S 1355 ISCommentsClose CommentsPermalink

To amend title XVIII of the Social Security Act to improve access to health care for individuals residing in underserved rural areas and for other purposes.CommentsClose CommentsPermalink

June 25, 2009CommentsClose CommentsPermalink

Mr. BARRASSO (for himself and Mr. WYDEN) introduced the following bill; which was read twice and referred to the Committee on FinanceCommentsClose CommentsPermalink

To amend title XVIII of the Social Security Act to improve access to health care for individuals residing in underserved rural areas and for other purposes.CommentsClose CommentsPermalink

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,CommentsClose CommentsPermalink

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) Short Title- This Act may be cited as the ‘Rural Health Clinic Patient Access and Improvement Act of 2009’.CommentsClose CommentsPermalink





(b) Table of Contents- The table of contents of this Act is as follows:CommentsClose CommentsPermalink





Sec. 1. Short title; table of contents.CommentsClose CommentsPermalink





Sec. 2. Rural health clinic reimbursement.CommentsClose CommentsPermalink





Sec. 3. Rural health clinic quality reporting initiative.CommentsClose CommentsPermalink





Sec. 4. Rural health clinic and community health center collaborative access expansion.CommentsClose CommentsPermalink





Sec. 5. GAO report on diabetes education and medical nutrition therapy services.CommentsClose CommentsPermalink





Sec. 6. Rural health clinic provider retention demonstration project.CommentsClose CommentsPermalink





Sec. 7. Definition of rural health clinic.CommentsClose CommentsPermalink





Sec. 8. Medicare Advantage plan payments.CommentsClose CommentsPermalink





Sec. 9. Sense of the Senate regarding adequacy of network-based health plans.CommentsClose CommentsPermalink

SEC. 2. RURAL HEALTH CLINIC REIMBURSEMENT.

Section 1833(f) of the Social Security Act (42 U.S.C. 1395l(f)) is amended--CommentsClose CommentsPermalink





(1) in paragraph (1), by striking ‘, and’ at the end and inserting a semicolon;CommentsClose CommentsPermalink





(2) in paragraph (2)--CommentsClose CommentsPermalink





(A) by striking ‘in a subsequent year’ and inserting ‘after 1988 and before 2010’; andCommentsClose CommentsPermalink





(B) by striking the period at the end and inserting a semicolon; andCommentsClose CommentsPermalink





(3) by adding at the end the following new paragraphs:CommentsClose CommentsPermalink





‘(3) in 2010, at $92 per visit; andCommentsClose CommentsPermalink





‘(4) in a subsequent year, at the limit established under this subsection for the previous year increased by the percentage increase in the MEI (as defined in section 1842(i)(3)) applicable to primary care services (as defined in section 1842(i)(4)) furnished as of the first day of that year.’.CommentsClose CommentsPermalink

SEC. 3. RURAL HEALTH CLINIC QUALITY REPORTING INITIATIVE.

Section 1833 of the Social Security Act (42 U.S.C. 1395l) is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





‘(x) Incentive Payments for Rural Health Clinic Quality Reporting-CommentsClose CommentsPermalink





‘(1) IN GENERAL- The Secretary shall implement a system to provide incentive payments for the satisfactory reporting of data on quality measures by eligible professionals, as defined in subsection (k)(3)(B) of section 1848, who are employed by a rural health clinic or provide services in a rural health clinic through a contractual arrangement, similar to the reporting system for covered professional services as established under subsections (k) and (m) of such section.CommentsClose CommentsPermalink





‘(2) AMOUNT; DURATION- Incentive payments in the amount of $2 per visit shall be made to rural health clinics with respect to eligible professionals who furnish rural health clinic services during the period beginning on January 1, 2010, and ending on December 31, 2013.CommentsClose CommentsPermalink





‘(3) PAYMENT FROM TRUST FUND- The incentive payments provided under this subsection shall be made available from the Federal Supplementary Medical Insurance Trust Fund under section 1841.CommentsClose CommentsPermalink





‘(4) PAYMENT LIMITS- Incentive payments made under this subsection shall not be subject to the payment limits established under subsection (f).CommentsClose CommentsPermalink





‘(5) SINGLE FORM- The Secretary shall provide rural health clinics that participate in the quality reporting system under this subsection with a single form for submission of data on quality measures and reimbursement claim information.CommentsClose CommentsPermalink





‘(6) REPORTING- Not later than December 31, 2012, the Secretary shall prepare and submit a report to Congress on the quality reporting system established under this subsection, including--CommentsClose CommentsPermalink





