[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 3819 Introduced in Senate (IS)]
109th CONGRESS
2d Session
S. 3819
To amend title XIX of the Social Security Act to provide for
redistribution and extended availability of unexpended medicaid DSH
allotments, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
August 3, 2006
Mr. Bingaman (for himself, Mr. Smith, Mrs. Lincoln, Mr. Pryor, and Mr.
Akaka) introduced the following bill; which was read twice and referred
to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to provide for
redistribution and extended availability of unexpended medicaid DSH
allotments, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Strengthening the Safety Net Act of
2006''.
SEC. 2. REDISTRIBUTION AND EXTENDED AVAILABILITY OF UNEXPENDED MEDICAID
DSH ALLOTMENTS.
Section 1923(f) of the Social Security Act (42 U.S.C. 1396r-4(f))
is amended--
(1) in paragraph (3)(A), by striking ``paragraph (5)'' and
inserting ``paragraphs (5) and (7)'';
(2) by redesignating paragraph (7) as paragraph (8); and
(3) by inserting after paragraph (6), the following new
paragraph:
``(7) Redistribution and extended availability of
unexpended allotments.--
``(A) Establishment of redistribution pool.--
``(i) In general.--Subject to clauses (ii)
and (iii), the Secretary shall establish, as of
October 1 of fiscal year 2007, and of each
fiscal year thereafter, the following
redistribution pool:
``(I) In the case of fiscal year
2007, a $150,000,000 redistribution
pool from the total amount of the
unexpended State DSH allotments for
fiscal year 2004.
``(II) In the case of fiscal year
2008, a $250,000,000 redistribution
pool from the total amount of the
unexpended State DSH allotments for
fiscal year 2005.
``(III) In the case of fiscal year
2009 and each succeeding fiscal year
thereafter, a $400,000,000
redistribution pool from the total
amount of the unexpended State DSH
allotments for the third preceding
fiscal year.
``(ii) Unexpended state dsh allotments.--If
a State claims Federal financial participation
for a payment adjustment made under this
section for a fiscal year from which a
redistribution pool of unexpended State DSH
allotments has already been created under
clause (i), then, for purposes of this
paragraph, the total amount of unexpended State
DSH allotments in the fiscal year following the
State claim for such Federal financial
participation, shall be reduced by the Federal
financial participation related to such claim.
``(iii) Reduction in amounts available.--If
the total amount of the unexpended State DSH
allotments for a fiscal year (taking into
account any adjustment to such amount required
under clause (ii)) is less than the amount
necessary to provide, for such fiscal year, the
redistribution pool described in clause (i) and
the amounts to be made available for grants
under section 3(g) of the Strengthening the
Safety Net Act of 2006 for such fiscal year,
the Secretary shall reduce the amounts that are
to be available for the redistribution pool
under this paragraph and grants under such
section, respectively, to such total amount.
``(B) Redistribution.--
``(i) In general.--Not later than October
1, 2006, and October 1 of each year thereafter,
the Secretary shall allot the redistribution
pool established for that fiscal year among
eligible States.
``(ii) Priority.--In making allotments
under clause (i), the Secretary shall give
priority--
``(I) first to eligible States
described in paragraph (5)(B) (without
regard to the requirement that total
expenditures under the State plan for
disproportionate share hospital
adjustments for fiscal year 2000 is
greater than 0); and
``(II) then to eligible States
whose State DSH allotment per medicaid
enrollee and uninsured individual for
the third preceding fiscal year is
below the national average DSH
allotment per medicaid enrollee and
uninsured individual for that fiscal
year.
``(C) Expenditure rules.--An amount allotted to a
State from the redistribution pool established for a
fiscal year--
``(i) shall not be included in the
determination of the State's DSH allotment for
any fiscal year under this section;
``(ii) notwithstanding any other provision
of law, shall remain available for expenditure
by the State through the end of the second
fiscal year after the fiscal year in which the
allotment from the redistribution pool is made
for expenditures incurred in any of such fiscal
years; and
``(iii) shall only be used to make payment
adjustments to disproportionate share hospitals
in accordance with the requirements of this
section.
``(D) Definitions.--In this paragraph:
``(i) Eligible state.--The term `eligible
State' means, with respect to the fiscal year
from which a redistribution pool is established
under subparagraph (A)(i), a State that has
expended at least 90 percent of the State DSH
allotment for that fiscal year by the end of
the succeeding fiscal year.
``(ii) State dsh allotment per medicaid
enrollee and uninsured individual.--The term
`State DSH allotment per medicaid enrollee and
uninsured individual' means the amount equal to
the State DSH allotment for a fiscal year
divided by the sum of the number of individuals
who received medical assistance under the State
program under this title for that fiscal year
and the number of State residents with no
health insurance coverage for that fiscal year,
as determined by the Bureau of the Census.
