Index for HR3962: Affordable Health Care for America Act

To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.

Mr. Dingell (for himself, Mr. Rangel, Mr. Waxman, Mr. George Miller of California, Mr. Stark, Mr. Pallone, and Mr. Andrews) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Labor, Oversight and Government Reform, and the Budget, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

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

(a) In general.—Part Q of title III (42 U.S.C. 280h et seq.) is amended by adding at the end the following:

“(a) Program.—The Secretary shall establish a school-based health clinic program consisting of awarding grants to eligible entities to support the operation of school-based health clinics (referred to in this section as ‘SBHCs’).

“(b) Eligibility.—To be eligible for a grant under this section, an entity shall—

“(1) be an SBHC (as defined in subsection (l)(3)); and

“(2) submit an application at such time, in such manner, and containing such information as the Secretary may require, including at a minimum—

“(A) evidence that the applicant meets all criteria necessary to be designated as an SBHC;

“(B) evidence of local need for the services to be provided by the SBHC;

“(C) an assurance that—

“(i) SBHC services will be provided in accordance with Federal, State, and local laws;

“(ii) the SBHC has established and maintains collaborative relationships with other health care providers in the catchment area of the SBHC;

“(iii) the SBHC will provide onsite access during the academic day when school is in session and has an established network of support and access to services with backup health providers when the school or SBHC is closed;

“(iv) the SBHC will be integrated into the school environment and will coordinate health services with appropriate school personnel and other community providers co-located at the school; and

“(v) the SBHC sponsoring facility assumes all responsibility for the SBHC administration, operations, and oversight; and

“(D) such other information as the Secretary may require.

“(c) Use of funds.—Funds awarded under a grant under this section—

“(1) may be used for—

“(A) providing training related to the provision of comprehensive primary health services and additional health services;

“(B) the management and operation of SBHC programs, including through subcontracts; and

“(C) the payment of salaries for health professionals and other appropriate SBHC personnel; and

“(2) may not be used to provide abortions.

“(d) Consideration of need.—In determining the amount of a grant under this section, the Secretary shall take into consideration—

“(1) the financial need of the SBHC;

“(2) State, local, or other sources of funding provided to the SBHC; and

“(3) other factors as determined appropriate by the Secretary.

“(e) Preferences.—In awarding grants under this section, the Secretary shall give preference to SBHCs that have a demonstrated record of service to at least one of the following:

“(1) A high percentage of medically underserved children and adolescents.

“(2) Communities or populations in which children and adolescents have difficulty accessing health and mental health services.

“(3) Communities with high percentages of children and adolescents who are uninsured, underinsured, or eligible for medical assistance under Federal or State health benefits programs (including titles XIX and XXI of the Social Security Act).

“(f) Matching requirement.—The Secretary may award a grant to an SBHC under this section only if the SBHC agrees to provide, from non-Federal sources, an amount equal to 20 percent of the amount of the grant (which may be provided in cash or in kind) to carry out the activities supported by the grant.

“(g) Supplement, not supplant.—The Secretary may award a grant to an SBHC under this section only if the SBHC demonstrates to the satisfaction of the Secretary that funds received through the grant will be expended only to supplement, and not supplant, non-Federal and Federal funds otherwise available to the SBHC for operation of the SBHC (including each activity described in paragraph (1) or (2) of subsection (c)).

“(h) Payor of last resort.—The Secretary may award a grant to an SBHC under this section only if the SBHC demonstrates to the satisfaction of the Secretary that funds received through the grant will not be expended for any activity to the extent that payment has been made, or can reasonably be expected to be made—

“(1) under any insurance policy;

“(2) under any Federal or State health benefits program (including titles XIX and XXI of the Social Security Act); or

“(3) by an entity which provides health services on a prepaid basis.

“(i) Regulations regarding reimbursement for health services.—The Secretary shall issue regulations regarding the reimbursement for health services provided by SBHCs to individuals eligible to receive such services through the program under this section, including reimbursement under any insurance policy or any Federal or State health benefits program (including titles XIX and XXI of the Social Security Act).

