Sec. 401 Short title
This subtitle may be cited as the “Health Empowerment Zone Act of 2014”.
Title IV — Improvement of Health Care Services
IV Improvement of Health Care Services
A Health Empowerment Zones
Sec. 402 Findings
The Congress finds the following:
Numerous studies and reports, including the 2012 National Healthcare Disparities Report of the Administration on Healthcare Research and Quality and the 2002 Unequal Treatment Report of the Institute of Medicine, document the extensiveness to which health disparities exist across the country.
These studies have found that, on average, racial and ethnic minorities are disproportionately afflicted with chronic and acute conditions—such as cancer, diabetes, musculoskeletal disease, obesity, and hypertension—and suffer worse health outcomes, worse health status, and higher mortality rates than their White counterparts.
Several recent studies also show that health disparities are a function of not only access to health care, but also the social determinants of health—including the environment, the physical structure of communities, nutrition and food options, educational attainment, employment, race, ethnicity, geography, and language preference—that directly and indirectly affect the health, health care, and wellness of individuals and communities.
Integrally involving and fully supporting the communities most affected by health inequities in the assessment, planning, launch, and evaluation of health disparity elimination efforts are among the leading recommendations made to adequately address and ultimately reduce health disparities.
Recommendations also include supporting the efforts of community stakeholders from a broad cross section—including, but not limited to local businesses, local departments of commerce, education, labor, urban planning, and transportation, and community-based and other nonprofit organizations—to find areas of common ground around health disparity elimination and collaborate to improve the overall health and wellness of a community and its residents.
Sec. 403 Designation of health empowerment zones
In general— At the request of an eligible community partnership, the Secretary may designate an eligible area as a health empowerment zone.
Eligibility criteria—
Eligible community partnership— A community partnership is eligible to submit a request under this section if the partnership—
demonstrates widespread public support from key individuals and entities in the eligible area, including members of the target community, State and local governments, nonprofit organizations, and community and industry leaders, for designation of the eligible area as a health empowerment zone; and
includes representatives of—
a broad cross section of stakeholders and residents from communities in the eligible area experiencing disproportionate disparities in health status and health care; and
organizations, facilities, and institutions that have a history of working within and serving such communities.
Eligible area— An area is eligible to be designated as a health empowerment zone under this section if one or more communities in the area experience disproportionate disparities in health status and health care. In determining whether a community experiences such disparities, the Secretary shall consider the data collected by the Department of Health and Human Services focusing on the following areas:
Access to affordable, high-quality health services.
The prevalence of disproportionate rates of certain illnesses or diseases including the following:
Arthritis, osteoporosis, chronic back conditions, and other musculoskeletal diseases.
Cancer.
Chronic kidney disease.
Diabetes.
Injury (intentional and unintentional).
Violence (intimate and nonintimate).
Maternal and paternal illnesses and diseases.
Infant mortality.
Mental illness and other disabilities.
Substance abuse treatment and prevention, including underage drinking.
Nutrition, obesity, and overweight conditions.
Heart disease.
Hypertension.
Cerebrovascular disease or stroke.
Tuberculosis.
HIV/AIDS and other sexually transmitted diseases.
Viral hepatitis.
Asthma.
Tooth decay and other oral health issues.
Within the target community, the historical and persistent presence of conditions that have been found to contribute to health disparities including any such conditions respecting the following:
Poverty.
Educational status and the quality of community schools.
Income.
Access to high-quality affordable health care.
Work and work environment.
Environmental conditions in the community, including with respect to clean water, clean air, and the presence or absence of pollutants.
Language and English proficiency.
Access to affordable healthy food.
Access to ethnically and culturally diverse health and human service providers and practitioners.
Access to culturally and linguistically competent health and human services and health and human service providers.
Health-supporting infrastructure.
Health insurance that is adequate and affordable.
Race, racism, and bigotry (conscious and unconscious).
Sexual orientation.
Health literacy.
Place of residence (such as urban areas, rural areas, and tribal reservations).
Stress.
Procedure—
Request— A request under subsection (a) shall—
describe the bounds of the area to be designated as a health empowerment zone and the process used to select those bounds;
demonstrate that the partnership submitting the request is an eligible community partnership described in subsection (b)(1);
demonstrate that the area is an eligible area described in subsection (b)(2);
include a comprehensive assessment of disparities in health status and health care experience by one or more communities in the area;
set forth—
a vision and a set of values for the area; and
a comprehensive and holistic set of goals to be achieved in the area through designation as a health empowerment zone; and
include a strategic plan and an action plan for achieving the goals described in subparagraph (E)(ii).
Approval— Not later than 60 days after the receipt of a request for designation of an area as a health empowerment zone under this section, the Secretary shall approve or disapprove the request.
Minimum number— The Secretary—
shall designate not more than 110 health empowerment zones under this section; and
shall designate at least one health empowerment zone in each of the several States, the District of Columbia, and each territory or possession of the United States.
Sec. 404 Assistance to those seeking designation
At the request of any organization or entity seeking to submit a request under section 403(a), the Secretary shall provide technical assistance, and may award a grant, to assist such organization or entity—
to form an eligible community partnership described in section 403(b)(1);
to complete a health assessment, including an assessment of health disparities under section 403(c)(1)(D); or
to prepare and submit a request, including a strategic plan, in accordance with section 403.
Sec. 405 Benefits of designation
Priority— In awarding any competitive grant, a Federal official shall give priority to any applicant that—
meets the eligibility criteria for the grant;
proposes to use the grant for activities in a health empowerment zone; and
demonstrates that such activities will directly and significantly further the goals of the strategic plan approved for such zone under section 403.
Grants for initial implementation of strategic plan—
In general— Upon designating an eligible area as a health empowerment zone at the request of an eligible community partnership, the Secretary shall, subject to the availability of appropriations, make a grant to the community partnership for implementation of the strategic plan for such zone.
Grant period— A grant under paragraph (1) for a health empowerment zone shall be for a period of 2 years and may be renewed, except that the total period of grants under paragraph (1) for such zone may not exceed 10 years.
Limitation— In awarding grants under this subsection, the Secretary shall not give less priority to an applicant or reduce the amount of a grant because the Secretary rendered technical assistance or made a grant to the same applicant under section 404.
Reporting— The Secretary shall require each recipient of a grant under this subsection to report to the Secretary not less than every 6 months on the progress in implementing the strategic plan for the health empowerment zone.
Sec. 406 Definition
In this subtitle, the term Secretary means the Secretary of Health and Human Services, acting through the Administrator of the Health Resources and Services Administration and the Deputy Assistant Secretary for Minority Health, and in cooperation with the Director of the Office of Community Services and the Director of the National Institute for Minority Health and Health Disparities.
Sec. 407 Authorization of appropriations
To carry out this subtitle, there is authorized to be appropriated $100,000,000 for fiscal year 2015.
B Other Improvements of Health Care Services
1 Expansion of Coverage
Sec. 411 Amendment to the Public Health Service Act
Title XXXIV of the Public Health Service Act, as amended by titles I, II, III, and IX of this Act, is further amended by inserting after subtitle C the following:
“D Reconstruction and Improvement Grants for Public Health Care Facilities Serving Pacific Islanders and the Insular Areas
“3451. Grant support for quality improvement initiatives
“(a) In general—The Secretary, in collaboration with the Administrator of the Health Resources and Services Administration, the Director of the Agency for Healthcare Research and Quality, and the Administrator of the Centers for Medicare & Medicaid Services, shall award grants to eligible entities for the conduct of demonstration projects to improve the quality of and access to health care.
“(b) Eligibility—To be eligible to receive a grant under subsection (a), an entity shall—
“(1) be a health center, hospital, health plan, health system, community clinic. or other health entity determined appropriate by the Secretary—
“(A) that, by legal mandate or explicitly adopted mission, provides patients with access to services regardless of their ability to pay;
“(B) that provides care or treatment for a substantial number of patients who are uninsured, are receiving assistance under a State program under title XIX of the Social Security Act, or are members of vulnerable populations, as determined by the Secretary; and
“(C)
“(i) with respect to which, not less than 50 percent of the entity’s patient population is made up of racial and ethnic minorities; or
“(ii) that—
“(I) serves a disproportionate percentage of local, minority racial and ethnic patients, or that has a patient population, at least 50 percent of which is limited-English-proficient; and
“(II) provides an assurance that amounts received under the grant will be used only to support quality improvement activities in the racial and ethnic population served; and
“(2) prepare and submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
“(c) Priority—In awarding grants under subsection (a), the Secretary shall give priority to applicants under subsection (b)(2) that—
“(1) demonstrate an intent to operate as part of a health care partnership, network, collaborative, coalition, or alliance where each member entity contributes to the design, implementation, and evaluation of the proposed intervention; or
“(2) intend to use funds to carry out systemwide changes with respect to health care quality improvement, including—
“(A) improved systems for data collection and reporting;
“(B) innovative collaborative or similar processes;
“(C) group programs with behavioral or self-management interventions;
“(D) case management services;
“(E) physician or patient reminder systems;
“(F) educational interventions; or
“(G) other activities determined appropriate by the Secretary.
