OASLibrary C2-C7-13 7500S'Kurib/Bivd. Df.ltimors. Maryjenci 21244 110thcongress H.R.3561 1stSession Toauthorizethe SecretaryofHealthandHuman Servicestomakeg^rants tocommunityhealthcoalitionstoassistinthedevelopmentofintegrated healthcaredelivery,andforotherpurposes. IN THE HOUSE OF REPRESENTATIVES September18,2007 Mr. Gene GreenofTexas (forhimself, Mr.Wamp, Mr. Smith ofWash- ington,andMr.Baca)introducedthefollowingbill;whichwasreferred totheCommitteeonEnergyandCommerce A BILL To authorize the Secretary^ of Health and Human Sendees to make grants to communityhealth coalitions to assist in the development of inte^ated health care delivery, andforotherpurposes. 1 BeitenactedbytheSenateandHouseofRepresenta- 2 tivesoftheUnitedStatesofAmericainCongressassembled, 3 SECTION1.SHORTTITLE. 4 ThisActmaybecitedasthe"CommunityCoalitions 5 forAccessandQualityImprovementActof2007". 6 SEC.2.PURPOSE. 7 The purpose ofthis Act is to pro\dde assistance to 8 communitv health coalitions as described in section 3(b) — — 1 withaclearlydefinedlocalneedtoincreaseaccesstoand 2 improvethequalityofhealthcaresei'vicesthroughacti\i- 3 tieswhich 4 (1) develop or strengthen coordination ofserv- 5 icesto allowall individuals, includingtheuninsured 6 andlow-income, toreceiveefficientandhigherqual- 7 itycare and to gain entry into and receive services 8 from a comprehensive system of medical, dental, 9 pharmaceutical,andbehavioralhealthcare; 10 (2) develop efficient and sustainable infrastruc- 11 ture for a health care delivery system characterized 12 by effective collaboration, information sharing, and 13 clinicalandfinancialcoordinationamongalltypesof 14 providersofcareinthecommunity;and 15 (3) develop or strengthen activities related to 16 pro\iding coordinated care for individuals with 17 chronicconditions. 18 SEC.3.GRANTSTOSTRENGTHENTHEEFFECTIVENESS,EF- 19 FICIENCY,ANDCOORDINATIONOFSERVICES. 20 (a) In General.—The Secretary of Health and 21 Human Services (in this Act referred to as the "Sec- 22 retary") shall award grants to assist in the development 23 ofintegratedhealthcaredelivery^systemstoservedefined 24 communitiesofindividuals >HR3661IH — — 3 1 (1) to improve the efficiency of and coordina- 2 tion amongtheproviders providingservices through 3 suchsystems; 4 (2) to assist local communities in developing 5 programs targeted toward preventingand managing 6 chronicdiseases;and 7 (3)toexjDandandenhancetheservicesprovided 8 throughsuchsystems. — 9 (b) Eligible Entities. Tobeeligibletoreceivea 10 grant under this section, an entity shall be an entity 11 that— 12 (1)representsabalancedconsortium 13 (A) whose principal purpose is to ensure 14 the sustainable capacity for the provision of a 15 broadrange ofcoordinated servicesforall resi- 16 dents within a community defined in the enti- 17 ty'sgrantapplicationasdescribedinparagraph 18 (2);and 19 (B) that includes at least one of each of 20 the following pro\dders that serve the commu- 21 nity (unless suchpro\iderdoesnotexistwithin 22 the community, declines or refuses to partici- 23 pate, orplacesunreasonableconditionsontheir 24 participation) •HR3561IH — - . 4 : 1 . (i) a Federallyqualified health center 2 (as defined in section 1861(aa) ofthe So- 3 cialSecurityAct(42U.S.C. 1395x(aa))); 4 (ii) rural health clinics and rural 5 health net^\'orks (as defined in sections 6 1861(aa) and 1820(d) ofthe Social Secu- 7 rity Act, respectively (42 U.S.C. 8 1395x(aa), 1395i-4(d))); 9 (iii) ahospitalwithalow-incomeutili- 10 zationratethatisgreaterthan25 percent 11 (as defined in section 1923(b)(3) of the 12 Social Security Act (42 U.S.C. 1396r- 13 4(b)(3))) or a critical access hospital (as 14 defined in section 1820(c)(2) ofthe Social 15 > SecurityAct(42U.S.C. 1395i-4(c)(2))); 16 (iv)apublichealthdepartment;and 17 (v) aninterestedpublicorprivatesec- 18 torhealthcareprovideroranorganization 19 that has traditionally served the medically 20 uninsured and low-income individuals; and 21 (2) submits to the Secretaryan application, in 22 such form and manner as the Secretary shall pre- 23 scribe,that 24 (A) clearly defines the community to be 25 served; >HR3561IH 5 • 1 (B) identifies the providers who will par- 2 ticipate in the community coalition under the 3 grant and specifies eachprovider's contribution 4 tothecareofindividualsinthecommunity; 5 (C) describes the activities that the appli- 6 cant and the community coalition propose to 7 perform under the grant to further the objec- 8 tivesofthissection; 9 (D) demonstrates that it is an established 10 coalition with ability to build on the current 11 system for serving the communityby involving 12 pro^dderswhohavetraditionallyprovided a sig- 13 nificant volume ofcare foruninsured and low- 14 incomeindividualsforthatcommunity; 15 (E) demonstrates the coalition's ability to 16 develop coordinated systems ofcare that either 17 directlypro\4de or ensure the promptprovision 18 of a broad range of high-quality, accessible 19 services,including,asappropriate,primary,sec- 20 ondary, and tertiarj'- services as well as phar- 21 macy, substance abuse, behavioral health and 22 oral health services, in a manner that ensures 23 