To amend title XVIII of the Social Security Act to enhance the access of medicare beneficiaries who live in medically underserved areas to critical primary and preventive health care benefits, to improve the Medicare+Choice program, and for other purposes.

March 22, 2002

Mr. BINGAMAN (for himself, Mr. BOND, and Mr. INOUYE) introduced the following bill; which was read twice and referred to the Committee on Finance

To amend title XVIII of the Social Security Act to enhance the access of medicare beneficiaries who live in medically underserved areas to critical primary and preventive health care benefits, to improve the Medicare+Choice program, 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; TABLE OF CONTENTS.

(a) SHORT TITLE- This Act may be cited as the `Medicare Safety Net Access Act of 2002'.

(b) TABLE OF CONTENTS- The table of contents of this Act is as follows:

Sec. 1. Short title; table of contents.

Sec. 2. Supplemental reimbursement for Federally qualified health centers participating in medicare managed care.

Sec. 3. Revision of Federally qualified health center payment limits.

Sec. 4. Coverage of additional Federally qualified health center services.

Sec. 5. Providing safe harbor for certain collaborative efforts that benefit medically underserved populations.

SEC. 2. SUPPLEMENTAL REIMBURSEMENT FOR FEDERALLY QUALIFIED HEALTH CENTERS PARTICIPATING IN MEDICARE MANAGED CARE.

(a) SUPPLEMENTAL REIMBURSEMENT-

(1) IN GENERAL- Section 1833(a)(3) of the Social Security Act (42 U.S.C. 1395l(a)(3)) is amended to read as follows:

`(3) in the case of services described in section 1832(a)(2)(D)--

`(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

`(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 Medicare+Choice organization under part C pursuant to a written agreement described in section 1853(j), the amount by which--

`(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

`(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);'.

(b) CONTINUATION OF MEDICARE+CHOICE MONTHLY PAYMENTS-

(1) IN GENERAL- Section 1853 of the Social Security Act (42 U.S.C. 1395w-23) is amended by adding at the end the following new subsection:

`(j) SPECIAL PAYMENT RULE FOR FEDERALLY QUALIFIED HEALTH CENTER SERVICES- If an individual who is enrolled with a Medicare+Choice organization under this part receives a service from a Federally qualified health center that has a written agreement with such organization for providing such a service (including any agreement required under section 1857(e)(3))--

`(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

`(2) the Secretary shall not reduce the amount of the monthly payments to the Medicare+Choice organization made under section 1853(a) as a result of the application of paragraph (1).'.

(2) CONFORMING AMENDMENTS-

(A) Paragraphs (1) and (2) of section 1851(i) of the Social Security Act (42 U.S.C. 1395w-21(i)(1)) are each amended by inserting `1853(j),' after `1853(h),'.

(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)'.

(c) ADDITIONAL MEDICARE+CHOICE CONTRACT REQUIREMENTS- Section 1857(e) of the Social Security Act (42 U.S.C. 1395w-27(e)) is amended by adding at the end the following new paragraph:

`(3) AGREEMENTS WITH FEDERALLY QUALIFIED HEALTH CENTERS-

`(A) ENSURING EQUAL ACCESS TO SERVICES OF FQHCS- A contract under this part shall require the Medicare+Choice organization to enter into (and to demonstrate to the Secretary that it has entered into) a sufficient number of written agreements with Federally qualified health centers providing Federally qualified health center services for which payment may be made under this title in the service area of each Medicare+Choice plan offered by such organization so that such services are reasonably available to individuals enrolled in the plan.

`(B) ENSURING EQUAL PAYMENT LEVELS AND AMOUNTS- A contract under this part shall require the Medicare+Choice organization to provide a level and amount of payment to each Federally qualified health center for services provided by such health center that are covered under the written agreement described in subparagraph (A) that is not less than the level and amount of payment that the organization would make for such services if the services had been furnished by a provider of services that was not a Federally qualified health center.

`(C) COST-SHARING- Under the written agreement described in subparagraph (A), a Federally qualified health center must accept the Medicare+Choice contract price plus the Federal payment 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) and do not result in a total payment to the center in excess of the amount determined under section 1833(a)(3)(A) (calculated as if `100 percent' were substituted for `80 percent' in such section).'.

(d) SAFE HARBOR FROM ANTIKICKBACK PROHIBITION- Section 1128B(b)(3) of the Social Security Act (42 U.S.C. 1320a-7b(b)(3)) is amended--

(1) in subparagraph (E), by striking `and' after the semicolon at the end;

(2) in subparagraph (F), by striking the period at the end and inserting `; and'; and

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

`(G) any remuneration between a Federally qualified health center (or an entity controlled by such a health center) and a Medicare+Choice organization pursuant to the written agreement described in section 1853(j).'.

(e) EFFECTIVE DATE- The amendments made by this section shall apply to services provided on or after January 1, 2003, and contract years beginning on or after such date.

SEC. 3. REVISION OF FEDERALLY QUALIFIED HEALTH CENTER PAYMENT LIMITS.