“(d) Use of funds—An entity shall use amounts received under a grant under subsection (a) to support the implementation and evaluation of health care quality improvement activities or minority health and health care disparity reduction activities that include—
“(1) with respect to health care systems, activities relating to improving—
“(A) patient safety;
“(B) timeliness of care;
“(C) effectiveness of care;
“(D) efficiency of care;
“(E) patient centeredness; and
“(F) health information technology; and
“(2) with respect to patients, activities relating to—
“(A) staying healthy;
“(B) getting well, mentally and physically;
“(C) living effectively with illness or disability; and
“(D) coping with end-of-life issues.
“(e) Common data systems—The Secretary shall provide financial and other technical assistance to grantees under this section for the development of common data systems.
“(f) Authorization of appropriations—There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2015 through 2020.
“3452. Centers of excellence
“(a) In general—The Secretary, acting through the Administrator of the Health Resources and Services Administration, shall designate centers of excellence at public hospitals, and other health systems serving large numbers of minority patients, that—
“(1) meet the requirements of section 3451(b)(1);
“(2) demonstrate excellence in providing care to minority populations; and
“(3) demonstrate excellence in reducing disparities in health and health care.
“(b) Requirements—A hospital or health system that serves as a center of excellence under subsection (a) shall—
“(1) design, implement, and evaluate programs and policies relating to the delivery of care in racially, ethnically, and linguistically diverse populations;
“(2) provide training and technical assistance to other hospitals and health systems relating to the provision of quality health care to minority populations; and
“(3) develop activities for graduate or continuing medical education that institutionalize a focus on cultural competence training for health care providers.
“(c) Authorization of appropriations—There are authorized to be appropriated to carry out this section, such sums as may be necessary for each of fiscal years 2015 through 2020.
“3453. Reconstruction and improvement grants for Public Health care facilities serving Pacific Islanders and the insular areas
“(a) In general—The Secretary shall provide direct financial assistance to designated health care providers and community health centers in American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the United States Virgin Islands, Puerto Rico, and Hawaii for the purposes of reconstructing and improving health care facilities and services in a culturally competent and sustainable manner.
“(b) Eligibility—To be eligible to receive direct financial assistance under subsection (a), an entity shall be a public health facility or community health center located in American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the United States Virgin Islands, Puerto Rico, or Hawaii that—
“(1) is owned or operated by—
“(A) the Government of American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the United States Virgin Islands, Puerto Rico, or Hawaii or a unit of local government; or
“(B) a nonprofit organization; and
“(2)
“(A) provides care or treatment for a substantial number of patients who are uninsured, receiving assistance under a State program under a title XVIII of the Social Security Act, or a State program under title XIX of such Act, or who are members of a vulnerable population, as determined by the Secretary; or
“(B) serves a disproportionate percentage of local, minority racial and ethnic patients.
“(c) Report—Not later than 180 days after the date of enactment of this title and annually thereafter, the Secretary shall submit to the Congress and the President a report that includes an assessment of health resources and facilities serving populations in American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the United States Virgin Islands, Puerto Rico, and Hawaii. In preparing such report, the Secretary shall—
“(1) consult with and obtain information on all health care facilities needs from the entities described in subsection (b);
“(2) include all amounts of Federal assistance received by each entity in the preceding fiscal year;
“(3) review the total unmet needs of each jurisdiction for health care facilities, including needs for renovation and expansion of existing facilities;
“(4) include a strategic plan for addressing the needs of each jurisdiction identified in the report; and
“(5) evaluate the effectiveness of the care provided by measuring patient outcomes and cost measures.
“(d) Authorization of appropriations—There are authorized to be appropriated such sums as necessary to carry out this section.”
Sec. 412 Removing citizenship and immigration barriers to access to affordable health care under the ACA
In general—
in subsection (c)(1)(B)—
by amending the subparagraph heading to read as follows: “Special rule for certain individuals ineligible for Medicaid due to status”, and
in clause (ii), by striking “lawfully present in the United States, but” and inserting “who”, and
by striking subsection (e).
Cost-sharing reductions— Section 1402 of the Patient Protection and Affordable Care Act (42 U.S.C. 18071) is amended by striking subsection (e).
Preexisting condition insurance plan— Section 1101(d) of the Patient Protection and Affordable Care Act (42 U.S.C. 18001(d)) is amended by striking paragraph (1) and redesignating paragraphs (2) and (3) as paragraphs (1) and (2), respectively.
Basic health program eligibility— Section 1331(e)(1)(B) of the Patient Protection and Affordable Care Act (42 U.S.C. 18051(e)(1)(B)) is amended by striking “lawfully present in the United States,”.
Restrictions on Federal payments— Section 1412 of the Patient Protection and Affordable Care Act (42 U.S.C. 18082) is amended by striking subsection (d).
Requirement to maintain minimum essential coverage— Subsection (d) of section 5000A of the Internal Revenue Code of 1986 is amended by striking paragraph (3) and by redesignating paragraph (4) as paragraph (3).
Conforming amendment—
Section 1411(a) of the Patient Protection and Affordable Care Act (42 U.S.C. 18081(a)) is amended by striking paragraph (1) and redesignating paragraphs (2), (3), and (4) as paragraphs (1), (2), and (3), respectively.
Section 1312(f) of the Patient Protection and Affordable Care Act (42 U.S.C. 18032(f)) is amended—
in the subsection heading, by striking “employers;” and all that follows through “residents”; and
by striking paragraph (3).
Sec. 413 Study on the uninsured
In general— The Secretary of Health and Human Services (in this section referred to as the “Secretary”) shall—
conduct a study, in accordance with the standards under section 3101 of the Public Health Service Act (42 U.S.C. 300kk), on the demographic characteristics of the population of individuals who do not have health insurance coverage; and
predict, based on such study, the demographic characteristics of the population of individuals who would remain without health insurance coverage after the end of open enrollment or any special enrollment period.
Reporting requirements—
In general— Not later than 12 months after the date of the enactment of this Act, the Secretary shall submit to the Congress the results of the study under subsection (a)(1) and the prediction made under subsection (a)(2).
Reporting of demographic characteristics— The Secretary shall report the demographic characteristics under paragraphs (1) and (2) of subsection (a) on the basis of racial and ethnic group, and shall stratify the reporting on each racial and ethnic group by other demographic characteristics that can impact access to health insurance coverage, such as sexual orientation, gender identity, primary language, disability status, sex, socioeconomic status, age group, and citizenship and immigration status, in a manner consistent with title I of this Act.
Sec. 414 Medicaid payment parity for the territories
Elimination of funding limitations for Puerto Rico, the United States Virgin Islands, Guam, the Commonwealth of the Northern Mariana Islands, and American Samoa—
in subsection (f), in the matter preceding paragraph (1), by striking “subsection (g)” and inserting “subsections (g) and (h)”;
in subsection (g)(2), in the matter preceding subparagraph (A)—
by striking “Notwithstanding subsection (f) and subject to and” and inserting “Notwithstanding subsection (f) and subject to”; and
by striking “paragraphs (3) and (5)” and inserting “, paragraphs (3) and (5) of this subsection, and subsection (h)”.
by adding at the end the following new subsection:
“(h) Sunset of funding limitations for Puerto Rico, the United States Virgin Islands, Guam, the Commonwealth of the Northern Mariana Islands, and American Samoa—Subsections (f) and (g) shall not apply to Puerto Rico, the United States Virgin Islands, Guam, the Commonwealth of the Northern Mariana Islands, and American Samoa for any fiscal year after fiscal year 2015.”
