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AMENDMENT NO.llll

Calendar No.lll

Purpose: To improve womens access to quality health care.

IN THE SENATE OF THE UNITED STATES114th Cong., 1st Sess.

H. R. 2
To amend title XVIII of the Social Security Act to repeal
the Medicare sustainable growth rate and strengthen
Medicare access by improving physician payments and
making other improvements, to reauthorize the Childrens Health Insurance Program, and for other purposes.
Referred to the Committee on llllllllll and
ordered to be printed
Ordered to lie on the table and to be printed
AMENDMENT intended to be proposed by lllllll
Viz:
1

At the appropriate place, insert the following:

TITLE llWOMENS ACCESS TO

QUALITY HEALTH CARE

SEC. l01. SHORT TITLE.

This title may be cited as the Womens Access to

6 Quality Health Care Act.

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SEC. l02. RENEWAL OF APPLICATION OF MEDICARE PAY-

MENT RATE FLOOR TO PRIMARY CARE SERV-

ICES FURNISHED UNDER MEDICAID AND IN-

CLUSION OF ADDITIONAL PROVIDERS.

(a) RENEWAL

OF

PAYMENT FLOOR; ADDITIONAL

6 PROVIDERS.
7

(1) IN

GENERAL.Section

1902(a)(13) of the

Social Security Act (42 U.S.C. 1396a(a)(13)) is

amended by striking subparagraph (C) and inserting

10

the following:

11

(C) payment for primary care services (as

12

defined in subsection (jj)) at a rate that is not

13

less than 100 percent of the payment rate that

14

applies to such services and physician under

15

part B of title XVIII (or, if greater, the pay-

16

ment rate that would be applicable under such

17

part if the conversion factor under section

18

1848(d) for the year involved were the conver-

19

sion factor under such section for 2009), and

20

that is not less than the rate that would other-

21

wise apply to such services under this title if

22

the rate were determined without regard to this

23

subparagraph, and that are

24

(i) furnished on or after January 1,

25

2013, and before January 1, 2015, by a

26

physician with a primary specialty designa-

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tion of family medicine, general internal

medicine, or pediatric medicine; or

3
4

(ii) furnished on or after January 1,

2015, and before January 1, 2017

(I) by a physician with a pri-

mary specialty designation of family

medicine, general internal medicine,

or pediatric medicine, but only if the

physician self-attests that the physi-

10

cian is Board certified in family medi-

11

cine, general internal medicine, or pe-

12

diatric medicine;

13

(II) by a physician with a pri-

14

mary specialty designation of obstet-

15

rics and gynecology, but only if the

16

physician self-attests that the physi-

17

cian is Board certified in obstetrics

18

and gynecology;

19

(III) by an advanced practice

20

clinician, as defined by the Secretary,

21

that works under the supervision of

22

(aa) a physician that satis-

23

fies the criteria specified in sub-

24

clause (I) or (II); or

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(bb) a nurse practitioner or

a physician assistant (as such

terms are defined in section

1861(aa)(5)(A)) who is working

in accordance with State law, or

a certified nurse-midwife (as de-

fined in section 1861(gg)) who is

working in accordance with State

law;

10

(IV) by a rural health clinic,

11

Federally-qualified health center, or

12

other health clinic that receives reim-

13

bursement on a fee schedule applica-

14

ble to a physician, a nurse practi-

15

tioner or a physician assistant (as

16

such terms are defined in section

17

1861(aa)(5)(A)) who is working in ac-

18

cordance with State law, or a certified

19

nurse-midwife (as defined in section

20

1861(gg)) who is working in accord-

21

ance with State law, for services fur-

22

nished by a physician, nurse practi-

23

tioner, physician assistant, or certified

24

nurse-midwife, or services furnished

25

by an advanced practice clinician su-

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pervised by a physician described in

subclause (I)(aa) or (II)(aa), another

advanced practice clinician, or a cer-

tified nurse-midwife; or

(V) by a nurse practitioner or a

physician assistant (as such terms are

defined in section 1861(aa)(5)(A))

who is working in accordance with

State law, or a certified nurse-midwife

10

(as defined in section 1861(gg)) who

11

is working in accordance with State

12

law, in accordance with procedures

13

that ensure that the portion of the

14

payment for such services that the

15

nurse practitioner, physician assist-

16

ant, or certified nurse-midwife is paid

17

is not less than the amount that the

18

nurse practitioner, physician assist-

19

ant, or certified nurse-midwife would

20

be paid if the services were provided

21

under part B of title XVIII;.