``(iii) National average dsh allotment per
medicaid enrollee and uninsured individual.--
The term `national average DSH allotment per
medicaid enrollee and uninsured individual'
means the amount equal to the total amount of
State DSH allotments for a fiscal year divided
by the sum of the total number of individuals
who received medical assistance under a State
program under this title for that fiscal year
and the total number of residents with respect
to all States who did not have health insurance
coverage for that fiscal year, as determined by
the Bureau of the Census.''.
SEC. 3. HEALTH SERVICES FOR THE UNINSURED.
(a) Demonstration Grants to Health Access Networks.--
(1) In general.--The Secretary of Health and Human Services
(in this section referred to as the ``Secretary'') shall award
demonstration grants to health access networks.
(2) Application.--Each applying health access network shall
submit a plan that meets the requirements of subsection (c) for
the purpose of improving access, quality, and continuity of
care for uninsured individuals through better coordination of
care by the network.
(3) Authority to limit number of grants.--The number of
demonstration grants awarded under this section shall be
limited, in the discretion of the Secretary, so that grants are
sufficient to permit grantees to provide patient care services
to no fewer than the number of uninsured individuals specified
by each network in its grant application.
(b) Definition of Health Access Network.--
(1) In general.--In this section, the term ``health access
network'' means a collection of safety net providers, including
hospitals, community health centers, public health departments,
physicians, safety net health plans, or other recognized safety
net providers organized for the purpose of restructuring and
improving the access, quality, and continuity of care to the
uninsured and underinsured, that offers patients access to all
levels of care, including primary, outpatient, specialty,
certain ancillary services, and acute inpatient care, within a
community or across a broad spectrum of providers across a
service region or State.
(2) Inclusion of section 330 networks and plans.--The term
``health access network'' includes networks and plans that meet
the requirements for funding under section 330(e)(1)(C) of the
Public Health Service Act (42 U.S.C. 254b(e)(1)(C)).
(3) Inclusion of integrated health care systems.--
(A) In general.--Such term also includes an
integrated health care system (including a pediatric
system).
(B) Definition of integrated health care system.--
For purposes of this section, an integrated health care
system (including a pediatric system) is a health care
provider that is organized to provide care in a
coordinated fashion and assures access to a full range
of primary, specialty, and hospital care, to uninsured
and under-insured individuals, as appropriate.
(c) Plan Requirements.--
(1) In general.--A health access network that desires a
grant under this section shall submit a plan to the Secretary
that details how the network intends to--
(A) manage costs associated with the provision of
health care services to uninsured and underinsured
individuals served by the health access network;
(B) improve access to, and the availability of,
health care services provided to uninsured and
underinsured individuals served by the health access
network;
(C) enhance the quality and coordination of health
care services provided to uninsured and underinsured
individuals served by the health access network;
(D) improve the health status of uninsured and
underinsured individuals served by the health access
network; and
(E) reduce health disparities in the population of
uninsured and underinsured individuals served by the
health access network.
(2) Identification of measurable goals.--The health access
network shall--
(A) identify in the plan measurable performance
targets for at least 3 of the goals described in
paragraph (1); and
(B) agree that a portion of the payment of grant
funds for patient care services after the first year
for which such payment is made shall be contingent upon
the health access network demonstrating success in
achieving such targets.
(d) Use of Funds.--A health access network that receives funds
under this section shall expend--
(1) an amount equal to not less than 90 percent of such
funds for direct patient care services; and
(2) an amount equal to not more than 10 percent of such
funds for the network's operation and development for the
purpose of improving the efficiency and effectiveness of the
business and clinical operations of providers within the health
access network, including through the integration of management
information systems (including development and implementation
of electronic medical records) and financial, administrative,
or clinical functions across providers.
(e) Rule of Construction Regarding Direct Patient Care Services.--
With respect to health access networks described in subsection (b)(2),
the term ``direct patient care services'' shall be construed to mean
the provision or purchase of services, such as specialty medical care
and diagnostic services, that are not available or are insufficiently
available through the network's providers. In purchasing such services
for uninsured and underinsured individuals, networks shall, to the
maximum extent feasible, endeavor to purchase such services from safety
net providers.
(f) Supplement, not supplant.--Funds paid to a health access
network under a grant made under this section shall supplement and not
supplant, other Federal or State payments that are made to the health
access network to support the provision of health care services to low-
income or uninsured patients.
(g) Funding.--
(1) Transfer of portion of unexpended dsh allotments.--
Notwithstanding any other provision of law, as of October 1 of
fiscal year 2007, and each fiscal year thereafter, amounts
described in paragraph (2) are hereby transferred from the
total amount of the unexpended State DSH allotments under
section 1923 of the Social Security Act (42 U.S.C. 1396r-4) and
made available for grants under this section.
(2) Amounts made available for grants.--The amounts to be
made available under this section for each fiscal year
beginning with fiscal year 2007 are equal to the redistribution
pool amounts determined for each fiscal year under section
1923(f)(7)(A)(i) of the Social Security Act (42 U.S.C. 1396r-
4(f)(7)(A)(i)) (as amended by section 2(3) of the Strengthening
the Safety Net Act of 2006).
<all>