‘(A) the number and types of services involved in the system;CommentsClose CommentsPermalink





‘(B) the number of rural health clinics participating in the system;CommentsClose CommentsPermalink





‘(C) the overall quality of care that was delivered by the rural health clinics during this period;CommentsClose CommentsPermalink





‘(D) the patient outcomes under the system;CommentsClose CommentsPermalink





‘(E) recommendations for improving the system; andCommentsClose CommentsPermalink





‘(F) any additional related matters that the Secretary determines appropriate.’.CommentsClose CommentsPermalink

SEC. 4. RURAL HEALTH CLINIC AND COMMUNITY HEALTH CENTER COLLABORATIVE ACCESS EXPANSION.

Section 330 of the Public Health Service Act (42 U.S.C. 254b) is amended by adding at the end the following:CommentsClose CommentsPermalink





‘(s) Rule of Construction With Respect to Rural Health Clinics-CommentsClose CommentsPermalink





‘(1) IN GENERAL- Nothing in this section shall be construed to prevent a community health center from contracting with a federally certified rural health clinic (as defined by section 1861(aa)(2) of the Social Security Act) for the delivery of primary health care services that are available at the rural health clinic to individuals who would otherwise be eligible for free or reduced cost care if that individual were able to obtain that care at the community health center. Such services may be limited in scope to those primary health care services available in that rural health clinic.CommentsClose CommentsPermalink





‘(2) ASSURANCES- In order for a rural health clinic to receive funds under this section through a contract with a community health center under paragraph (1), such rural health clinic shall establish policies to ensure--CommentsClose CommentsPermalink





‘(A) nondiscrimination based upon the ability of a patient to pay; andCommentsClose CommentsPermalink





‘(B) the establishment of a sliding fee scale for low-income patients.’.CommentsClose CommentsPermalink

SEC. 5. GAO REPORT ON DIABETES EDUCATION AND MEDICAL NUTRITION THERAPY SERVICES.

Not later than July 1, 2012, the Comptroller General of the United States shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report concerning the medical nutrition therapy counseling services provided by federally qualified health clinics. Such report shall specifically examine--CommentsClose CommentsPermalink





(1) the availability, health provider cost, reimbursement amount, and barriers to diabetes education and medical nutrition therapy services in federally qualified health clinics;CommentsClose CommentsPermalink





(2) the availability, health provider cost, reimbursement amount, and quality outcomes of diabetes education and medical nutrition therapy services in rural and frontier areas;CommentsClose CommentsPermalink





(3) the feasibility of implementing diabetes education and medical nutrition therapy services in rural health clinics; andCommentsClose CommentsPermalink





(4) to the extent practical, analyze existing health outcomes and cost savings attributed to diabetes education and medical nutrition therapy services provided by federally qualified health centers and the potential health outcomes and cost savings if those services are offered in rural health clinics.CommentsClose CommentsPermalink

SEC. 6. RURAL HEALTH CLINIC PROVIDER RETENTION DEMONSTRATION PROJECT.

(a) In General- The Secretary shall establish a demonstration project under which States are awarded grants to examine whether health care professionals can be recruited or retained to work in underserved rural areas by providing such professionals with medical malpractice subsidies.CommentsClose CommentsPermalink





(b) Duration; Scope- The demonstration project shall be conducted--CommentsClose CommentsPermalink





(1) for a 3-year period, beginning not later than January 1, 2011; andCommentsClose CommentsPermalink





(2) in not more than 5 States.CommentsClose CommentsPermalink





(c) State Application- A State that desires to receive a grant under the demonstration project shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require, including adequate assurances that the State--CommentsClose CommentsPermalink





(1) promotes the establishment and continued maintenance of rural health clinics within the State; andCommentsClose CommentsPermalink





(2) is working to improve access to primary care and other health care services for rural residents of the State.CommentsClose CommentsPermalink





(d) State Selection- In awarding grants to States under this section, the Secretary shall--CommentsClose CommentsPermalink





(1) ensure the participation of States with a diverse selection of rural health clinics, including clinics with 3 or less full-time equivalent physicians, physician assistants, and nurse practitioners;CommentsClose CommentsPermalink





(2) ensure the participation of States that maintain both provider-based and independent rural health clinics;CommentsClose CommentsPermalink





(3) give preference to States with existing State-funded medical malpractice subsidy programs; andCommentsClose CommentsPermalink





(4) give preference to States with 15 or more rural health clinics.CommentsClose CommentsPermalink