Conforming amendment— Section 1903(u) of such Act (42 U.S.C. 1396c(u)) is amended by striking paragraph (4).
Effective date— The amendments made by this subsection shall apply beginning with fiscal year 2016.
Parity in FMAP—
In general— Section 1905(b) of such Act (42 U.S.C. 1396d(b)) is amended by inserting after “and American Samoa shall be 55 percent,” the following: “(except that, beginning with fiscal year 2018, the Federal medical assistance percentage for Puerto Rico, the United States Virgin Islands, Guam, the Commonwealth of the Northern Mariana Islands, and American Samoa shall be the Federal medical assistance percentage determined by the Secretary in consultation (for the United States Virgin Islands, Guam, the Commonwealth of the Northern Mariana Islands, and American Samoa) with the Secretary of the Interior)”.
2-fiscal-year transition— Notwithstanding any other provision of law, during fiscal years 2016 and 2017, the Federal medical assistance percentage established under section 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) for Puerto Rico, the United States Virgin Islands, Guam, the Commonwealth of the Northern Mariana Islands, and American Samoa shall be the highest such Federal medical assistance percentage applicable to any of the 50 States or the District of Columbia for the fiscal year involved.
Per capita income data—
Report to Congress— Not later than October 1, 2016, the Secretary of Health and Human Services shall submit to Congress a report that describes the per capita income data used to promulgate the Federal medical assistance percentage in the territories and how such data differ from the per capita income data used to promulgate Federal medical assistance percentages for the 50 States and the District of Columbia. The report should include recommendations on how the Federal medical assistance percentages can be calculated for the territories to ensure parity with the 50 States and the District of Columbia.
by striking “(other than Puerto Rico, the United States Virgin Islands, and Guam)” and inserting “(including Puerto Rico, the United States Virgin Islands, Guam, the Commonwealth of the Northern Mariana Islands, and American Samoa)”; and
by inserting “(or, if such satisfactory data are not available in the case of the United States Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa, satisfactory data available from the Department of the Interior for the same period, or if such satisfactory data are not available in the case of Puerto Rico, satisfactory data available from the government of the Commonwealth of Puerto Rico for the same period)” after “Department of Commerce”.
Sec. 415 Extension of Medicare secondary payer
in the last sentence, by inserting “, and before January 1, 2015” after “prior to such date)”; and
by adding at the end the following new sentence: “Effective for items and services furnished on or after January 1, 2015 (with respect to periods beginning on or after the date that is 42 months prior to such date), clauses (i) and (ii) shall be applied by substituting “42-month” for “12-month” each place it appears in the first sentence.”.
Effective date— The amendments made by this section shall take effect on the date of enactment of this Act. For purposes of determining an individual’s status under section 1862(b)(1)(C) of the Social Security Act (42 U.S.C. 1395y(b)(1)(C)), as amended by subsection (a), an individual who is within the coordinating period as of the date of enactment of this Act shall have that period extended to the full 42 months described in the last sentence of such section, as added by the amendment made by subsection (a)(2).
Sec. 416 Border health grants
Eligible entity defined— In this section, the term eligible entity means a State, public institution of higher education, local government, tribal government, nonprofit health organization, community health center, or community clinic receiving assistance under section 330 of the Public Health Service Act (42 U.S.C. 254b), that is located in the border area.
Authorization— From funds appropriated under subsection (f), the Secretary of Health and Human Services (in this section referred to as the Secretary), acting through the United States members of the United States-Mexico Border Health Commission, shall award grants to eligible entities to address priorities and recommendations to improve the health of border area residents that are established by—
the United States members of the United States-Mexico Border Health Commission;
the State border health offices; and
the Secretary.
Application— An eligible entity that desires a grant under subsection (b) shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.
Use of funds— An eligible entity that receives a grant under subsection (b) shall use the grant funds for—
programs relating to—
maternal and child health;
primary care and preventative health;
public health and public health infrastructure;
musculoskeletal health and obesity;
health education and promotion;
oral health;
mental and behavioral health;
substance abuse;
health conditions that have a high prevalence in the border area;
medical and health services research;
workforce training and development;
community health workers or promotoras;
health care infrastructure problems in the border area (including planning and construction grants);
health disparities in the border area;
environmental health; and
outreach and enrollment services with respect to Federal programs (including programs authorized under titles XIX and XXI of the Social Security Act (42 U.S.C. 1396 and 1397aa)); and
other programs determined appropriate by the Secretary.
Supplement, not supplant— Amounts provided to an eligible entity awarded a grant under subsection (b) shall be used to supplement and not supplant other funds available to the eligible entity to carry out the activities described in subsection (d).
Authorization of appropriations— There are authorized to be appropriated to carry out this section, $200,000,000 for fiscal year 2015, and such sums as may be necessary for each succeeding fiscal year.
Sec. 417 Removing Medicare barrier to health care
Part A— Section 1818(a)(3) of the Social Security Act (42 U.S.C. 1395i–2(a)(3)) is amended by striking “(B)” and all that follows through “under this section” and inserting “(B) an individual who is lawfully present in the United States”.
Part B— Section 1836(2) of the Social Security Act (42 U.S.C. 1395o(2)) is amended by striking “(B)” and all that follows through “under this part” and inserting “(B) an individual who is lawfully present in the United States”.
Sec. 418 100 percent FMAP for medical assistance provided by urban Indian health centers
In general— The third sentence of section 1905(b) of the Social Security Act (42 U.S.C. 1396(b)), as amended by section 415(c), is further amended by inserting “or are received through a program operated by an urban Indian organization through a grant or contract under title V of such Act” after “(as defined in section 4 of the Indian Health Care Improvement Act)”.
Effective date— The amendment made by this section shall apply to medical assistance provided on or after the date of enactment of this Act.
Sec. 419 100 percent FMAP for medical assistance provided to a Native Hawaiian through a federally qualified health center or a Native Hawaiian health care system under the Medicaid program
In general— The third sentence of section 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)), as amended by section 419, is amended by inserting “; and, with respect to medical assistance provided to a Native Hawaiian (as defined in section 12(2) of the Native Hawaiian Health Care Improvement Act) through a federally qualified health center or a Native Hawaiian health care system (as defined in section 12(6) of such Act), whether directly, by referral, or under contract or other arrangement between such federally qualified health center or Native Hawaiian health care system and another health care provider” before the period.
Effective date— The amendment made by this section shall apply to medical assistance provided on or after the date of enactment of this Act.
2 Expansion of Access
Sec. 421 Grants for racial and ethnic approaches to community health
Purpose— It is the purpose of this section to provide for the awarding of grants to assist communities in mobilizing and organizing resources in support of effective and sustainable programs that will reduce or eliminate disparities in health and health care experienced by racial and ethnic minority individuals.
Authority To Award Grants— The Secretary of Health and Human Services, acting through the Administrator of the Health Resources and Services Administration, shall award grants to eligible entities to assist in designing, implementing, and evaluating culturally and linguistically appropriate, science-based, and community-driven sustainable strategies to eliminate racial and ethnic health and health care disparities.
Eligible Entities— To be eligible to receive a grant under this section, an entity shall—
represent a coalition—
whose principal purpose is to develop and implement interventions to reduce or eliminate a health or health care disparity in a targeted racial or ethnic minority group in the community served by the coalition; and
that includes—
members selected from among—
public health departments;
community-based organizations;
university and research organizations;
American Indian tribal organizations, national American Indian organizations, Indian Health Service, or organizations serving Alaska Natives; and
interested public or private health care providers or organizations as deemed appropriate by the Secretary; and
at least 1 member from a community-based organization that represents the targeted racial or ethnic minority group; and
submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require, which shall include—
a description of the targeted racial or ethnic populations in the community to be served under the grant;
a description of at least 1 health disparity that exists in the racial or ethnic targeted populations, including health issues such as infant mortality, breast and cervical cancer screening and management, musculoskeletal diseases and obesity, prostate cancer screening and management, cardiovascular disease, diabetes, child and adult immunization levels, or other health priority areas as designated by the Secretary; and
a demonstration of a proven record of accomplishment of the coalition members in serving and working with the targeted community.
Sustainability— The Secretary shall give priority to an eligible entity under this section if the entity agrees that, with respect to the costs to be incurred by the entity in carrying out the activities for which the grant was awarded, the entity (and each of the participating partners in the coalition represented by the entity) will maintain its expenditures of non-Federal funds for such activities at a level that is not less than the level of such expenditures during the fiscal year immediately preceding the first fiscal year for which the grant is awarded.