“(j) Technical Assistance.—The Secretary shall provide (either directly or by grant or contract) technical and other assistance to SBHCs to assist such SBHCs to meet the requirements of this section. Such assistance may include fiscal and program management assistance, training in fiscal and program management, operational and administrative support, and the provision of information to the SBHCs of the variety of resources available under this title and how those resources can be best used to meet the health needs of the communities served by the SBHCs.

“(k) Evaluation; report.—The Secretary shall—

“(1) develop and implement a plan for evaluating SBHCs and monitoring quality performances under the awards made under this section; and

“(2) submit to the Congress on an annual basis a report on the program under this section.

“(l) Definitions.—In this section:

“(1) COMPREHENSIVE PRIMARY HEALTH SERVICES.—The term ‘comprehensive primary health services’ means the core services offered by SBHCs, which—

“(A) shall include—

“(i) comprehensive health assessments, diagnosis, and treatment of minor, acute, and chronic medical conditions and referrals to, and followup for, specialty care; and

“(ii) mental health assessments, crisis intervention, counseling, treatment, and referral to a continuum of services including emergency psychiatric care, community support programs, inpatient care, and outpatient programs; and

“(B) may include additional services, such as oral health, social, and age-appropriate health education services, including nutritional counseling.

“(2) MEDICALLY UNDERSERVED CHILDREN AND ADOLESCENTS.—The term ‘medically underserved children and adolescents’ means a population of children and adolescents who are residents of an area designated by the Secretary as an area with a shortage of personal health services and health infrastructure for such children and adolescents.

“(3) SCHOOL-BASED HEALTH CLINIC.—The term ‘school-based health clinic’ means a health clinic that—

“(A) is located in, or is adjacent to, a school facility of a local educational agency;

“(B) is organized through school, community, and health provider relationships;

“(C) is administered by a sponsoring facility;

“(D) provides comprehensive primary health services during school hours to children and adolescents by health professionals in accordance with State and local laws and regulations, established standards, and community practice; and

“(E) does not perform abortion services.

“(4) SPONSORING FACILITY.—The term ‘sponsoring facility’ is—

“(A) a hospital;

“(B) a public health department;

“(C) a community health center;

“(D) a nonprofit health care entity whose mission is to provide access to comprehensive primary health care services;

“(E) a local educational agency; or

“(F) a program administered by the Indian Health Service or the Bureau of Indian Affairs or operated by an Indian tribe or a tribal organization under the Indian Self-Determination and Education Assistance Act, a Native Hawaiian entity, or an urban Indian program under title V of the Indian Health Care Improvement Act.

“(m) Authorization of appropriations.—For purposes of carrying out this section, there are authorized to be appropriated $50,000,000 for fiscal year 2011 and such sums as may be necessary for each of fiscal years 2012 through 2015.”.

(b) Effective date.—The Secretary of Health and Human Services shall begin awarding grants under section 399Z–1 of the Public Health Service Act, as added by subsection (a), not later than July 1, 2010, without regard to whether or not final regulations have been issued under section 399Z–1(i) of such Act.

(c) Termination of study.—Section 2(b) of the Health Care Safety Net Act of 2008 (42 U.S.C. 254b note) is amended by striking paragraph (2) (relating to a school-based health center study).

Title III (42 U.S.C. 241 et seq.) is amended by adding at the end the following:

“(a) Program.—The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall establish a nurse-managed health center program consisting of awarding grants to entities under subsection (b).

“(b) Grant.—The Secretary shall award grants to entities—

“(1) to plan and develop a nurse-managed health center; or

“(2) to operate a nurse-managed health center.

“(c) Use of funds.—Amounts received as a grant under subsection (b) may be used for activities including the following:

“(1) Purchasing or leasing equipment.

“(2) Training and technical assistance related to the provision of comprehensive primary care services and wellness services.