22

(2)

CONFORMING

AMENDMENT.Section

23

1905(dd) of the Social Security Act (42 U.S.C.

24

1396d(dd)) is amended by striking January 1,

25

2015 and inserting January 1, 2017.

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2
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(b) ENSURING PAYMENT

BY

MANAGED CARE ENTI-

TIES.

(1) IN

GENERAL.Section

1903(m)(2)(A) of

the Social Security Act (42 U.S.C. 1396b(m)(2)(A))

is amended

6
7

(A) in clause (xii), by striking and after

the semicolon;

(B) by realigning the left margin of clause

(xiii) so as to align with the left margin of

10

clause (xii) and by striking the period at the

11

end of clause (xiii) and inserting ; and; and

12

(C) by inserting after clause (xiii) the fol-

13

lowing:

14

(xiv) such contract provides that (I) payments

15

to providers specified in section 1902(a)(13)(C) for

16

primary care services defined in section 1902(jj)

17

that are furnished during a period specified in sec-

18

tion 1902(a)(13)(C) and section 1905(dd) are at

19

least equal to the amounts set forth and required by

20

the Secretary by regulation, (II) the entity shall,

21

upon request, provide documentation to the State,

22

sufficient to enable the State and the Secretary to

23

ensure compliance with subclause (I), and (III) the

24

Secretary shall approve payments described in sub-

25

clause (I) that are furnished through an agreed

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upon capitation, partial capitation, or other value-

based payment arrangement if the capitation, partial

capitation, or other value-based payment arrange-

ment is based on a reasonable methodology and the

entity provides documentation to the State sufficient

to enable the State and the Secretary to ensure com-

pliance with subclause (I)..

(2)

CONFORMING

AMENDMENT.Section

1932(f) of the Social Security Act (42 U.S.C.

10

1396u2(f)) is amended by inserting and clause

11

(xiv) of section 1903(m)(2)(A) before the period.

12
13
14

SEC. l03. INCREASING ACCESS TO SAFETY-NET PROVIDERS.

Title X of the Public Health Service Act (42 U.S.C.

15 300 et seq.) is amended by inserting after section 1003

16 the following:
17
18

SEC. 1003A. GRANTS FOR FACILITIES IMPROVEMENTS.

(a) IN GENERAL.The Secretary is authorized to

19 award grants to, and enter into contracts with, public or

20 nonprofit private entities to plan, develop, or make im21 provements to facilities carrying out family planning serv22 ice projects, and to expand preventive health services,
23 under section 1001.
24

(b) FUNDING.There is authorized to be appro-

25 priated, and there is appropriated, out of any monies in

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1 the Treasury not otherwise appropriated, $500,000,000
2 for each of fiscal years 2016 through 2019, to enable the
3 Secretary to expand access to family planning services and
4 to provide enhanced funding for the family planning pro5 gram under section 1001..
6

SEC. l04. STRENGTHENING AND IMPROVING COMMUNITY

HEALTH CENTERS, THE NATIONAL HEALTH

SERVICE CORPS, AND TEACHING HEALTH

CENTERS.

10

(a) IN GENERAL.The Medicare Access and CHIP

11 Reauthorization Act of 2015 is amended by striking sec12 tion 221.

13
14
15

(b) FUNDING
AND THE

FOR

COMMUNITY HEALTH CENTERS

NATIONAL HEALTH SERVICE CORPS.