Nonduplication— Funds provided through this grant program should supplement, not supplant, existing Federal funding, and the funds should not be used to duplicate the activities of the other health disparity grant programs in this Act.
Technical Assistance— The Secretary may, either directly or by grant or contract, provide any entity that receives a grant under this section with technical and other nonfinancial assistance necessary to meet the requirements of this section.
Dissemination— The Secretary shall encourage and enable grantees to share best practices, evaluation results, and reports with communities not affiliated with grantees using the Internet, conferences, and other pertinent information regarding the projects funded by this section, including the outreach efforts of the Office of Minority Health and Health Disparity Elimination and the Centers for Disease Control and Prevention.
Administrative Burdens— The Secretary shall make every effort to minimize duplicative or unnecessary administrative burdens on grantees.
Definition— In this section, the term Secretary means the Secretary of Health and Human Services.
Authorization of appropriations— There are authorized to be appropriated such sums as may be necessary to carry out this section.
Sec. 422 Critical access hospital improvements
Elimination of isolation test for cost-Based ambulance reimbursement—
in subparagraph (B)—
by striking “owned and”; and
by inserting “(including when such services are provided by the entity under an arrangement with the hospital)” after “hospital”; and
by striking the comma at the end of subparagraph (B) and all that follows and inserting a period.
Effective date— The amendments made by this subsection shall apply to services furnished on or after January 1, 2015.
Provision of a more flexible alternative to the CAH designation 25 inpatient bed limit requirement—
in subparagraph (B)(iii), by striking “provides not more than” and inserting “subject to subparagraph (F), provides not more than”; and
by adding at the end the following new subparagraph:
“(F) Alternative to 25 inpatient bed limit requirement
“(i) In general—A State may elect to treat a facility, with respect to the designation of the facility for a cost-reporting period, as satisfying the requirement of subparagraph (B)(iii) relating to a maximum number of acute care inpatient beds if the facility elects, in accordance with a method specified by the Secretary and before the beginning of the cost reporting period, to meet the requirement under clause (ii).
“(ii) Alternate requirement—The requirement under this clause, with respect to a facility and a cost-reporting period, is that the total number of inpatient bed days described in subparagraph (B)(iii) during such period will not exceed 7,300. For purposes of this subparagraph, an individual who is an inpatient in a bed in the facility for a single day shall be counted as one inpatient bed day.
“(iii) Withdrawal of election—The option described in clause (i) shall not apply to a facility for a cost-reporting period if the facility (for any two consecutive cost-reporting periods during the previous 5 cost-reporting periods) was treated under such option and had a total number of inpatient bed days for each of such two cost-reporting periods that exceeded the number specified in such clause.”
Effective date— The amendments made by paragraph (1) shall apply to cost-reporting periods beginning on or after the date of the enactment of this Act.
Sec. 423 Establishment of Rural Community Hospital (RCH) Program
In general— Section 1861 of the Social Security Act (42 U.S.C. 1395x), as amended by section 203(b)(1), is amended by adding at the end of the following new subsection:
“(jjj) Rural Community Hospital; Rural Community Hospital Services
“(1) The term rural community hospital means a hospital (as defined in subsection (e)) that—
“(A) is located in a rural area (as defined in section 1886(d)(2)(D)) or treated as being so located pursuant to section 1886(d)(8)(E);
“(B) subject to paragraph (2), has less than 51 acute care inpatient beds, as reported in its most recent cost report;
“(C) makes available 24-hour emergency care services;
“(D) subject to paragraph (3), has a provider agreement in effect with the Secretary and is open to the public as of January 1, 2010; and
“(E) applies to the Secretary for such designation.
“(2) For purposes of paragraph (1)(B), beds in a psychiatric or rehabilitation unit of the hospital which is a distinct part of the hospital shall not be counted.
“(3) Paragraph (1)(D) shall not be construed to prohibit any of the following from qualifying as a rural community hospital:
“(A) A replacement facility (as defined by the Secretary in regulations in effect on January 1, 2012) with the same service area (as defined by the Secretary in regulations in effect on such date).
“(B) A facility obtaining a new provider number pursuant to a change of ownership.
“(C) A facility which has a binding written agreement with an outside, unrelated party for the construction, reconstruction, lease, rental, or financing of a building as of January 1, 2012.
“(4) Nothing in this subsection shall be construed as prohibiting a critical access hospital from qualifying as a rural community hospital if the critical access hospital meets the conditions otherwise applicable to hospitals under subsection (e) and section 1866.
“(5) Nothing in this subsection shall be construed as prohibiting a rural community hospital participating in the demonstration program under section 410A of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108–173; 117 Stat. 2313) from qualifying as a rural community hospital if the rural community hospital meets the conditions otherwise applicable to hospitals under subsection (e) and section 1866.”
Payment—
Inpatient hospital services— Section 1814 of the Social Security Act (42 U.S.C. 1395f) is amended by adding at the end the following new subsection:
“(m) Payment for Inpatient Services Furnished in Rural Community Hospitals—The amount of payment under this part for inpatient hospital services furnished in a rural community hospital, other than such services furnished in a psychiatric or rehabilitation unit of the hospital which is a distinct part, is, at the election of the hospital in the application referred to in section 1861(jjj)(1)(E)—
“(1) 101 percent of the reasonable costs of providing such services, without regard to the amount of the customary or other charge, or
“(2) the amount of payment provided for under the prospective payment system for inpatient hospital services under section 1886(d).”
Outpatient services— Section 1834 of such Act (42 U.S.C. 1395m) is amended by adding at the end the following new subsection:
“(p) Payment for outpatient services furnished in rural community hospitals—The amount of payment under this part for outpatient services furnished in a rural community hospital is, at the election of the hospital in the application referred to in section 1861(jjj)(1)(E)—
“(1) 101 percent of the reasonable costs of providing such services, without regard to the amount of the customary or other charge and any limitation under section 1861(v)(1)(U), or
“(2) the amount of payment provided for under the prospective payment system for covered OPD services under section 1833(t).”
Exemption from 30-percent reduction in reimbursement for bad debt— Section 1861(v)(1)(T) of such Act (42 U.S.C. 1395x(v)(1)(T)) is amended by inserting “(other than for a rural community hospital)” after “In determining such reasonable costs for hospitals”.
Beneficiary cost-Sharing for outpatient services— Section 1834(p) of such Act (as added by subsection (b)(2)) is amended—
by redesignating paragraphs (1) and (2) as subparagraphs (A) and (B), respectively;
by inserting “(1)” after “(p)”; and
by adding at the end the following:
“(2) The amounts of beneficiary cost-sharing for outpatient services furnished in a rural community hospital under this part shall be as follows:
“(A) For items and services that would have been paid under section 1833(t) if provided by a hospital, the amount of cost-sharing determined under paragraph (8) of such section.
“(B) For items and services that would have been paid under section 1833(h) if furnished by a provider or supplier, no cost-sharing shall apply.
“(C) For all other items and services, the amount of cost-sharing that would apply to the item or service under the methodology that would be used to determine payment for such item or service if provided by a physician, provider, or supplier, as the case may be.”
Conforming amendments—
Part A payment— Section 1814(b) of such Act (42 U.S.C. 1395f(b)) is amended in the matter preceding paragraph (1) by inserting “other than inpatient hospital services furnished by a rural community hospital,” after “critical access hospital services,”.
Part B payment— Section 1833(a) of such Act (42 U.S.C. 1395l(a)), as amended by section 203(b)(2), is amended—
in paragraph (2), in the matter before subparagraph (A), by striking “and (I)” and inserting “(I), and (K)”;
by striking “and” at the end of paragraph (9);
by striking the period at the end of paragraph (10) and inserting “; and”; and
by adding at the end the following:
“(11) in the case of outpatient services furnished by a rural community hospital, the amounts described in section 1834(p).”
Technical amendments—
Consultation with State agencies— Section 1863 of such Act (42 U.S.C. 1395z) is amended by striking “and (dd)(2)” and inserting “(dd)(2), (mm)(1), and (jjj)(1)”.
Provider agreements— Section 1866(a)(2)(A) of such Act (42 U.S.C. 1395cc(a)(2)(A)) is amended by inserting “section 1834(p)(2),” after “section 1833(b),”.