“(3) Other activities for planning, developing, or operating, as applicable, a nurse-managed health center.

“(d) Assurances applicable to both planning and operation grants.—

“(1) IN GENERAL.—The Secretary may award a grant under this section to an entity only if the entity demonstrates to the Secretary’s satisfaction that—

“(A) nurses, in addition to managing the center, will be adequately represented as providers at the center; and

“(B) not later than 90 days after receiving the grant, the entity will establish a community advisory committee composed of individuals, a majority of whom are being served by the center, to provide input into the nurse-managed health center’s operations.

“(2) MATCHING REQUIREMENT.—The Secretary may award a grant under this section to an entity only if the entity agrees to provide, from non-Federal sources, an amount equal to 20 percent of the amount of the grant (which may be provided in cash or in kind) to carry out the activities supported by the grant.

“(3) PAYOR OF LAST RESORT.—The Secretary may award a grant under this section to an entity only if the entity demonstrates to the satisfaction of the Secretary that funds received through the grant will not be expended for any activity to the extent that payment has been made, or can reasonably be expected to be made—

“(A) under any insurance policy;

“(B) under any Federal or State health benefits program (including titles XIX and XXI of the Social Security Act); or

“(C) by an entity which provides health services on a prepaid basis.

“(4) MAINTENANCE OF EFFORT.—The Secretary may award a grant under this section to an entity only if the entity demonstrates to the satisfaction of the Secretary that—

“(A) funds received through the grant will be expended only to supplement, and not supplant, non-Federal and Federal funds otherwise available to the entity for the activities to be funded through the grant; and

“(B) with respect to such activities, the entity will maintain expenditures of non-Federal amounts for such activities at a level not less than the lesser of such expenditures maintained by the entity for the fiscal year preceding the fiscal year for which the entity receives the grant.

“(e) Additional assurance for planning grants.—The Secretary may award a grant under subsection (b)(1) to an entity only if the entity agrees—

“(1) to assess the needs of the medically underserved populations proposed to be served by the nurse-managed health center; and

“(2) to design services and operations of the nurse-managed health center for such populations based on such assessment.

“(f) Additional assurance for operation grants.—The Secretary may award a grant under subsection (b)(2) to an entity only if the entity assures that the nurse-managed health center will provide—

“(1) comprehensive primary care services, wellness services, and other health care services deemed appropriate by the Secretary;

“(2) care without respect to insurance status or income of the patient; and

“(3) direct access to client-centered services offered by advanced practice nurses, other nurses, physicians, physician assistants, or other qualified health professionals.

“(g) Technical assistance.—The Secretary shall provide (either directly or by grant or contract) technical and other assistance to nurse-managed health centers to assist such centers in meeting the requirements of this section. Such assistance may include fiscal and program management assistance, training in fiscal and program management, operational and administrative support, and the provision of information to nurse-managed health centers regarding the various resources available under this section and how those resources can best be used to meet the health needs of the communities served by nurse-managed health centers.

“(h) Report.—The Secretary shall submit to the Congress an annual report on the program under this section.

“(i) Definitions.—In this section:

“(1) COMPREHENSIVE PRIMARY CARE SERVICES.—The term ‘comprehensive primary care services’ has the meaning given to the term ‘required primary health services’ in section 330(b)(1).

“(2) MEDICALLY UNDERSERVED POPULATION.—The term ‘medically underserved population’ has the meaning given to such term in section 330(b)(3).

“(3) NURSE-MANAGED HEALTH CENTER.—The term ‘nurse-managed health center’ has the meaning given to such term in section 801.

“(4) WELLNESS SERVICES.—The term ‘wellness services’ means any health-related service or intervention, not including primary care, which is designed to reduce identifiable health risks and increase healthy behaviors intended to prevent the onset of disease or lessen the impact of existing chronic conditions by teaching more effective management techniques that focus on individual self-care and patient-driven decisionmaking.

“(j) Authorization of appropriations.—To carry out this section, there are authorized to be appropriated such sums as may be necessary for each of fiscal years 2011 through 2015.”.