(1) COMMUNITY

HEALTH CENTERS.Section

16

10503(b)(1)(E) of the Patient Protection and Af-

17

fordable Care Act (42 U.S.C. 254b-2(b)(1)(E)) is

18

amended by striking for fiscal year 2015 and in-

19

serting for each of fiscal years 2015 through

20

2019.

21

(2) NATIONAL

HEALTH SERVICE CORPS.Sec-

22

tion 10503(b)(2)(E) of the Patient Protection and

23

Affordable Care Act (42 U.S.C. 254b-2(b)(2)(E)) is

24

amended by striking for fiscal year 2015 and in-

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serting for each of fiscal years 2015 through

2019.

(c) EXTENSION

OF

TEACHING HEALTH CENTERS

4 PROGRAM.Section 340H(g) of the Public Health Service

5 Act (42 U.S.C. 256h(g)) is amended by inserting , and
6 $100,000,000 for each of fiscal years 2016 through 2019
7 before the period.
8
9
10

SEC. l05. INVESTING IN PRIMARY CARE, NURSE PRACTITIONERS.

Part B of title VIII of the Public Health Service Act

11 (42 U.S.C. 296j et seq.) is amended by adding at the end

12 the following:
13
14
15

SEC. 812. DEMONSTRATION GRANTS FOR NURSE PRACTITIONER TRAINING PROGRAM.

(a) ESTABLISHMENT

OF

PROGRAM.The Secretary

16 shall establish a demonstration program (referred to in

17 this section as the program) to award grants to eligible
18 entities for the training of nurse practitioners specializing
19 in womens health care for careers as providers in health
20 centers that receive assistance under title X (referred to
21 in this section as health centers).
22

(b) PURPOSE.The purpose of the program is to

23 enable each grant recipient to

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(1) provide new nurse practitioners with clin-

ical training to enable such practitioners to serve as

providers in health centers;

(2) train new nurse practitioners to work

under a model of care that is consistent with the

principles set forth by the Report Providing Quality

Family Planning Services of the Centers for Disease

Control and Prevention; and

(3) establish a model of training for nurse

10

practitioners that specialize in womens health care

11

that may be replicated nationwide.

12

(c) GRANTS.Under the program, the Secretary

13 shall award 3-year grants to eligible entities that meet the

14 requirements established by the Secretary, for the purpose
15 of operating the nurse practitioner programs described in
16 subsection (a) at such entities.
17

(d) ELIGIBLE ENTITIES.To be eligible to receive

18 a grant under this section, an entity shall be

19
20

(1) a health center that receives funding under

section 1001; and

21

(2) submit to the Secretary an application at

22

such time, in such manner, and containing such in-

23

formation as the Secretary may require.

24

(e) ELIGIBILITY OF NURSE PRACTITIONERS.

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(1) IN

GENERAL.To

be eligible for accept-

ance into a training program carried out by an eligi-

ble entity under a grant under this section, an indi-

vidual shall

(A) be licensed, or eligible for licensure,

in the State in which the program is being car-

ried out as an advanced practice registered

nurse or advanced practice nurse and be eligible

or board-certified as a nurse practitioner; and

10

(B) demonstrate commitment to a career

11

as a provider in a health center.

12

(2) PREFERENCE.In accepting individuals

13

into a training program under this section, a grant

14

recipient shall give preference to bilingual applicants

15

that meet the requirements described in paragraph

16

(1).

17

(f) GRANT AMOUNT.Each grant awarded under

18 this section shall be in an amount not to exceed $600,000

19 per year. A grant recipient may carry over funds from 1
20 fiscal year to another without obtaining approval from the
21 Secretary.
22

(g) TECHNICAL ASSISTANCE GRANTS.The Sec-

23 retary may award technical assistance grants to 1 or more

24 health centers that have demonstrated expertise in estab25 lishing a nurse practitioner residency training program.

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1 Such technical assistance grants shall be for the purpose
2 of providing technical assistance to other recipients of
3 grants under subsection (c).
4

(h) AUTHORIZATION

OF

APPROPRIATIONS.To

5 carry out this section, there is authorized to be appro6 priated $10,000,000 for each of fiscal years 2016 through
7 2019..