I
111th CONGRESS
1st Session
H. R. 1296
IN THE HOUSE OF REPRESENTATIVES
March 4, 2009
Mr. Clyburn (for himself, Mr. Abercrombie, Mr. Berman, Mr. Bishop of New York, Mr. Blumenauer, Ms. Bordallo, Mr. Boswell, Mr. Boucher, Mr. Butterfield, Mr. Carney, Mrs. Christensen, Mr. Clay, Mr. Costa, Mr. Davis of Illinois, Mr. Davis of Tennessee, Mr. DeFazio, Ms. DeGette, Mr. Cooper, Mr. Delahunt, Mr. Doggett, Mr. Ellison, Ms. Eshoo, Mr. Filner, Mr. Frank of Massachusetts, Mr. Grijalva, Mr. Gutierrez, Mr. Higgins, Mr. Hinojosa, Mr. Larson of Connecticut, Ms. Lee of California, Mr. Lewis of Georgia, Mrs. Maloney, Mr. Markey of Massachusetts, Mr. Meek of Florida, Mr. Moore of Kansas, Ms. Moore of Wisconsin, Mr. Moran of Virginia, Mr. Murtha, Mr. Nadler of New York, Mrs. Napolitano, Ms. Norton, Mr. Olver, Mr. Ortiz, Mr. Pascrell, Mr. Pastor of Arizona, Mr. Payne, Mr. Perlmutter, Mr. Price of North Carolina, Mr. Rahall, Mr. Rodriguez, Mr. Rothman of New Jersey, Ms. Roybal-Allard, Mr. Rush, Mr. Sarbanes, Ms. Schwartz, Mr. Scott of Georgia, Mr. Serrano, Ms. Shea-Porter, Mr. Sires, Ms. Slaughter, Mr. Spratt, Mr. Towns, Ms. Velázquez, Mr. Weiner, Mr. Welch, Mr. Wexler, Mr. Wilson of Ohio, Mr. Wu, Mr. Yarmuth, Mr. Cleaver, Mr. Farr, Ms. Clarke, Mr. Salazar, Mr. Ross, Mr. Thompson of California, and Ms. Schakowsky) introduced the following bill; which was referred to the Committee on Energy and Commerce
A BILL
To achieve access to comprehensive primary health care services for all Americans and to reform the organization of primary care delivery through an expansion of the Community Health Center and National Health Service Corps programs.
Short title
This Act may be cited as the
Access for All America
Act
.
Findings
Congress makes the following findings:
Providing universal coverage for health care for all Americans will be incomplete if access to medical and other health services is not improved.
Currently, 56,000,000 Americans, both insured and uninsured, have inadequate access to primary care due to a shortage of physicians and other like providers in their community.
Several
demonstrations are underway at the Federal and State level to link patients to
a primary care medical home
as a means of assuring access,
controlling costs, and improving quality.
Yet, there already exists a proven medical home model that accomplishes these goals and has done so over the past 40 years while serving over 18,000,000 Americans.
Community health centers, also known as Federally Qualified Health Centers (FQHCs), have been found to more than pay for themselves by providing coordinated, comprehensive medical, dental, behavioral health, and prescription drug services that reduce unnecessary emergency room visits, ambulatory-sensitive hospitalizations, and avoidable specialty care.
The result is that the American Academy of Family Physicians’ Robert Graham Center found that medical expenses for health center patients are 41 percent lower compared to patients seen elsewhere, an average savings of $1,810 per person per year.
The Lewin Group found that providing access to a medical home for every American would produce health care savings of $67,000,000,000 per year, more than 8 times the subsidy needed to sustain the 1,100 current health centers and to create 3,900 new or expanded health center sites to accomplish full access.
Hand in hand with the expansion of the community health center program, a renewed investment in the National Health Service Corps is essential to reverse the decline in the supply of primary care physicians and dentists.
Both the expansion of the community health center program and the investment in the National Health Service Corps can be accomplished for less than 1 percent of total health care spending today.
Finally, to encourage broader adoption of the cost-effective community health center model of care beyond underserved areas and populations and to encourage the pursuit and practice of primary care as a career, all willing primary care practitioners should be encouraged to collaborate with community health centers.
Spending for Federally Qualified Health Centers (FQHCs)
Section 330(r) of the Public Health Service Act (42 U.S.C. 254b(r)) is amended by striking paragraph (1) and inserting the following:
General amounts for grants
For the purpose of carrying out this section, in addition to the amounts authorized to be appropriated under subsection (d), there is authorized to be appropriated the following:
For fiscal year 2010, $2,988,821,592.
For fiscal year 2011, $3,862,107,440.
For fiscal year 2012, $4,990,553,440.
For fiscal year 2013, $6,448,713,307.
For fiscal year 2014, $7,332,924,155.
For fiscal year 2015, $8,332,924,155.
For fiscal year 2016, and each subsequent fiscal year, the amount appropriated for the preceding fiscal year adjusted by the product of—
one plus the average percentage increase in costs incurred per patient served; and
one plus the average percentage increase in the total number of patients served.
.
Other provisions
Settings for service delivery
Section 330(a)(1) of the Public Health Service
Act (42 U.S.C. 254b(a)(1)) is amended by adding at the end the following:
Required primary health services and additional health services may be
provided either at facilities directly operated by the center or at any other
inpatient or outpatient settings determined appropriate by the center to meet
the needs of its patents.
