscal years 2016 through 2019'' before the period.

SEC. _05. INVESTING IN PRIMARY CARE, NURSE PRACTITIONERS.

Part B of title VIII of the Public Health Service Act (42
U.S.C. 296j et seq.) is amended by adding at the end the
following:

``SEC. 812. DEMONSTRATION GRANTS FOR NURSE PRACTITIONER
TRAINING PROGRAM.

``(a) Establishment of Program.--The Secretary shall
establish a demonstration program (referred to in this
section as the `program') to award grants to eligible
entities for the training of nurse practitioners specializing
in women's health care for careers as providers in health
centers that receive assistance under title X (referred to in
this section as `health centers').
``(b) Purpose.--The purpose of the program is to enable
each grant recipient to--
``(1) provide new nurse practitioners with clinical
training to enable such practitioners to serve as providers
in health centers;
``(2) train new nurse practitioners to work under a model
of care that is consistent with the principles set forth by
the Report Providing Quality Family Planning Services of the
Centers for Disease Control and Prevention; and
``(3) establish a model of training for nurse practitioners
that specialize in women's health care that may be replicated
nationwide.
``(c) Grants.--Under the program, the Secretary shall award
3-year grants to eligible entities that meet the requirements
established by the Secretary, for the purpose of operating
the nurse practitioner programs described in subsection (a)
at such entities.
``(d) Eligible Entities.--To be eligible to receive a grant
under this section, an entity shall be--
``(1) a health center that receives funding under section
1001; and
``(2) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require.
``(e) Eligibility of Nurse Practitioners.--
``(1) In general.--To be eligible for acceptance into a
training program carried out by an eligible entity under a
grant under this section, an individual shall--
``(A) be licensed, or eligible for licensure, in the State
in which the program is being carried out as an advanced
practice registered nurse or advanced practice nurse and be
eligible or board-certified as a nurse practitioner; and
``(B) demonstrate commitment to a career as a provider in a
health center.
``(2) Preference.--In accepting individuals into a training
program under this section, a grant recipient shall give
preference to bilingual applicants that meet the requirements
described in paragraph (1).
``(f) Grant Amount.--Each grant awarded under this section
shall be in an amount not to exceed $600,000 per year. A
grant recipient may carry over funds from 1 fiscal year to
another without obtaining approval from the Secretary.
``(g) Technical Assistance Grants.--The Secretary may award
technical assistance grants to 1 or more health centers that
have demonstrated expertise in establishing a nurse
practitioner residency training program. Such technical
assistance grants shall be for the purpose of providing
technical assistance to other recipients of grants under
subsection (c).
``(h) Authorization of Appropriations.--To carry out this
section, there is authorized to be appropriated $10,000,000
for each of fiscal years 2016 through 2019.''.
______