(a) PER VISIT PAYMENT REQUIREMENTS FOR FQHCS- Section 1833(a)(3)(A) of the Social Security Act (42 U.S.C. 1395l(a)(3)(A)), as amended by section 2(a), is amended by adding `(which regulations may not limit the per visit payment amount, or a component of such amount, for services described in section 1832(a)(2)(D)(ii))' after `the Secretary may prescribe in regulations'.

(b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply to services provided on or after January 1, 2003.

SEC. 4. COVERAGE OF ADDITIONAL FEDERALLY QUALIFIED HEALTH CENTER SERVICES.

(a) COVERAGE FOR FQHC AMBULATORY SERVICES- Section 1861(aa)(3) of the Social Security Act (42 U.S.C. 1395x(aa)(3)) is amended to read as follows:

`(3) The term `Federally qualified health center services' means--

`(A) services of the type described in subparagraphs (A) through (C) of paragraph (1), and such other services furnished by a Federally qualified health center for which payment may otherwise be made under this title if such services were furnished by a health care provider or health care professional other than a Federally qualified health center; and

`(B) preventive primary health services that a center is required to provide under section 330 of the Public Health Service Act,

when furnished to an individual as a patient of a Federally qualified health center.'.

(b) OFFSITE FQHC SERVICES-

(1) PATIENTS OF HOSPITALS AND CRITICAL ACCESS HOSPITALS- Section 1862(a)(14) of the Social Security Act (42 U.S.C. 1395y(a)) is amended by inserting `Federally qualified health center services,' after `qualified psychologist services,'.

(2) EXCLUSION OF FEDERALLY QUALIFIED HEALTH CENTER SERVICES FROM THE PPS FOR SKILLED NURSING FACILITIES- Section 1888(e) of the Social Security Act (42 U.S.C. 1395yy(e)) is amended--

(A) in paragraph (2)(A)(i)(II), by striking `clauses (ii) and (iii)' and inserting `clauses (ii) through (iv)'; and

(B) by adding at the end of paragraph (2)(A) the following new clause:

`(iv) EXCLUSION OF FEDERALLY QUALIFIED HEALTH CENTER SERVICES- Services described in this clause are Federally qualified health center services (as defined in section 1861(aa)(3)).'.

(c) TECHNICAL CORRECTIONS-

(1) Section 1861(aa)(1)(B) of the Social Security Act (42 U.S.C. 1395x(aa)(1)(B)) is amended by striking `subsection (hh)(1)),,' and inserting `subsection (hh)(1)),'.

(2) Clauses (i) and (ii)(II) of section 1861(aa)(4)(A) of the Social Security Act (42 U.S.C. 1395x(aa)(4)(A)) are each amended by striking `(other than subsection (h))'.

(d) EFFECTIVE DATES- The amendments made--

(1) by subsections (a) and (b) shall apply to services furnished on or after January 1, 2003; and

(2) by subsection (c) shall take effect on the date of enactment of this Act.

SEC. 5. PROVIDING SAFE HARBOR FOR CERTAIN COLLABORATIVE EFFORTS THAT BENEFIT MEDICALLY UNDERSERVED POPULATIONS.

(a) IN GENERAL- Section 1128B(b)(3) of the Social Security Act (42 U.S.C. 1320a-7(b)(3)), as amended by section 2(d), is amended--

(1) in subparagraph (F), by striking `and' after the semicolon at the end;

(2) in subparagraph (G), by striking the period at the end and inserting `; and'; and

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

`(H) any remuneration between a public or nonprofit private health center entity described under clauses (i) and (ii) of section 1905(l)(2)(B) and any individual or entity providing goods, items, services, donations or loans, or a combination thereof, to such health center entity pursuant to a contract, lease, grant, loan, or other agreement, if such agreement produces a community benefit that will be used by the health center entity to maintain or increase the availability or accessibility, or enhance the quality, of services provided to a medically underserved population served by the health center entity.'.

(b) RULEMAKING FOR EXCEPTION FOR HEALTH CENTER ENTITY ARRANGEMENTS-

(1) ESTABLISHMENT-

(A) IN GENERAL- The Secretary of Health and Human Services (in this subsection referred to as the `Secretary') shall establish, on an expedited basis, standards relating to the exception for health center entity arrangements to the antikickback penalties described in section 1128B(b)(3)(F) of the Social Security Act, as added by subsection (a).

(B) FACTORS TO CONSIDER- In establishing standards relating to the exception for health center entity arrangements under subparagraph (A), the Secretary--

(i) shall extend the exception where the arrangement between the health center entity and the other party--

(I) results in savings of Federal grant funds or increased revenues to the health center entity;

(II) does not limit or restrict a patient's freedom of choice; and

(III) does not interfere with a health care professional's independent medical judgment regarding medically appropriate treatment; and

(ii) may include other standards and criteria that are consistent with the intent of Congress in enacting the exception established under this subsection.

(2) INTERIM FINAL EFFECT- No later than 60 days after the date of enactment of this Act, the Secretary shall publish a rule in the Federal Register consistent with the factors under paragraph (1)(B). Such rule shall be effective and final immediately on an interim basis, subject to change and revision after public notice and opportunity (for a period of not more than 60 days) for public comment, provided that any change or revision shall be consistent with this subsection.

END