H.R. 3200/Division B/Title VII/Subtitle C

==SUBTITLE C — ACCESS==

Sec. 1721. Payments to Primary Care Practitioners.

(a) In General.—

(1) Fee-for-Service Payments.—

Section 1902(a)(13) of the Social Security Act (42 U.S.C. 1396b(a)(13)) is amended—

(A) by striking ``and´´ at the end of subparagraph (A);

(B) by adding ``and´´ at the end of subparagraph (B); and

(C) by adding at the end the following new subparagraph:

``(C) payment for primary care services (as defined in section 1848(j)(5)(A), but applied without regard to clause (ii) thereof) furnished by physicians (or for services furnished by other health care professionals that would be primary care services under such section if furnished by a physician) at a rate not less than 80 percent of the payment rate applicable to such services and physicians or professionals (as the case may be) under part B of title XVIII for services furnished in 2010, 90 percent of such rate for services and physicians (or professionals) furnished in 2011, and 100 percent of such payment rate for services and physicians (or professionals) furnished in 2012 or a subsequent year;´´.

(2) Under Medicaid Managed Care Plans.—

Section 1923(f) of such Act (42 U.S.C. 1396u–2(f)) is amended—

(A) in the heading, by adding at the end the following: ``; Adequacy of payment for primary care services´´; and

(B) by inserting before the period at the end the following: ``and, in the case of primary care services described in section 1902(a)(13)(C), consistent with the minimum payment rates specified in such section (regardless of the manner in which such payments are made, including in the form of capitation or partial capitation)´´.

(b) Increase in Payment Using 100% FMAP.—

Section 1905(y), as added by section 1701(a)(2)(B) and as amended by section 1701(c)(2), is amended by adding at the end the following:

``(3)(A) The portion of the amounts expended for medical assistance for services described in section 1902(a)(13)(C) furnished on or after January 1, 2010, that is attributable to the amount by which the minimum payment rate required under such section (or, by application, section 1932(f)) exceeds the payment rate applicable to such services under the State plan as of June 16, 2009.

``(B) Subparagraphs (A) shall not be construed as preventing the payment of Federal financial participation based on the Federal medical assistance percentage for amounts in excess of those specified under such subparagraphs.´´.

(c) Effective Date.—

The amendments made by this section shall apply to services furnished on or after January 1, 2010.

Sec. 1722. Medical Home Pilot Program.

(a) In General.—

The Secretary of Health and Human Services shall establish under this section a medical home pilot program under which a State may apply to the Secretary for approval of a medical home pilot project described in subsection (b) (in this section referred to as a ``pilot project´´) for the application of the medical home concept under title XIX of the Social Security Act. The pilot program shall operate for a period of up to 5 years.

(b) Pilot Project Described.—

(1) In General.—

A pilot project is a project that applies one or more of the medical home models described in section 1866E(a)(3) of the Social Security Act (as inserted by section 1302(a)) or such other model as the Secretary may approve, to high need beneficiaries (including medically fragile children and high-risk pregnant women) who are eligible for medical assistance under title XIX of the Social Security Act. The Secretary shall provide for appropriate coordination of the pilot program under this section with the medical home pilot program under section 1866E of such Act.

(2) Limitation.—

A pilot project shall be for a duration of not more than 5 years.

(c) Additional Incentives.—

In the case of a pilot project, the Secretary may—

(1) waive the requirements of section 1902(a)(1) of the Social Security Act (relating to statewideness) and section 1902(a)(10)(B) of such Act (relating to comparability); and

(2) increase to up to 90 percent (for the first 2 years of the pilot program) or 75 percent (for the next 3 years) the matching percentage for administrative expenditures (such as those for community care workers).

(d) Medically Fragile Children.—

In the case of a model involving medically fragile children, the model shall ensure that the patient-centered medical home services received by each child, in addition to fulfilling the requirements under 1866E(b)(1) of the Social Security Act, provide for continuous involvement and education of the parent or caregiver and for assistance to the child in obtaining necessary transitional care if a child’s enrollment ceases for any reason.

(e) Evaluation; Report.—

(1) Evaluation.—

The Secretary, using the criteria described in section 1866E(g)(1) of the Social Security Act (as inserted by section 1123), shall conduct an evaluation of the pilot program under this section.

(2) Report.—

Not later than 60 days after the date of completion of the evaluation under paragraph (1), the Secretary shall submit to Congress and make available to the public a report on the findings of the evaluation under such paragraph.

(f) Funding.—

The additional Federal financial participation resulting from the implementation of the pilot program under this section may not exceed in the aggregate $1,235,000,000 over the 5-year period of the program.

Sec. 1723. Translation or Interpretation Services.

(a) In General.—

Section 1903(a)(2)(E) of the Social Security Act (42 U.S.C. 1396b(a)(2)), as added by section 201(b)(2)(A) of the Children’s Health Insurance Program Reauthorization Act of 2009 (Public Law 111-3), is amended by inserting ``and other individuals´´ after ``children of families´´.

(b) Effective Date.—

The amendment made by subsection (a) shall apply to payment for translation or interpretation services furnished on or after January 1, 2010.

Sec. 1724. Optional Coverage for Freestanding Birth Center Services.

(a) In General.—

Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by section 1713(a), is amended—

(1) in subsection (a)—

(A) by redesignating paragraph (29) as paragraph (30);

(B) in paragraph (28), by striking at the end ``and´´; and

(C) by inserting after paragraph (28) the following new paragraph:

``(29) freestanding birth center services (as defined in subsection (l)(3)(A)) and other ambulatory services that are offered by a freestanding birth center (as defined in subsection (l)(3)(B)) and that are otherwise included in the plan; and´´; and

(2) in subsection (l), by adding at the end the following new paragraph:

``(3)(A) The term ‘freestanding birth center services’ means services furnished to an individual at a freestanding birth center (as defined in subparagraph (B)), including by a licensed birth attendant (as defined in subparagraph (C)) at such center.

``(B) The term ‘freestanding birth center’ means a health facility—

``(i) that is not a hospital; and

``(ii) where childbirth is planned to occur away from the pregnant woman’s residence.

``(C) The term ‘licensed birth attendant’ means an individual who is licensed or registered by the State involved to provide health care at childbirth and who provides such care within the scope of practice under which the individual is legally authorized to perform such care under State law (or the State regulatory mechanism provided by State law), regardless of whether the individual is under the supervision of, or associated with, a physician or other health care provider. Nothing in this subparagraph shall be construed as changing State law requirements applicable to a licensed birth attendant.´´.

(b) Effective Date.—

The amendments made by this section shall apply to items and services furnished on or after the date of the enactment of this Act.

Sec. 1725. Inclusion of Public Health Clinics Under the Vaccines for Children Program.

Section 1928(b)(2)(A)(iii)(I) of the Social Security Act (42 U.S.C. 1396s(b)(2)(A)(iii)(I)) is amended—

(1) by striking ``or a rural health clinic´´ and inserting ``, a rural health clinic´´; and

(2) by inserting ``or a public health clinic,´´ after ```1905(l)(1)),´´.