.
Location of service delivery sites
Section 330(a) of the Public Health Service Act (42 U.S.C. 254b(a)) is amended by adding at the end the following:
Considerations
Location of sites
Subject to subparagraph (B), a center shall not be required to locate its service facility or facilities within a designated medically underserved area in order to serve either the residents of its catchment area or a special medically underserved population comprised of migratory and seasonal agricultural workers, the homeless, or residents of public housing, if that location is determined by the center to be reasonably accessible to and appropriate to meet the needs of the medically underserved residents of the center’s catchment area or the special medically underserved population, in accordance with subparagraphs (A) and (J) of subsection (k)(3).
Location within another center's area
The Secretary may permit applicants for grants under this section to propose the location of a service delivery site within another center’s catchment area if the applicant demonstrates sufficient unmet need in such area and can otherwise justify the need for additional Federal resources in the catchment area. In determining whether to approve such a proposal, the Secretary shall take into consideration whether collaboration between the two centers exists, or whether the applicant has made reasonable attempts to establish such collaboration, and shall consider any comments timely submitted by the affected center concerning the potential impact of the proposal on the availability or accessibility of services the affected center currently provides or the financial viability of the affected center.
.
Affiliation agreements
Section 330(k)(3)(B) of the Public Health Service Act
(42 U.S.C. 254b(k)(3)(B)) is amended by inserting before the semicolon the
following: , including contractual arrangements as appropriate, while
maintaining full compliance with the requirements of this section, including
the requirements of subparagraph (H) concerning the composition and authorities
of the center’s governing board, and, except as otherwise provided in clause
(ii) of such subparagraph, ensuring full autonomy of the center over policies,
direction, and operations related to health care delivery, personnel, finances,
and quality assurance
.
Governance requirements
Section 330(k)(3) of the Public Health Service Act (42 U.S.C. 254b(k)(3)) is amended—
in subparagraph (H)—
in clause (ii), by
striking ; and
and inserting , except that in the case of
a public center (as defined in the second sentence of this paragraph), the
public entity may retain authority to establish financial and personnel
policies for the center; and
;
in clause (iii),
by adding and
at the end; and
by inserting after clause (iii) the following:
in the case of a co-applicant with a public entity, meets the requirements of clauses (i) and (ii);
; and
in the second
sentence, by inserting before the period the following: that is governed
by a board that satisfies the requirements of subparagraph (H) or that jointly
applies (or has applied) for funding with a co-applicant board that meets such
requirements
.
Adjustment in center's operating plan and budget
Section 330(k)(3)(I)(i) of the
Public Health Service Act (42 U.S.C. 254b(k)(3)(I)(i)) is amended by inserting
before the semicolon the following: , which may be modified by the
center at any time during the fiscal year involved if such modifications do not
require additional grant funds, do not compromise the availability or
accessibility of services currently provided by the center, and otherwise meet
the conditions of subsection (a)(3)(B), except that any such modifications that
do not comply with this clause, as determined by the health center, shall be
submitted to the Secretary for approval
.
Joint purchasing arrangements for reduced cost
Section 330(l) of the Public Health Service Act (42 U.S.C. 254b(l)) is amended—
by striking
The Secretary
and inserting the following:
In general
The Secretary
; and
by adding at the end the following:
Assistance with supplies and services costs
The Secretary, directly or through grants or contracts, may carry out projects to establish and administer arrangements under which the costs of providing the supplies and services needed for the operation of federally qualified health centers are reduced through collaborative efforts of the centers, through making purchases that apply to multiple centers, or through such other methods as the Secretary determines to be appropriate.
.
Opportunity To Correct Material Failure Regarding Grant Conditions
Section 330(e) of the Public Health Service Act (42 U.S.C. 254b(e)) is amended by adding at the end the following:
Opportunity to Correct Material Failure Regarding Grant Conditions
If the Secretary finds that a center materially fails to meet any requirement (except for any requirements waived by the Secretary) necessary to qualify for its grant under this subsection, the Secretary shall provide the center with an opportunity to achieve compliance (over a period of up to 1 year from making such finding) before terminating the center's grant. A center may appeal and obtain an impartial review of any Secretarial determination made with respect to a grant under this subsection, or may appeal and receive a fair hearing on any Secretarial determination involving termination of the center's grant entitlement, modification of the center's service area, termination of a medically underserved population designation within the center's service area, disallowance of any grant expenditures, or a significant reduction in a center's grant amount.
.
Funding for National Health Service Corps
Section 338H(a) of the Public Health Service Act (42 U.S.C. 254q(a)) is amended to read as follows:
Authorization of appropriations
For the purpose of carrying out this section, there is authorized to be appropriated, out of any funds in the Treasury not otherwise appropriated, the following:
For fiscal year 2010, $320,461,632.
For fiscal year 2011, $414,095,394.
For fiscal year 2012, $535,087,442.
For fiscal year 2013, $691,431,432.
For fiscal year 2014, $893,456,433.
For fiscal year 2015, $1,154,510,336.
For fiscal year 2016, and each subsequent fiscal year, the amount appropriated for the preceding fiscal year adjusted by the product of—
one plus the average percentage increase in the costs of health professions education during the prior fiscal year; and
one plus the average percentage change in the number of individuals residing in health professions shortage areas designated under section 333 during the prior fiscal year, relative to the number of individuals residing in such areas during the previous fiscal year.
.