Section 1913 (42 U.S.C. 300x–3) is amended—

(1) in subsection (a)(2)(A), by striking “community mental health services” and inserting “behavioral health services (of the type offered by federally qualified behavioral health centers consistent with subsection (c)(3))”;

(2) in subsection (b)—

(A) by striking paragraph (1) and inserting the following:

“(1) services under the plan will be provided only through appropriate, qualified community programs (which may include federally qualified behavioral health centers, child mental health programs, psychosocial rehabilitation programs, mental health peer-support programs, and mental health primary consumer-directed programs); and”; and

(B) in paragraph (2), by striking “community mental health centers” and inserting “federally qualified behavioral health centers”; and

(3) by striking subsection (c) and inserting the following:

“(c) Criteria for federally qualified behavioral health centers.—

“(1) IN GENERAL.—The Administrator shall certify, and recertify at least every 5 years, federally qualified behavioral health centers as meeting the criteria specified in this subsection.

“(2) REGULATIONS.—Not later than 18 months after the date of the enactment of the Affordable Health Care for America Act, the Administrator shall issue final regulations for certifying centers under paragraph (1).

“(3) CRITERIA.—The criteria referred to in subsection (b)(2) are that the center performs each of the following:

“(A) Provide services in locations that ensure services will be available and accessible promptly and in a manner which preserves human dignity and assures continuity of care.

“(B) Provide services in a mode of service delivery appropriate for the target population.

“(C) Provide individuals with a choice of service options where there is more than one efficacious treatment.

“(D) Employ a core staff of clinical staff that is multidisciplinary and culturally and linguistically competent.

“(E) Provide services, within the limits of the capacities of the center, to any individual residing or employed in the service area of the center.

“(F) Provide, directly or through contract, to the extent covered for adults in the State Medicaid plan and for children in accordance with section 1905(r) of the Social Security Act regarding early and periodic screening, diagnosis, and treatment, each of the following services:

“(i) Screening, assessment, and diagnosis, including risk assessment.

“(ii) Person-centered treatment planning or similar processes, including risk assessment and crisis planning.

“(iii) Outpatient clinic mental health services, including screening, assessment, diagnosis, psychotherapy, substance abuse counseling, medication management, and integrated treatment for mental illness and substance abuse which shall be evidence-based (including cognitive behavioral therapy, dialectical behavioral therapy, motivational interviewing, and other such therapies which are evidence-based).

“(iv) Outpatient clinic primary care services, including screening and monitoring of key health indicators and health risk (including screening for diabetes, hypertension, and cardiovascular disease and monitoring of weight, height, body mass index (BMI), blood pressure, blood glucose or HbA1C, and lipid profile).

“(v) Crisis mental health services, including 24-hour mobile crisis teams, emergency crisis intervention services, and crisis stabilization.

“(vi) Targeted case management (services to assist individuals gaining access to needed medical, social, educational, and other services and applying for income security and other benefits to which they may be entitled).

“(vii) Psychiatric rehabilitation services including skills training, assertive community treatment, family psychoeducation, disability self-management, supported employment, supported housing services, therapeutic foster care services, multisystemic therapy, and such other evidence-based practices as the Secretary may require.

“(viii) Peer support and counselor services and family supports.

“(G) Maintain linkages, and where possible enter into formal contracts with, inpatient psychiatric facilities and substance abuse detoxification and residential programs.

“(H) Make available to individuals served by the center, directly, through contract, or through linkages with other programs, each of the following:

“(i) Adult and youth peer support and counselor services.

“(ii) Family support services for families of children with serious mental disorders.

“(iii) Other community or regional services, supports, and providers, including schools, child welfare agencies, juvenile and criminal justice agencies and facilities, housing agencies and programs, employers, and other social services.

“(iv) Onsite or offsite access to primary care services.

“(v) Enabling services, including outreach, transportation, and translation.

“(vi) Health and wellness services, including services for tobacco cessation.”.