Effective date— The amendments made by this section shall apply to items and services furnished on or after October 1, 2014.
Sec. 424 Medicare remote monitoring pilot projects
Pilot projects—
In general— Not later than 9 months after the date of enactment of this Act, the Secretary of Health and Human Services (in this section referred to as the Secretary) shall conduct pilot projects under title XVIII of the Social Security Act for the purpose of providing incentives to home health agencies to utilize home monitoring and communications technologies that—
enhance health outcomes for Medicare beneficiaries; and
reduce expenditures under such title.
Site requirements—
Urban and Rural— The Secretary shall conduct the pilot projects under this section in both urban and rural areas.
Site in a small State— The Secretary shall conduct at least 3 of the pilot projects in a State with a population of less than 1,000,000.
Definition of home health agency— In this section, the term home health agency has the meaning given that term in section 1861(o) of the Social Security Act (42 U.S.C. 1395x(o)).
Medicare beneficiaries within the scope of projects— The Secretary shall specify the criteria for identifying those Medicare beneficiaries who shall be considered within the scope of the pilot projects under this section for purposes of the application of subsection (c) and for the assessment of the effectiveness of the home health agency in achieving the objectives of this section. Such criteria may provide for the inclusion in the projects of Medicare beneficiaries who begin receiving home health services under title XVIII of the Social Security Act after the date of the implementation of the projects.
Incentives—
Performance targets— The Secretary shall establish for each home health agency participating in a pilot project under this section a performance target using one of the following methodologies, as determined appropriate by the Secretary:
Adjusted historical performance target— The Secretary shall establish for the agency—
a base expenditure amount equal to the average total payments made to the agency under parts A and B of title XVIII of the Social Security Act for Medicare beneficiaries determined to be within the scope of the pilot project in a base period determined by the Secretary; and
an annual per capita expenditure target for such beneficiaries, reflecting the base expenditure amount adjusted for risk and adjusted growth rates.
Comparative performance target— The Secretary shall establish for the agency a comparative performance target equal to the average total payments under such parts A and B during the pilot project for comparable individuals in the same geographic area that are not determined to be within the scope of the pilot project.
Incentive— Subject to paragraph (3), the Secretary shall pay to each participating home care agency an incentive payment for each year under the pilot project equal to a portion of the Medicare savings realized for such year relative to the performance target under paragraph (1).
Limitation on expenditures— The Secretary shall limit incentive payments under this section in order to ensure that the aggregate expenditures under title XVIII of the Social Security Act (including incentive payments under this subsection) do not exceed the amount that the Secretary estimates would have been expended if the pilot projects under this section had not been implemented.
Waiver authority— The Secretary may waive such provisions of titles XI and XVIII of the Social Security Act as the Secretary determines to be appropriate for the conduct of the pilot projects under this section.
Report to Congress— Not later than 5 years after the date that the first pilot project under this section is implemented, the Secretary shall submit to Congress a report on the pilot projects. Such report shall contain a detailed description of issues related to the expansion of the projects under subsection (f) and recommendations for such legislation and administrative actions as the Secretary considers appropriate.
Expansion— If the Secretary determines that any of the pilot projects under this section enhance health outcomes for Medicare beneficiaries and reduce expenditures under title XVIII of the Social Security Act, the Secretary may initiate comparable projects in additional areas.
Incentive payments have no effect on other Medicare payments to agencies— An incentive payment under this section—
shall be in addition to the payments that a home health agency would otherwise receive under title XVIII of the Social Security Act for the provision of home health services; and
shall have no effect on the amount of such payments.
Sec. 425 Rural health quality advisory commission and demonstration projects
Rural Health Quality Advisory Commission—
Establishment— Not later than 6 months after the date of the enactment of this section, the Secretary of Health and Human Services (in this section referred to as the Secretary) shall establish a commission to be known as the Rural Health Quality Advisory Commission (in this section referred to as the Commission).
Duties of commission—
National plan— The Commission shall develop, coordinate, and facilitate implementation of a national plan for rural health quality improvement. The national plan shall—
identify objectives for rural health quality improvement;
identify strategies to eliminate known gaps in rural health system capacity and improve rural health quality; and
provide for Federal programs to identify opportunities for strengthening and aligning policies and programs to improve rural health quality.
Demonstration projects— The Commission shall design demonstration projects to test alternative models for rural health quality improvement, including with respect to both personal and population health.
Monitoring— The Commission shall monitor progress toward the objectives identified pursuant to paragraph (1)(A).
Membership—
Number— The Commission shall be composed of 11 members appointed by the Secretary.
Selection— The Secretary shall select the members of the Commission from among individuals with significant rural health care and health care quality expertise, including expertise in clinical health care, health care quality research, population or public health, or purchaser organizations.
Contracting authority— Subject to the availability of funds, the Commission may enter into contracts and make other arrangements, as may be necessary to carry out the duties described in paragraph (2).
Staff— Upon the request of the Commission, the Secretary may detail, on a reimbursable basis, any of the personnel of the Office of Rural Health Policy of the Health Resources and Services Administration, the Agency for Healthcare Quality and Research, or the Centers for Medicare & Medicaid Services to the Commission to assist in carrying out this subsection.
Reports to congress— Not later than 1 year after the establishment of the Commission, and annually thereafter, the Commission shall submit a report to the Congress on rural health quality. Each such report shall include the following:
An inventory of relevant programs and recommendations for improved coordination and integration of policy and programs.
An assessment of achievement of the objectives identified in the national plan developed under paragraph (2) and recommendations for realizing such objectives.
Recommendations on Federal legislation, regulations, or administrative policies to enhance rural health quality and outcomes.
Rural Health Quality Demonstration Projects—
In general— Not later than 270 days after the date of the enactment of this section, the Secretary, in consultation with the Rural Health Quality Advisory Commission, the Office of Rural Health Policy of the Health Resources and Services Administration, the Agency for Healthcare Research and Quality, and the Centers for Medicare & Medicaid Services, shall make grants to eligible entities for 5 demonstration projects to implement and evaluate methods for improving the quality of health care in rural communities. Each such demonstration project shall include—
alternative community models that—
will achieve greater integration of personal and population health services; and
address safety, effectiveness, patient- or community-centeredness, timeliness, efficiency, and equity (the 6 aims identified by the Institute of Medicine of the National Academies in its report entitled Crossing the Quality Chasm: A New Health System for the 21st Century released on March 1, 2001);
innovative approaches to the financing and delivery of health services to achieve rural health quality goals; and
development of quality improvement support structures to assist rural health systems and professionals (such as workforce support structures, quality monitoring and reporting, clinical care protocols, and information technology applications).
Eligible entities— In this subsection, the term eligible entity means a consortium that—
shall include—
at least one health care provider or health care delivery system located in a rural area; and
at least one organization representing multiple community stakeholders; and
may include other partners such as rural research centers.
Consultation— In developing the program for awarding grants under this subsection, the Secretary shall consult with the Administrator of the Agency for Healthcare Research and Quality, rural health care providers, rural health care researchers, and private and nonprofit groups (including national associations) which are undertaking similar efforts.
Expedited waivers— The Secretary shall expedite the processing of any waiver that—
is authorized under title XVIII or XIX of the Social Security Act (42 U.S.C. 1395 et seq.); and
is necessary to carry out a demonstration project under this subsection.
Demonstration project sites— The Secretary shall ensure that the 5 demonstration projects funded under this subsection are conducted at a variety of sites representing the diversity of rural communities in the Nation.
Duration— Each demonstration project under this subsection shall be for a period of 4 years.
Independent evaluation— The Secretary shall enter into an arrangement with an entity that has experience working directly with rural health systems for the conduct of an independent evaluation of the program carried out under this subsection.
Report— Not later than 1 year after the conclusion of all of the demonstration projects funded under this subsection, the Secretary shall submit a report to the Congress on the results of such projects. The report shall include—
an evaluation of patient access to care, patient outcomes, and an analysis of the cost effectiveness of each such project; and
recommendations on Federal legislation, regulations, or administrative policies to enhance rural health quality and outcomes.
Appropriation—
In general— Out of funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary to carry out this section $30,000,000 for the period of fiscal years 2015 through 2019.
Availability—
In general— Funds appropriated under paragraph (1) shall remain available for expenditure through fiscal year 2019.
