Communities Building Access Act - Amends the Public Health Service Act to require the Secretary of Health and Human Services (HHS) to make grants to public or nonprofit private entities to carry out demonstration projects for the purpose of making health care coverage available, on a cost-sharing basis, to: (1) employees through employers that have not contributed to health care benefits for employees during the prior 12 months; and (2) self-employed individuals who have been without such coverage during the prior 12 months.
Requires the Secretary to make matching 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.
Directs the Secretary to make an award of a grant or contract for the establishment and operation of a clearinghouse for information on demonstration projects under this Act and similar projects that are community initiated. Allows the Secretary to carry out a program to encourage public and private entities that plan or operate such projects to submit information to the clearinghouse.
[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2925 Introduced in House (IH)]
111th CONGRESS
1st Session
H. R. 2925
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
June 17, 2009
Mr. Hoekstra (for himself, Mr. Ehlers, Mr. Heller, and Mr. Barrett of
South Carolina) 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 2 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 2010 through 2016, of
which there are authorized to be appropriated amounts as follows:
``(1) For fiscal year 2010, $2,000,000.
``(2) For each of the fiscal years 2011 and 2012,
$5,000,000.
``(3) For each of the fiscal years 2013 through 2016,
$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.
``(e) Matching Funds.--
``(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 2010 through 2016, of
which there are authorized to be appropriated amounts as follows:
``(1) For each of the fiscal years 2010 and 2011, $500,000.
``(2) For each of the fiscal years 2012 and 2013,
$1,000,000.
``(3) For each of the fiscal years 2014 through 2016,
$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 2010 through
2016.''.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
Referred to the Subcommittee on Health.
Llama 3.2 · runs locally in your browser
Ask anything about this bill. The AI reads the full text to answer.
Enter to send · Shift+Enter for new line