110th CONGRESS
1st Session
H. R. 1683
To amend the Public Health Service Act to provide for community
projects that will reduce the number of individuals who are uninsured with
respect to health care, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
March 26, 2007
Mr. HOEKSTRA (for himself, Mr. STUPAK, Mr. LARSEN of Washington, Mr. SOUDER,
Mr. EHLERS, Mr. UPTON, Mr. BOOZMAN, Mr. MCHUGH, Mr. GILLMOR, Mr. CHABOT,
Mr. VAN HOLLEN, Mr. MCCOTTER, Ms. KAPTUR, Mr. RYAN of Ohio, Mr. LATHAM,
Mr. NUNES, Mr. RADANOVICH, and Mr. CAMP of Michigan) introduced the following
bill; which was referred to the Committee on Energy and Commerce
A BILL
To amend the Public Health Service Act to provide for community
projects that will reduce the number of individuals who are uninsured with
respect to health care, 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 `Communities Building Access Act'.
SEC. 2. FINDINGS.
The Congress finds as follows:
(1) Two models of community programs for the uninsured have emerged as
effective in generating community support and funding in urban and rural
areas; in providing effective care and coverage for the uninsured; in
avoiding displacement of private coverage; and in avoiding duplication
of other Federal programs for the uninsured.
(2) These community models have demonstrated community-wide economic benefit.
Employers in the community experience less health care cost-shifting,
in addition to increased productivity and employee retention. With greater
emphasis on preventive and chronic care, a community's uninsured population
becomes less of a financial burden on State and local budgets.
(3) These community models have demonstrated potential national solutions
for certain uninsured populations, including the working uninsured. Such
lessons learned from these models include, for example, the level of subsidy
necessary to get small employers to purchase coverage for their employees,
how to effectively market access programs to the uninsured, and how to
effectively manage chronic care among lower-income populations.
(4) These community models have succeeded in raising much of the funding
necessary to function, but have lacked financial stability and would enjoy
greater success with a stable partial funding stream from the Federal
Government.
(5) These community models, if involved in a Federal partnership, have
the ability and willingness to be accountable for a return on investment
for Federal funding, and to disseminate expertise to like-minded communities.
SEC. 3. GRANTS FOR MULTI-SHARE HEALTH CARE COVERAGE PROJECTS FOR UNINSURED
WORKING INDIVIDUALS.
Subpart I of part D of title III of the Public Health Service Act (42 U.S.C.
254b et seq.) is amended by adding at the end the following:
`SEC. 330M. MULTI-SHARE HEALTH CARE COVERAGE PROJECTS FOR UNINSURED WORKING
INDIVIDUALS.
`(a) In General- The Secretary shall make grants to public or nonprofit
private entities to carry out demonstration projects for the purpose of--
`(1) making available, on a cost-sharing basis as described in subsection
(c)(2)(C), health care coverage to qualifying employees through employers
that have not contributed to health care benefits for employees during
the 12-month period prior to participating in such a project; and
`(2) making available, on such basis, health care coverage to qualifying
self-employed individuals who have been without such coverage during the
12-month period prior to participating in such a project.
`(b) Qualifying Employees and Self-Employed Individuals- For purposes of
this section, the term `qualifying', with respect to an employee or self-employed
individual, means that the employee or self-employed individual is not eligible
for health services under the program under title XVIII, XIX, or XXI of
the Social Security Act (relating to the Medicare program, the Medicaid
program, and the State children's health insurance program, respectively).
`(c) Requirements for Grant-
`(1) IN GENERAL- A grant may be made under subsection (a) for a project
only if the applicant involved--
`(A) has defined a service area for the project;
`(B) has formed a consortium of entities in such service area, which
consortium is composed of employers whose employees may or may not be
served by the project, health care providers who will provide services
through the project, and other appropriate entities;
`(C) has ensured that the consortium has established a set of unified
goals for the project;
`(D) has conducted a basic level of demographic research to obtain data
on the uninsured businesses, working uninsured, and provider community
within the service area in order to determine the potential value and
effectiveness of operating such a project, which data includes--
`(i) the rate of uncompensated care;
`(ii) the number of women lacking prenatal services;
`(iii) immunization rates; and
`(iv) the number of employers that do not provide health insurance
to their employees; and
`(E) has conducted a basic evaluation of State health insurance and
local laws that might impact the implementation of the project.