Report— For purposes of carrying out subsection (b)(8), funds appropriated under paragraph (1) shall remain available for expenditure through fiscal year 2020.
Reservation— Of the amount appropriated under paragraph (1), the Secretary shall reserve—
$5,000,000 to carry out subsection (a); and
$25,000,000 to carry out subsection (b), of which—
2 percent shall be for the provision of technical assistance to grant recipients; and
5 percent shall be for independent evaluation under subsection (b)(7).
Sec. 426 Rural health care services
Section 330A of the Public Health Service Act (42 U.S.C. 254c) is amended to read as follows:
“330A. Rural health care services outreach, rural health network development, Delta rural disparities and health systems development, and small rural health care provider quality improvement grant programs
“(a) Purpose—The purpose of this section is to provide for grants—
“(1) under subsection (b), to promote rural health care services outreach;
“(2) under subsection (c), to provide for the planning and implementation of integrated health care networks in rural areas;
“(3) under subsection (d), to assist rural communities in the Delta Region to reduce health disparities and to promote and enhance health system development; and
“(4) under subsection (e), to provide for the planning and implementation of small rural health care provider quality improvement activities.
“(b) Rural health care services outreach grants
“(1) Grants—The Director of the Office of Rural Health Policy of the Health Resources and Services Administration may award grants to eligible entities to promote rural health care services outreach by expanding the delivery of health care services to include new and enhanced services in rural areas. The Director may award the grants for periods of not more than 3 years.
“(2) Eligibility—To be eligible to receive a grant under this subsection for a project, an entity—
“(A) shall be a rural public or rural nonprofit private entity, a facility that qualifies as a rural health clinic under title XVIII of the Social Security Act, a public or nonprofit entity existing exclusively to provide services to migrant and seasonal farm workers in rural areas, or a tribal government whose grant-funded activities will be conducted within federally recognized tribal areas;
“(B) shall represent a consortium composed of members—
“(i) that include 3 or more independently owned health care entities; and
“(ii) that may be nonprofit or for-profit entities; and
“(C) shall not previously have received a grant under this subsection for the same or a similar project, unless the entity is proposing to expand the scope of the project or the area that will be served through the project.
“(3) Applications—To be eligible to receive a grant under this subsection, an eligible entity shall prepare and submit to the Director an application at such time, in such manner, and containing such information as the Director may require, including—
“(A) a description of the project that the eligible entity will carry out using the funds provided under the grant;
“(B) a description of the manner in which the project funded under the grant will meet the health care needs of rural populations in the local community or region to be served;
“(C) a plan for quantifying how health care needs will be met through identification of the target population and benchmarks of service delivery or health status, such as—
“(i) quantifiable measurements of health status improvement for projects focusing on health promotion; or
“(ii) benchmarks of increased access to primary care, including tracking factors such as the number and type of primary care visits, identification of a medical home, or other general measures of such access;
“(D) a description of how the local community or region to be served will be involved in the development and ongoing operations of the project;
“(E) a plan for sustaining the project after Federal support for the project has ended;
“(F) a description of how the project will be evaluated;
“(G) the administrative capacity to submit annual performance data electronically as specified by the Director; and
“(H) other such information as the Director determines to be appropriate.
“(c) Rural health network development grants
“(1) Grants
“(A) In general—The Director may award rural health network development grants to eligible entities to promote, through planning and implementation, the development of integrated health care networks that have combined the functions of the entities participating in the networks in order to—
“(i) achieve efficiencies and economies of scale;
“(ii) expand access to, coordinate, and improve the quality of the health care delivery system through development of organizational efficiencies;
“(iii) implement health information technology to achieve efficiencies, reduce medical errors, and improve quality;
“(iv) coordinate care and manage chronic illness; and
“(v) strengthen the rural health care system as a whole in such a manner as to show a quantifiable return on investment to the participants in the network.
“(B) Grant periods—The Director may award such a rural health network development grant—
“(i) for a period of 3 years for implementation activities; or
“(ii) for a period of 1 year for planning activities to assist in the initial development of an integrated health care network, if the proposed participants in the network do not have a history of collaborative efforts and a 3-year grant would be inappropriate.
“(2) Eligibility—To be eligible to receive a grant under this subsection, an entity—
“(A) shall be a rural public or rural nonprofit private entity, a facility that qualifies as a rural health clinic under title XVIII of the Social Security Act, a public or nonprofit entity existing exclusively to provide services to migrant and seasonal farm workers in rural areas, or a tribal government whose grant-funded activities will be conducted within federally recognized tribal areas;
“(B) shall represent a network composed of participants—
“(i) that include 3 or more independently owned health care entities; and
“(ii) that may be nonprofit or for-profit entities; and
“(C) shall not previously have received a grant under this subsection (other than a 1-year grant for planning activities) for the same or a similar project.
“(3) Applications—To be eligible to receive a grant under this subsection, an eligible entity, in consultation with the appropriate State office of rural health or another appropriate State entity, shall prepare and submit to the Director an application at such time, in such manner, and containing such information as the Director may require, including—
“(A) a description of the project that the eligible entity will carry out using the funds provided under the grant;
“(B) an explanation of the reasons why Federal assistance is required to carry out the project;
“(C) a description of—
“(i) the history of collaborative activities carried out by the participants in the network;
“(ii) the degree to which the participants are ready to integrate their functions; and
“(iii) how the local community or region to be served will benefit from and be involved in the activities carried out by the network;
“(D) a description of how the local community or region to be served will experience increased access to quality health care services across the continuum of care as a result of the integration activities carried out by the network, including a description of—
“(i) return on investment for the community and the network members; and
“(ii) other quantifiable performance measures that show the benefit of the network activities;
“(E) a plan for sustaining the project after Federal support for the project has ended;
“(F) a description of how the project will be evaluated;
“(G) the administrative capacity to submit annual performance data electronically as specified by the Director; and
“(H) other such information as the Director determines to be appropriate.
“(d) Delta rural disparities and health systems development grants
“(1) Grants—The Director may award grants to eligible entities to support reduction of health disparities, improve access to health care, and enhance rural health system development in the Delta Region.
“(2) Eligibility—To be eligible to receive a grant under this subsection, an entity shall be a rural public or rural nonprofit private entity, a facility that qualifies as a rural health clinic under title XVIII of the Social Security Act, a public or nonprofit entity existing exclusively to provide services to migrant and seasonal farm workers in rural areas, or a tribal government whose grant-funded activities will be conducted within federally recognized tribal areas.
“(3) Applications—To be eligible to receive a grant under this subsection, an eligible entity shall prepare and submit to the Director an application at such time, in such manner, and containing such information as the Director may require, including—
“(A) a description of the project that the eligible entity will carry out using the funds provided under the grant;
“(B) an explanation of the reasons why Federal assistance is required to carry out the project;
“(C) a description of the manner in which the project funded under the grant will meet the health care needs of the Delta Region;
“(D) a description of how the local community or region to be served will experience increased access to quality health care services as a result of the activities carried out by the entity;
“(E) a description of how health disparities will be reduced or the health system will be improved;
“(F) a plan for sustaining the project after Federal support for the project has ended;
“(G) a description of how the project will be evaluated including process and outcome measures related to the quality of care provided or how the health care system improves its performance;
“(H) a description of how the grantee will develop an advisory group made up of representatives of the communities to be served to provide guidance to the grantee to best meet community need; and
“(I) other such information as the Director determines to be appropriate.
“(e) Small rural health care provider quality improvement grants
“(1) Grants—The Director may award grants to provide for the planning and implementation of small rural health care provider quality improvement activities. The Director may award the grants for periods of 1 to 3 years.
“(2) Eligibility—To be eligible for a grant under this subsection, an entity—
“(A) shall be—
“(i) a rural public or rural nonprofit private health care provider or provider of health care services, such as a rural health clinic; or
“(ii) another rural provider or network of small rural providers identified by the Director as a key source of local care; and
“(B) shall not previously have received a grant under this subsection for the same or a similar project.
“(3) Preference—In awarding grants under this subsection, the Director shall give preference to facilities that qualify as rural health clinics under title XVIII of the Social Security Act.