(e) Distribution of Grant Funds by States to Rural Health Clinics-CommentsClose CommentsPermalink





(1) IN GENERAL- A State awarded a grant under the demonstration project shall, acting through the State Office of Rural Health, select not less than 5 rural health clinics to receive grant funds for the purpose of subsidizing medical malpractice insurance costs for health care professionals employed by such clinics.CommentsClose CommentsPermalink





(2) RURAL HEALTH CLINIC APPLICATION- A rural health clinic that desires to receive a grant from the State under the demonstration project shall submit to the State Office of Rural Health an application at such time, in such manner, and containing such information as the Secretary may require, including assurances that the clinic shall--CommentsClose CommentsPermalink





(A) provide access to health care services for all individuals, regardless of ability to pay;CommentsClose CommentsPermalink





(B) establish a sliding fee scale for low-income patients;CommentsClose CommentsPermalink





(C) make health care services available to individuals for not less than 20 hours per week; andCommentsClose CommentsPermalink





(D) meet any other requirements established by the Secretary to ensure proper and efficient use of grant funds.CommentsClose CommentsPermalink





(3) REQUIRED CLINIC PARTICIPATION- A State awarded a grant under the demonstration project shall provide grant funds to at least 1 provider-based rural health clinic and at least 1 independent rural health clinic.CommentsClose CommentsPermalink





(4) DISTRIBUTION OF GRANT FUNDS-CommentsClose CommentsPermalink





(A) IN GENERAL- Subject to paragraph (B), a State shall provide each rural health clinic participating in the demonstration project with the lesser of--CommentsClose CommentsPermalink





(i) $5,000; orCommentsClose CommentsPermalink





(ii) 50 percent of the aggregate cost of malpractice insurance purchased by each physician, physician assistant, nurse practitioner, and certified nurse midwife (or purchased by the rural health clinic on behalf of each physician, physician assistant, nurse practitioner, and certified nurse midwife) who, on a weekly basis, provides patient care services at the rural health clinic for an average of not less than--CommentsClose CommentsPermalink





(I) 20 hours per week; orCommentsClose CommentsPermalink





(II) 80 percent of the operational hours of the clinic.CommentsClose CommentsPermalink





(B) SPECIAL RULE FOR OBSTETRICS AND GYNECOLOGY- Subject to subparagraph (C), in the case of a rural health clinic participating in the demonstration project that provides obstetrical services, a State shall provide such clinic with the lesser of--CommentsClose CommentsPermalink





(i) $10,000; orCommentsClose CommentsPermalink





(ii) 50 percent of the aggregate cost of malpractice insurance purchased by each physician, physician assistant, nurse practitioner, and certified nurse midwife (or purchased by the rural health clinic on behalf of each physician, physician assistant, nurse practitioner, and certified nurse midwife) who provides obstetrical services at the rural health clinic.CommentsClose CommentsPermalink





(C) AMOUNT OF OBSTETRICAL CARE- The Administrator of the Office of Rural Health Policy of the Health Resources and Services Administration shall develop standards for the amount of obstetrical care that a rural health clinic would have to provide in order to qualify for a grant under subparagraph (B).CommentsClose CommentsPermalink





(f) Reporting-CommentsClose CommentsPermalink





(1) ANNUAL EVALUATIONS AND REPORTS- The Secretary, acting through the Administrator of the Office of Rural Health Policy of the Health Resources and Services Administration, shall provide for an annual evaluation of the demonstration project and submit to Congress a report on the status of the project.CommentsClose CommentsPermalink





(2) FINAL EVALUATION AND REPORT- Not later than 12 months after completion of the demonstration project, the Secretary, acting through the Administrator of the Office of Rural Health Policy of the Health Resources and Services Administration, shall prepare and submit to Congress a final report and evaluation of the project. The report shall include--CommentsClose CommentsPermalink





(A) an assessment of the effectiveness of the project at recruiting and retaining health care professionals in underserved rural areas;CommentsClose CommentsPermalink





(B) an assessment of the feasibility and efficacy of an expansion of the project to all States; andCommentsClose CommentsPermalink





(C) an evaluation of the project in comparison with an expansion of coverage under chapter 171 of title 28, United States Code (commonly referred to as the ‘Federal Tort Claims Act’) to include rural health clinics as a means of recruiting and retaining health care professionals in underserved rural areas.CommentsClose CommentsPermalink