`(2) AGREEMENTS- A grant may be made under subsection (a) for a project
only if the applicant involved agrees as follows:
`(A) Eligibility criteria will be established for employers to participate
in the project, including the requirement that the employers be located
within the service area defined under paragraph (1)(A) for the project,
which may include--
`(i) a maximum average income earned by the employees of the business;
`(ii) criteria, in addition to the 12-month periods under subsection
(a), to avoid creating any incentive for an employer or self-employed
individual to discontinue health plans or health insurance policies;
and
`(iii) such other criteria as the consortium under paragraph (1)(B)
considers to be appropriate.
`(B) A network of health care providers will be formed to provide services
to qualifying employees and self-employed individuals who participate
in the project, which services will be provided according to a schedule
of fees and copayments negotiated by the project.
`(C) Of the cost of providing health care coverage through the project--
`(i) not more than 30 percent will be paid by the project with funds
from the grant; and
`(ii) not less than 70 percent will be paid by the employer, the employee,
and any additional sources of funds (such as the community in which
the project is located) that may be available pursuant to arrangements
with the project.
`(D) A minimum benefit package will be selected that includes--
`(i) physicians services;
`(ii) prescription drug benefits;
`(iii) in-patient hospital services;
`(iv) out-patient services;
`(v) emergency room visits;
`(vi) emergency ambulance services; and
`(vii) diagnostic laboratory tests and x-rays.
With respect to compliance with the agreement under this subparagraph,
the project is not required to provide coverage for any service performed
outside the service area of the project, except to the extent that a
service specified in any of clauses (i) through (vii) is not reasonably
available within the service area.
`(E) The minimum benefit package will not exclude coverage of a medical
condition on the basis that it is a pre-existing condition.
`(F) An entity will be selected by the consortium under paragraph (1)(B)
to carry out administrative and accounting functions with respect to
the health care coverage to be offered by the project, including monthly
billings, verification and enrollment of eligible employers and employees,
maintenance of membership rosters, operation of the utilization management
program under subparagraph (G), and development of a marketing plan.
`(G) A utilization management program will be selected that ensures
delivery of care in the appropriate setting, using appropriate resources
and clinical practice guidelines.
`(H) A plan will be implemented for measuring quality and efficiency
of care provided through the project within two years after the project
begins operation.
`(I) A plan will be implemented for managing care for enrollees with
chronic illness, as well as additional cost-control initiatives that
will be employed by the project within 2 years after the project begins
operation.
`(J) A plan will be implemented for protecting the project from high
risks, which may include affiliation with State high-risk pool or local
safety net program, and purchase of reinsurance.
`(K) A plan will be implemented for evaluating the project on an interim
basis, not less frequently than annually.
`(d) Application for Grant- A grant may be made under subsection (a) only
if an application for the grant is submitted to the Secretary and the application
is in such form, is made in such manner, and contains such agreements, assurances,
and information as the Secretary determines to be necessary to carry out
this section.
`(e) Authorization of Appropriations- For the purpose of making grants under
subsection (a), there is authorized to be appropriated $36,000,000 in the
aggregate for the fiscal years 2008 through 2014, of which there are authorized
to be appropriated amounts as follows:
`(1) For fiscal year 2008, $2,000,000.
`(2) For each of the fiscal years 2009 and 2010, $5,000,000.
`(3) For each of the fiscal years 2011 through 2014, $6,000,000.
`SEC. 330N. GRANTS FOR VOLUNTEER SPECIALTY PROVIDER NETWORKS.
`(a) In General- The Secretary shall make grants to public or nonprofit
private entities to carry out demonstration projects for the purpose of
forming and maintaining networks composed of health care specialists who
volunteer health services to eligible individuals.
`(b) Eligible Individuals- For purposes of this section, the term `eligible
individual' means an individual who has been enrolled by a project under
subsection (a) and--
`(1) whose employer does not provide health care coverage;
`(2) is unable to obtain health care coverage through a family member
or common law partner;
`(3) is at or below a poverty level specified by the Secretary; and
`(4) is not eligible for health services under the program under title
XVIII, XIX, or XXI of the Social Security Act (relating to the Medicare
program, the Medicaid program, and the State children's health insurance
program, respectively).
`(c) Qualified Grant Expenditures- A grant may be made under subsection
(a) for a project only if the applicant involved agrees that the grant will
be expended to assist specialists that are participants in the network involved
through any or all of the following means:
`(1) Paying nominal administrative fees to the participants for the costs
of providing services to eligible individuals.