“(4) Applications—To be eligible to receive a grant under this subsection, an eligible entity shall prepare and submit to the Director an application at such time, in such manner, and containing such information as the Director may require, including—
“(A) a description of the project that the eligible entity will carry out using the funds provided under the grant;
“(B) an explanation of the reasons why Federal assistance is required to carry out the project;
“(C) a description of the manner in which the project funded under the grant will assure continuous quality improvement in the provision of services by the entity;
“(D) a description of how the local community or region to be served will experience increased access to quality health care services as a result of the activities carried out by the entity;
“(E) a plan for sustaining the project after Federal support for the project has ended;
“(F) a description of how the project will be evaluated including process and outcome measures related to the quality of care provided; and
“(G) other such information as the Director determines to be appropriate.
“(f) General requirements
“(1) Prohibited uses of funds—An entity that receives a grant under this section may not use funds provided through the grant—
“(A) to build or acquire real property; or
“(B) for construction.
“(2) Coordination with other agencies—The Director shall coordinate activities carried out under grant programs described in this section, to the extent practicable, with Federal and State agencies and nonprofit organizations that are operating similar grant programs, to maximize the effect of public dollars in funding meritorious proposals.
“(g) Report—Not later than September 30, 2016, the Secretary shall prepare and submit to the appropriate committees of Congress a report on the progress and accomplishments of the grant programs described in subsections (b), (c), (d), and (e).
“(h) Definitions—In this section:
“(1) The term Delta Region has the meaning given to the term region in section 382A of the Consolidated Farm and Rural Development Act (7 U.S.C. 2009aa).
“(2) The term Director means the Director of the Office of Rural Health Policy of the Health Resources and Services Administration.
“(i) Authorization of appropriations—There are authorized to be appropriated to carry out this section $40,000,000 for fiscal year 2015, and such sums as may be necessary for each of fiscal years 2016 through 2019.”
Sec. 427 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:
“(t) Miscellaneous Provisions
“(1) Rule of construction with respect to rural health clinics—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 and other mental, dental, and physical health 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 and other mental, dental, and physical health services available in that rural health clinic.
“(2) Enabling services—To the extent possible, enabling services such as transportation and translation assistance shall be provided by rural health clinics described in paragraph (1).
“(3) Assurances—In order for a rural health clinic to receive funds under this section through a contract with a community health center for the delivery of primary health care and other services described in paragraph (1), such rural health clinic shall establish policies to ensure—
“(A) nondiscrimination based upon the ability of a patient to pay;
“(B) the establishment of a sliding fee scale for low-income patients; and
“(C) any such services should be subject to full reimbursement according to the Prospective Payment System scale.”
Sec. 428 Facilitating the provision of telehealth services across State lines
In general— For purposes of expediting the provision of telehealth services, for which payment is made under the Medicare Program, across State lines, the Secretary of Health and Human Services shall, in consultation with representatives of States, physicians, health care practitioners, and patient advocates, encourage and facilitate the adoption of provisions allowing for multistate practitioner practice across State lines.
Definitions— In subsection (a):
Telehealth service— The term telehealth service has the meaning given that term in subparagraph (F) of section 1834(m)(4) of the Social Security Act (42 U.S.C. 1395m(m)(4)).
Physician, practitioner— The terms physician and practitioner have the meaning given those terms in subparagraphs (D) and (E), respectively, of such section.
Medicare program— The term Medicare Program means the program of health insurance administered by the Secretary of Health and Human Services under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).
Sec. 429 Scoring of preventive health savings
Section 202 of the Congressional Budget and Impoundment Control Act of 1974 (2 U.S.C. 602) is amended by adding at the end the following new subsection:
“(h) Scoring of preventive health savings
“(1) Determination by the Director—Upon a request by the chairman or ranking minority member of the Committee on the Budget of the Senate, or by the chairman or ranking minority member of the Committee on the Budget of the House of Representatives, the Director shall determine if a proposed measure would result in reductions in budget outlays in budgetary outyears through the use of preventive health and preventive health services.
“(2) Projections—If the Director determines that a measure would result in substantial reductions in budget outlays as described in paragraph (1), the Director—
“(A) shall include, in any projection prepared by the Director, a description and estimate of the reductions in budget outlays in the budgetary outyears and a description of the basis for such conclusions; and
“(B) may prepare a budget projection that includes some or all of the budgetary outyears, notwithstanding the time periods for projections described in subsection (e) and sections 308, 402, and 424.
“(3) Definitions—As used in this subsection—
“(A) the term preventive health means an action that focuses on the health of the public, individuals, and defined populations in order to protect, promote, and maintain health, wellness, and functional ability, and prevent disease, disability, and premature death that is demonstrated by credible and publicly available epidemiological projection models, incorporating clinical trials or observational studies in humans, to avoid future health care costs; and
“(B) the term budgetary outyears means the 2 consecutive 10-year periods beginning with the first fiscal year that is 10 years after the budget year provided for in the most recently agreed to concurrent resolution on the budget.”
Sec. 430 Sense of Congress
It is the sense of the Congress that—
the maintenance of effort provisions added to sections 1902 and 2105(d) of the Social Security Act by sections 2001(b) and 2101(b) of the Patient Protection and Affordable Care Act were written to maintain the eligibility standards for the Medicaid program under title XIX of the Social Security Act and Children’s Health Insurance Program under title XXI of such Act until the American Health Benefit Exchanges in the States are fully operational;
it is imperative that the maintenance of effort provisions are enforced to the strict standard intended by the Congress;
waiving the maintenance of effort provisions should not be permitted, except in the case of a request for a waiver that meets the explicit nonapplication requirements;
the maintenance of effort provisions ensure the continued success of the Medicaid program and Children’s Health Insurance Program and were written deliberately to specifically protect vulnerable and disabled individuals, children, and senior citizens, many of whom are also members of communities of color; and
the maintenance of effort provisions must be strictly enforced and proposals to weaken the maintenance of effort provisions must not be considered.
Sec. 431 Repeal of requirement for documentation evidencing citizenship or nationality under the Medicaid program
Repeal— Subsections (i)(22) and (x) of section 1903 of the Social Security Act (42 U.S.C. 1396b) are each repealed.
Conforming amendments—
Section 1902 of the Social Security Act (42 U.S.C. 1396a) is amended—
by amending paragraph (46) of subsection (a) to read as follows:
“(46) provide that information is requested and exchanged for purposes of income and eligibility verification in accordance with a State system which meets the requirements of section 1137 of this Act;”
in subsection (e)(13)(A)(i)—
in the matter preceding subclause (I), by striking “sections 1902(a)(46)(B) and 1137(d)” and inserting “section 1137(d)”; and
in subclause (IV), by striking “1902(a)(46)(B) or”; and
by striking subsection (ee).
Section 1903 of the Social Security Act (42 U.S.C. 1396b) is amended—
in subsection (i), by redesignating paragraphs (23) through (26) as paragraphs (22) through (25), respectively; and
by redesignating subsections (y) and (z) as subsections (x) and (y), respectively.
Subsection (c) of section 6036 of the Deficit Reduction Act of 2005 (42 U.S.C. 1396b note) is repealed.
Effective date— The repeals and amendments made by this section shall take effect as if included in the enactment of the Deficit Reduction Act of 2005.
Sec. 432 Office of Minority Health in Veterans Health Administration of Department of Veterans Affairs
Establishment and functions— Subchapter I of chapter 73 of title 38, United States Code, is amended by adding at the end the following new section:
“7310. Office of Minority Health
“(a) Establishment—There is established in the Department within the Office of the Under Secretary for Health an office to be known as the “Office of Minority Health” (in this section referred to as the Office).
“(b) Head—The Director of the Office of Minority Health shall be the head of the Office. The Director of the Office of Minority Health shall be appointed by the Under Secretary of Health from among individuals qualified to perform the duties of the position.
“(c) Functions—The functions of the Office are as follows:
“(1) To establish short-range and long-range goals and objectives and coordinate all other activities within the Veterans Health Administration that relate to disease prevention, health promotion, health care services delivery, and health care research concerning veterans who are members of a racial or ethnic minority group.
“(2) To support research, demonstrations, and evaluations to test new and innovative models for the discharge of activities described in paragraph (1).
“(3) To increase knowledge and understanding of health risk factors for veterans who are members of a racial or ethnic minority group.
“(4) To develop mechanisms that support better health care information dissemination, education, prevention, and services delivery to veterans from disadvantaged backgrounds, including veterans who are members of a racial or ethnic minority group.