(g) Definitions- In this section:CommentsClose CommentsPermalink





(1) CERTIFIED NURSE MIDWIFE- The term ‘certified nurse midwife’ has the same meaning given such term in section 1861(gg)(2) of the Social Security Act (42 U.S.C. 1395x(gg)(2)).CommentsClose CommentsPermalink





(2) DEMONSTRATION PROJECT- The term ‘demonstration project’ means the demonstration project conducted under this section.CommentsClose CommentsPermalink





(3) NURSE PRACTITIONER; PHYSICIAN ASSISTANT; RURAL HEALTH CLINIC- The terms ‘nurse practitioner’, ‘physician assistant’, and ‘rural health clinic’ have the same meaning given such terms in section 1861(aa) of the Social Security Act (42 U.S.C. 1395x(aa)).CommentsClose CommentsPermalink





(4) PHYSICIAN- The term ‘physician’ has the same meaning given such term in section 1861(r) of the Social Security Act (42 U.S.C. 1395x(r)).CommentsClose CommentsPermalink





(5) SECRETARY- The term ‘Secretary’ means the Secretary of Health and Human Services.CommentsClose CommentsPermalink

SEC. 7. DEFINITION OF RURAL HEALTH CLINIC.

Section 1861(aa)(2) of the Social Security Act (42 U.S.C. 1395x(aa)(2)) is amended in the flush text by inserting before the last sentence the following: ‘A facility that is in operation, that qualifies as a rural health clinic under this title or title XIX and that subsequently fails to satisfy the requirement in clause (i) that the clinic is not located in an urbanized area, shall, with respect to services furnished on or after the date of enactment of the Rural Health Clinic Patient Access and Improvement Act of 2009, be considered, for purposes of this title and title XIX, as still satisfying such requirement if it is determined that the clinic is located in an area defined by the State and certified by the Secretary as rural.’.CommentsClose CommentsPermalink

SEC. 8. MEDICARE ADVANTAGE PLAN PAYMENTS.

(a) In General- Section 1857(e) of the Social Security Act (42 U.S.C. 1395w-27(e)) is amended by adding at the end the following:CommentsClose CommentsPermalink





‘(4) MINIMUM PAYMENT RATE FOR SERVICES FURNISHED BY A RURAL HEALTH CLINIC- A contract under this section between a Medicare Advantage organization and the Secretary for the offering of a Medicare Advantage plan shall require the organization to provide for a payment rate under the plan for rural health clinic services furnished to enrollees of the plan (whether or nor the services are furnished pursuant to an agreement between the organization and a rural health clinic) that is not less than--CommentsClose CommentsPermalink





‘(A) the applicable payment rate established under part A or part B (which includes the payment of an interim rate and a subsequent cost reconciliation) with respect to the rural health clinic for such rural health clinic services; orCommentsClose CommentsPermalink





‘(B) if the rural health clinic determines appropriate, 103 percent of the applicable interim payment rate established under part A or part B with respect to the rural health clinic for such rural health clinic services.’.CommentsClose CommentsPermalink





(b) Effective Date- The amendments made by this section shall apply to Medicare Advantage contract years beginning on or after January 1, 2010.CommentsClose CommentsPermalink

SEC. 9. SENSE OF THE SENATE REGARDING ADEQUACY OF NETWORK-BASED HEALTH PLANS.

It is the sense of the Senate that network-based health plans shall--CommentsClose CommentsPermalink





(1) be expected to provide a pool of health care professionals that is adequate to meet the needs of enrollees residing in rural and frontier areas;CommentsClose CommentsPermalink





(2) ensure that enrollees residing in rural and frontier areas that have been designated by the Federal Government or a State government as lacking an adequate number of health care professionals are provided with reasonable access to an in-network provider;CommentsClose CommentsPermalink





(3) make every effort to include as part of their provider network any State-licensed or certified health care professionals (particularly primary care and mental health professionals) that are available in many underserved rural and frontier areas; andCommentsClose CommentsPermalink





(4) recognize that reliance on a physician-only network, or forcing enrollees to travel for more than 30 minutes to receive primary care or mental health services from a network provider, does not constitute an ‘adequate’ network. The following distances should be used as guidelines in determining distances that correspond to a 30-minute travel time:CommentsClose CommentsPermalink





(A) Under normal conditions with primary roads available: 20 miles.CommentsClose CommentsPermalink





(B) In mountainous terrain or in areas with only secondary roads available: 15 miles.CommentsClose CommentsPermalink





(C) In flat terrain or in areas connected by interstate highways: 25 miles.CommentsClose CommentsPermalink