`(2) Assisting with the cost of training primary care practitioners to
manage the chronic conditions that are most often treated by the network
specialists.
`(3) Assisting participants with the costs of providing fees to recruit
specialists to practice in the service area of the project.
`(4) Assisting with the costs of operating a community clinic staffed
by volunteer network specialists.
`(5) Assisting participants with the costs of installing or operating
information technology that is of benefit to patients, such as technology
to avoid medical errors or to facilitate the authorized electronic transfer
of the health records of eligible individuals.
`(6) Paying for necessary prescription drug costs for necessary treatment
prescribed by network specialists.
`(7) Such additional means as the Secretary may authorize.
`(d) Certain Requirements for Grant- A grant may be made under subsection
(a) for a project only if the applicant involved--
`(1) has defined a service area for the project;
`(2) has formed a consortium of various community members, leaders, and
organizations in such area;
`(3) has ensured that the consortium has established a set of unified
goals for the project;
`(4) has conducted the basic level of demographic research described in
section 330M(c)(1)(D);
`(5) has a plan for managing the care of eligible individuals with chronic
illness; and
`(6) has a plan for evaluating the project on an interim basis, not less
frequently than once each year.
`(1) IN GENERAL- With respect to the costs of the project to be carried
out under subsection (a) by an applicant, a grant under such subsection
may be made only if the applicant agrees to make available (directly or
through donations from public or private entities) non-Federal contributions
toward such costs in an amount that is not less than 1/3 of such costs
($1 for each $2 provided in the grant).
`(2) DETERMINATION OF AMOUNT CONTRIBUTED- Non-Federal contributions required
in paragraph (1) may be in cash or in kind, fairly evaluated, including
plant, equipment, or services. Amounts provided by the Federal Government,
or services assisted or subsidized to any significant extent by the Federal
Government, may not be included in determining the amount of such non-Federal
contributions.
`(f) Application for Grant- A grant may be made under subsection (a) only
if an application for the grant is submitted to the Secretary and the application
is in such form, is made in such manner, and contains such agreements, assurances,
and information as the Secretary determines to be necessary to carry out
this section.
`(g) Authorization of Appropriations- For the purpose of making grants under
subsection (a), there is authorized to be appropriated $9,000,000 in the
aggregate for the fiscal years 2008 through 2014, of which there are authorized
to be appropriated amounts as follows:
`(1) For each of the fiscal years 2008 and 2009, $500,000.
`(2) For each of the fiscal years 2010 and 2011, $1,000,000.
`(3) For each of the fiscal years 2012 through 2014, $2,000,000.
`SEC. 330O. CLEARINGHOUSE FOR INFORMATION ON COMMUNITY-INITIATED PROJECTS
TO PROVIDE HEALTH CARE COVERAGE TO UNINSURED INDIVIDUALS.
`(a) In General- The Secretary shall make an award of a grant or contract
for the establishment and operation of a clearinghouse to collect and make
available, on a national basis, information on projects under sections 330M
and 330N and similar projects that are community-initiated (referred to
in this section as `access projects').
`(b) Certain Requirements- The Secretary shall ensure that the information
collected and made available under subsection (a) by the Clearinghouse includes
the following:
`(1) A database identifying technical-assistance experts who are or have
been involved in the planning or operation of access projects.
`(2) Information regarding the success and progress of access projects,
including--
`(A) information on best-practices identified for such projects;
`(B) the number of individuals who lacked health care coverage prior
to receiving such coverage through the projects;
`(C) the number of individuals served by the projects who have chronic
conditions that are managed by the projects;
`(D) the economic impact of the projects for businesses in the communities
in which the projects operated; and
`(E) the savings of hospitals and other health care providers in such
communities that resulted from the operation of the projects.
`(c) Application- An award may be made under subsection (a) only if an application
for the award is submitted to the Secretary and the application is in such
form, is made in such manner, and contains such agreements, assurances,
and information as the Secretary determines to be necessary to carry out
this section.
`(d) Solicitation of Reports- The Secretary may carry out a program to encourage
public and private entities that plan or operate access projects to submit
to the Clearinghouse reports that provide information on the projects.
`(e) Definition- For purposes of this section, the term `Clearinghouse'
means the clearinghouse under subsection (a).
`(f) Authorization of Appropriation- For the purpose of making awards under
subsection (a), there are authorized to be appropriated such sums as may
be necessary for each of the fiscal years 2008 through 2014.'.
END