“(5) To enter into contracts or agreements with appropriate public and nonprofit private entities to develop and carry out programs to provide bilingual or interpretive services to assist veterans who are members of a racial or ethnic minority group and who lack proficiency in speaking the English language in accessing and receiving health care services through the Veterans Health Administration.
“(6) To carry out programs to improve access to health care services through the Veterans Health Administration for veterans with limited proficiency in speaking the English language, including the development and evaluation of demonstration and pilot projects for that purpose.
“(7) To advise the Under Secretary of Health on matters relating to the development, implementation, and evaluation of health professions education in decreasing disparities in health care outcomes between veterans who are members of a racial or ethnic minority group and other veterans, including cultural competency as a method of eliminating such health disparities.
“(8) To perform such other functions and duties as the Secretary or the Under Secretary for Health considers appropriate.
“(d) Definitions—In this section:
“(1) The term racial or ethnic minority group means the following:
“(A) American Indians (including Alaska Natives, Eskimos, and Aleuts).
“(B) Asian-Americans.
“(C) Native Hawaiians and other Pacific Islanders.
“(D) Blacks.
“(E) Hispanics.
“(2) The term Hispanic means individuals whose origin is Mexican, Puerto Rican, Cuban, Central or South American, or any other Spanish-speaking country.”
Clerical amendment— The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 7309 the following new item:
Sec. 433 Indian defined in PPACA
Definition of Indian— Section 1304 of the Patient Protection and Affordable Care Act (42 U.S.C. 18024) is amended by adding at the end the following:
“(f) Indian
“(1) In general—In this title, the term Indian means any individual—
“(A) described in paragraph (13) or (28) of section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603);
“(B) who is eligible for health services provided by the Indian Health Service under section 809 of the Indian Health Care Improvement Act (25 U.S.C. 1679);
“(C) who is of Indian descent and belongs to the Indian community served by the local facilities and program of the Indian Health Service; or
“(D) who is described in paragraph (2).
“(2) Included individuals—The following individuals shall be considered to be an “Indian”:
“(A) A member of a federally recognized Indian tribe.
“(B) A resident of an urban center who meets 1 or more of the following 4 criteria:
“(i) Membership in a tribe, band, or other organized group of Indians, including those tribes, bands, or groups terminated since 1940 and those recognized as of the date of enactment of the Health Equity and Accountability Act of 2014 or later by the State in which they reside, or being a descendant, in the first or second degree, of any such member.
“(ii) Is an Eskimo or Aleut or other Alaska Native.
“(iii) Is considered by the Secretary of the Interior to be an Indian for any purpose.
“(iv) Is determined to be an Indian under regulations promulgated by the Secretary.
“(C) An individual who is considered by the Secretary of the Interior to be an Indian for any purpose.
“(D) An individual who is considered by the Secretary to be an Indian for purposes of eligibility for Indian health care services, including as a California Indian, Eskimo, Aleut, or other Alaska Native.”
Conforming amendments—
Affordable choices health benefit plans— Section 1311(c)(6)(D) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)(6)(D)) is amended by striking “section 4 of the Indian Health Care Improvement Act” and inserting “section 1304(f)”.
Reduced cost-sharing for individuals enrolling in qualified health plans— Section 1402(d) of the Patient Protection and Affordable Care Act (42 U.S.C. 18071(d)) is amended—
in paragraph (1), in the matter preceding subparagraph (A), by striking “section 4(d) of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b(d))” and inserting “section 1304(f)”; and
in paragraph (2), in the matter preceding subparagraph (A), by striking “(as so defined)” and inserting “(as defined in section 1304(f))”.
Exemption from penalty for not maintaining minimum essential coverage— Section 5000A(e) of the Internal Revenue Code of 1986 is amended by striking paragraph (3) and inserting the following:
“(3) Indians—Any applicable individual who is an Indian (as defined in section 1304(f) of the Patient Protection and Affordable Care Act).”
Sec. 434 Study of DSH payments to ensure hospital access for low-income patients
In general— Not later than January 1, 2016, the Comptroller General of the United States shall conduct a study on how certain amendments made by the Patient Protection and Affordable Care Act (Public Law 111–148) to titles XVIII and XIX of the Social Security Act affect the timely access to health care services for low-income patients. Such study shall—
evaluate and examine whether States electing to make medical assistance available under section 1902(a)(10)(A)(i)(VIII) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)(i)(VIII)) (including States making such an election through a waiver of the State plan) to individuals described in such section mitigates the need for payments to disproportionate share hospitals under section 1886(d)(5)(F) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(F)) and section 1923 of such Act (42 U.S.C. 1396r–4), including the impact of such States electing to make medical assistance available to such individuals on—
the number of individuals in the United States who are without health insurance and the distribution of such individuals in relation to areas primarily served by disproportionate share hospitals; and
the low-income utilization rate of such hospitals and the resulting fiscal sustainability of such hospitals;
evaluate the appropriate level and distribution of such payments among disproportionate hospitals for purposes of—
sufficiently accounting for the level of uncompensated care provided by such hospitals to low-income patients; and
providing timely access to health services for individuals in medically underserved areas; and
assess, with respect to disproportionate hospitals—
the role played by such hospitals in providing critical access to emergency, inpatient, and outpatient health services, as well as the location of such hospitals in relation to medically underserved areas; and
the extent to which such hospitals satisfy the requirements established for charitable hospital organizations under section 501(r) of the Internal Revenue Code of 1986 with respect to community health needs assessments, financial assistance policy requirements, limitations on charges, and billing and collection requirements.
Reports—
Report to Congress— Not later than 180 days after the date on which the study under subsection (a) is completed, the Comptroller General of the United States shall submit to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate a report that contains—
the results of the study;
recommendations to Congress for any legislative changes to the payments to disproportionate share hospitals under section 1886(d)(5)(F) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(F)) and section 1923 of such Act (42 U.S.C. 1396r–4) that are needed to ensure access to health services for low-income patients that—
are based on the number of individuals without health insurance, the amount of uncompensated care provided by such hospitals, and the impact of reduced payments levels on low-income communities; and
takes into account any reports submitted by the Secretary of the Treasury, in consultation with the Secretary of Health and Human Services, to Congressional committees regarding the costs incurred by charitable hospital organizations for charity care, bad debt, nonreimbursed expenses for services provided to individuals under the Medicare Program under title XVIII of the Social Security Act and the Medicaid Program under title XIX of such Act, and any community benefit activities provided by such organizations.
Report to the Secretary of Health and Human Services— Not later than 180 days after the date on which the study under subsection (a) is completed, the Comptroller General of the United States shall submit to the Secretary of Health and Human Services a report that contains—
the results of the study; and
any recommendations for purposes of assisting in the development of the methodology for the adjustment of payments to disproportionate share hospitals, as required under section 1886(r) of the Social Security Act (42 U.S.C. 1395ww(r)) and the reduction of such payments section 1923(f)(7) of such Act (42 U.S.C. 1396r–4(f)(7)), taking into account the reports referred to in paragraph (1)(B)(ii).
Sec. 435 Assistant Secretary of the Indian Health Service
References— Any reference in a law, regulation, document, paper, or other record of the United States to the Director of the Indian Health Service shall be deemed to be a reference to the Assistant Secretary of the Indian Health Service.
Executive Schedule— Section 5315 of title 5, United States Code, is amended in the matter relating to the Assistant Secretaries of Health and Human Services by striking “(6)” and inserting “(7), 1 of whom shall be the Assistant Secretary of the Indian Health Service”.
Conforming amendment— Section 5316 of title 5, United States Code, is amended by striking “Director, Indian Health Service, Department of Health and Human Services.”.
Sec. 436 Reauthorization of the Native Hawaiian Health Care Improvement Act
Native Hawaiian health care systems— Section 6(h)(1) of the Native Hawaiian Health Care Improvement Act (42 U.S.C. 11705(h)(1)) is amended by striking “may be necessary for fiscal years 1993 through 2019” and inserting “are necessary”.
Administrative grant for papa ola lokahi— Section 7(b) of the Native Hawaiian Health Care Improvement Act (42 U.S.C. 11706(b)) is amended by striking “may be necessary for fiscal years 1993 through 2019” and inserting “are necessary”.
Native Hawaiian health scholarships— Section 10(c) of the Native Hawaiian Health Care Improvement Act (42 U.S.C. 11709(c)) is amended by striking “may be necessary for fiscal years 1993 through 2019” and inserting “are necessary”.