continuityofcareinthecommunity; 24 (F) provides evidence of community in- 25 volvement,includingthebusinesscommunity,in m •HR3561 6 1 the development, implementation, and direction 2 ofthesystemofcarethatthecoalitionproposes 3 toensure; 4 (G) demonstrates the coalition's ability to 5 ensure that participating individuals are en- 6 rolled in health care coverage programs, both 7 publicandprivate,forwhichtheindividualsare 8 eligible; 9 (H) presents a plan for leveraging other 10 sources of revenue, which may include State 11 and local sources and private grant funds, and 12 integrating current and proposed new funding 13 sources in a manner to ensure long-term sus- 14 tainabilityofthesystemofcare; 15 (I) describes a plan for evaluation of the 16 activitiescarriedoutunderthegrant, including 17 measurement ofprogress toward the goals and 18 objectivesoftheprogramandtheuseofevalua- 19 tionfindingstoimprovesystemperformance; 20 (J) demonstrates fiscal responsibility 21 through the use ofappropriate accountingpro- 22 ceduresandmanagementsystems; 23 (K) demonstratescommitmenttoservethe 24 community without regard to the ability ofan 25 individual orfamilyto paybyarrangingfor or >HR3561IH — — 7 1 pro\ddmg free or reduced charge care for the 2 poor;and 3 (L) includes suchotherinformation asthe 4 Secretarymayprescribe. — 5 (c)Limitations. — 6 (1) In general. ^An ehgible entity may re- 7 ceiveagrantunderthissectionfor3consecutivefis- 8 calyears andmayreceive such a grant award for 2 9 additionalyearsif 10 (A) the eligible entity submits to the Sec- 11 retaryarequestforagrantforsuch additional 12 years; 13 (B) the Secretary determines that current 14 performancejustifiesthe grantingofsuchare- 15 quest;and 16 (C) the Secretarydeterminesthatgranting 17 such request is necessary to ftirther the objec- 18 fivesdescribedinsubsection(a). — 19 (d) Priorities. Inawardinggrantsunderthissec- 20 tion,theSecretary 21 (1) mayaccordprioritytoapplicantsthatdem- 22 onstrate the greatest extent of unmet need in the 23 community for a more coordinated system of care; 24 and •HR3561IH — 8 1 (2) shall accord priorityto applicants thatbest 2 promote the objectives of this section, taking into 3 considerationtheextenttowhichtheapplicant 4 (A) identifies a community whose geo- 5 graphicalareahasahighorincreasingpercent- 6 age ofindividualswho areunmsured orlow-in- 7 come; 8 (B) demonstrates that the applicant has 9 included in its community coalition providers, 10 supportsystems, andprogramsthathaveatra- il dition ofservingindividuals andfamiliesin the 12 community who are uninsured or earn below 13 200percentoftheFederalpovertylevel; 14 (C) showsevidencethattheproposedcoali- 15 tion activities would expand utilization of pre- 16 ventiveandprimarycare servicesforuninsured 17 and underinsured individuals and families in 18 the community, including pharmaceuticals, be- 19 havioral andmentalhealthservices, oralhealth 20 services,orsubstanceabuseservices; 21 (D) proposes approaches that would im- 22 prove coordination between health care pro- 23 viders and appropriate social service providers; 24 (E) demonstrates collaboration with State 25 andlocalgovernments; •HR3561m — 9 1 (F) demonstratesthattheapphcantmakes 2 useofnon-Federalcontributionstothe^eatest 3 extentpossible;or 4 (G) demonstrates likelihood that the pro- 5 posed activities will lead to sustainable inte- 6 grated delivery system as additional efforts of 7 healthsystemsdevelopmentevolve. — 8 (e)UseofFunds. — 9 (1) Usebygrantees. — 10 (A) In general. Except as provided in 11 paragraphs (2) and (3), a grantee may use 12 amountsprovidedunderthis section onlyfor 13 (i) direct expenses associated with 14 achieving the greater integration of a 15 healthcaredeliverysystemsothatthesys- 16 tem eitherdirectlyprovides orensures the 17 provision of a broad range of culturally 18 competent services, including as appro- 19 priate primary, secondary, and tertiary 20 care and oral health, substance abuse, be- 21 havioral and mental health, and pharma- 22 ceuticalservices;and 23 (ii) directpatient care and service ex- 24 pansions to fill identified or documented 25 gaps within an integi'ated delivery system. •HR3561IH 10 — 1 (B) Specificuses. Thefollowingareex- 2 amplesofpurposesforwhichagranteemayuse 3 grant funds under this section, when such use 4 meets the conditions stated in subparagraph 5 (A): 6 (i) Increasesinoutreachactivitiesand 7 closinggaps in health care service, includ- 8 ing referral to specialty services and pre- 9 scription drugs and conducting ongoing 10 outreachtohealthdisparitypopulations. 11 (ii) Improvements to care manage- 12 mentanddeliver}^ofpatient-centeredcare, 13 includingpatientnavigationservices. 14 (iii) Improvements to coordination of 15 transportationtohealthcarefacilities. 16 (iv) Developmentofprovidernetworks 17 andotherinnovativemodelstoengagephy- 18 sicians in voluntaiT efforts to serve the 19 medicallyunderservedwithinacommunity. 20 (v) Recruitment, training, and com- 21 pensationofnecessarypersonnel. 22 (vi) Acquisition of technology for the 23 purpose of coordinating care and improv- 24 ing provider conununication, including im- •HR3561IH