[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 1277 Introduced in Senate (IS)]
106th CONGRESS
1st Session
S. 1277
To amend title XIX of the Social Security Act to establish a new
prospective payment system for Federally-qualified health centers and
rural health clinics.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 24, 1999
Mr. Grassley (for himself, Mr. Baucus, Mr. Murkowski, Mr. Rockefeller,
Mr. Conrad, Mr. Harkin, and Mr. Robb) introduced the following bill;
which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to establish a new
prospective payment system for Federally-qualified health centers and
rural health clinics.
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 ``Safety Net Preservation Act of
1999''.
SEC. 2. NEW PROSPECTIVE PAYMENT SYSTEM FOR FEDERALLY-QUALIFIED HEALTH
CENTERS AND RURAL HEALTH CLINICS.
(a) In General.--Section 1902(a) of the Social Security Act (42
U.S.C. 1396a(a)) is amended--
(1) in paragraph (13)--
(A) in subparagraph (A), by adding ``and'' at the
end;
(B) in subparagraph (B), by striking ``and'' at the
end; and
(C) by striking subparagraph (C); and
(2) by inserting after paragraph (14) the following new
paragraph:
``(15) for payment for services described in clause (B) or
(C) of section 1905(a)(2) under the plan in accordance with
subsection (aa);''.
(b) New Prospective Payment System.--Section 1902 of the Social
Security Act (42 U.S.C. 1396a) is amended by adding at the end the
following:
``(aa) Payment for Services Provided by Federally-Qualified Health
Centers and Rural Health Clinics.--
``(1) In general.--Beginning with fiscal year 2000 and each
succeeding fiscal year, the State plan shall provide for
payment for services described in section 1905(a)(2)(C)
furnished by a Federally-qualified health center and services
described in section 1905(a)(2)(B) furnished by a rural health
clinic in accordance with the provisions of this subsection.
``(2) Fiscal year 2000.--Subject to paragraph (4), for
services furnished during fiscal year 2000, the State plan
shall provide for payment for such services in an amount
(calculated on a per visit basis) that is equal to 100 percent
of the costs of the center or clinic of furnishing such
services during fiscal year 1999 which are reasonable and
related to the cost of furnishing such services, or based on
such other tests of reasonableness as the Secretary prescribes
in regulations under section 1833(a)(3), or, in the case of
services to which such regulations do not apply, the same
methodology used under section 1833(a)(3), adjusted to take
into account any increase in the scope of such services
furnished by the center or clinic during fiscal year 2000.
``(3) Fiscal year 2001 and succeeding fiscal years.--
Subject to paragraph (4), for services furnished during fiscal
year 2001 or a succeeding fiscal year, the State plan shall
provide for payment for such services in an amount (calculated
on a per visit basis) that is equal to the amount calculated
for such services under this subsection for the preceding
fiscal year--
``(A) 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)) for that fiscal year; and
``(B) adjusted to take into account any increase in
the scope of such services furnished by the center or
clinic during that fiscal year.
``(4) Establishment of initial year payment amount for new
centers or clinics.--In any case in which an entity first
qualifies as a Federally-qualified health center or rural
health clinic after fiscal year 1999, the State plan shall
provide for payment for services described in section
1905(a)(2)(C) furnished by the center or services described in
section 1905(a)(2)(B) furnished by the clinic in the first
fiscal year in which the center or clinic so qualifies in an
amount (calculated on a per visit basis) that is equal to 100
percent of the costs of furnishing such services during such
fiscal year in accordance with the regulations and methodology
referred to in paragraph (2). For each fiscal year following
the fiscal year in which the entity first qualifies as a
Federally-qualified health center or rural health clinic, the
State plan shall provide for the payment amount to be
calculated in accordance with paragraph (3).
``(5) Administration in the case of managed care.--In the
case of services furnished by a Federally-qualified health
center or rural health clinic pursuant to a contract between
the center or clinic and a managed care entity (as defined in
section 1932(a)(1)(B)), the State plan shall provide for
payment to the center or clinic (at least quarterly) by the
State of a supplemental payment equal to the amount (if any) by
which the amount determined under paragraphs (2), (3), and (4)
of this subsection exceeds the amount of the payments provided
under the contract.
``(6) Alternative payment methodologies.--Notwithstanding
any other provision of this section, the State plan may provide
for payment in any fiscal year to a Federally-qualified health
center for services described in section 1905(a)(2)(C) or to a
rural health clinic for services described in section
1905(a)(2)(B) in an amount which is determined under an
alternative payment methodology that--
``(A) is agreed to by the State and the center or
clinic; and
``(B) results in payment to the center or clinic of
an amount which is at least equal to the amount
otherwise required to be paid to the center or clinic
under this section.''.
(c) Conforming Amendments.--
(1) Section 4712 of the Balanced Budget Act of 1997 (Public
Law 105-33; 111 Stat. 508) is amended by striking subsection
(c).
(2) Section 1915(b) of the Social Security Act (42 U.S.C.
1396n(b)) is amended by striking ``1902(a)(13)(E)'' and
inserting ``1902(a)(15), 1902(aa),''.
(d) Effective Date.--The amendments made by this section take
effect on October 1, 1999, and apply to services furnished on or after
such date.
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S7600)
Read twice and referred to the Committee on Finance.
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