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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 Chil-drens Health Insurance Program, and for other pur-poses.

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:

At the appropriate place, insert the following: 1

TITLE llWOMENS ACCESS TO 2QUALITY HEALTH CARE 3

SEC. l01. SHORT TITLE. 4

This title may be cited as the Womens Access to 5

Quality Health Care Act. 6

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SEC. l02. RENEWAL OF APPLICATION OF MEDICARE PAY-1

MENT RATE FLOOR TO PRIMARY CARE SERV-2

ICES FURNISHED UNDER MEDICAID AND IN-3

CLUSION OF ADDITIONAL PROVIDERS. 4

(a) RENEWAL OF PAYMENT FLOOR; ADDITIONAL 5

PROVIDERS. 6

(1) IN GENERAL.Section 1902(a)(13) of the 7

Social Security Act (42 U.S.C. 1396a(a)(13)) is 8

amended by striking subparagraph (C) and inserting 9

the following: 10

(C) payment for primary care services (as 11

defined in subsection (jj)) at a rate that is not 12

less than 100 percent of the payment rate that 13

applies to such services and physician under 14

part B of title XVIII (or, if greater, the pay-15

ment rate that would be applicable under such 16

part if the conversion factor under section 17

1848(d) for the year involved were the conver-18

sion factor under such section for 2009), and 19

that is not less than the rate that would other-20

wise apply to such services under this title if 21

the rate were determined without regard to this 22

subparagraph, and that are 23

(i) furnished on or after January 1, 24

2013, and before January 1, 2015, by a 25

physician with a primary specialty designa-26

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tion of family medicine, general internal 1

medicine, or pediatric medicine; or 2

(ii) furnished on or after January 1, 3

2015, and before January 1, 2017 4

(I) by a physician with a pri-5

mary specialty designation of family 6

medicine, general internal medicine, 7

or pediatric medicine, but only if the 8

physician self-attests that the physi-9

cian is Board certified in family medi-10

cine, general internal medicine, or pe-11

diatric medicine; 12

(II) by a physician with a pri-13

mary specialty designation of obstet-14

rics and gynecology, but only if the 15

physician self-attests that the physi-16

cian is Board certified in obstetrics 17

and gynecology; 18

(III) by an advanced practice 19

clinician, as defined by the Secretary, 20

that works under the supervision of 21

(aa) a physician that satis-22

fies the criteria specified in sub-23

clause (I) or (II); or 24

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(bb) a nurse practitioner or 1

a physician assistant (as such 2

terms are defined in section 3

1861(aa)(5)(A)) who is working 4

in accordance with State law, or 5

a certified nurse-midwife (as de-6

fined in section 1861(gg)) who is 7

working in accordance with State 8

law; 9

(IV) by a rural health clinic, 10

Federally-qualified health center, or 11

other health clinic that receives reim-12

bursement on a fee schedule applica-13

ble to a physician, a nurse practi-14

tioner or a physician assistant (as 15

such terms are defined in section 16

1861(aa)(5)(A)) who is working in ac-17

cordance with State law, or a certified 18

nurse-midwife (as defined in section 19

1861(gg)) who is working in accord-20

ance with State law, for services fur-21

nished by a physician, nurse practi-22

tioner, physician assistant, or certified 23

nurse-midwife, or services furnished 24

by an advanced practice clinician su-25

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pervised by a physician described in 1

subclause (I)(aa) or (II)(aa), another 2

advanced practice clinician, or a cer-3

tified nurse-midwife; or 4

(V) by a nurse practitioner or a 5

physician assistant (as such terms are 6

defined in section 1861(aa)(5)(A)) 7

who is working in accordance with 8

State law, or a certified nurse-midwife 9

(as defined in section 1861(gg)) who 10

is working in accordance with State 11

law, in accordance with procedures 12

that ensure that the portion of the 13

payment for such services that the 14

nurse practitioner, physician assist-15

ant, or certified nurse-midwife is paid 16

is not less than the amount that the 17

nurse practitioner, physician assist-18

ant, or certified nurse-midwife would 19

be paid if the services were provided 20

under part B of title XVIII;. 21

(2) CONFORMING AMENDMENT.Section 22

1905(dd) of the Social Security Act (42 U.S.C. 23

1396d(dd)) is amended by striking January 1, 24

2015 and inserting January 1, 2017. 25

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(b) ENSURING PAYMENT BY MANAGED CARE ENTI-1

TIES. 2

(1) IN GENERAL.Section 1903(m)(2)(A) of 3

the Social Security Act (42 U.S.C. 1396b(m)(2)(A)) 4

is amended 5

(A) in clause (xii), by striking and after 6

the semicolon; 7

(B) by realigning the left margin of clause 8

(xiii) so as to align with the left margin of 9

clause (xii) and by striking the period at the 10

end of clause (xiii) and inserting ; and; and 11

(C) by inserting after clause (xiii) the fol-12

lowing: 13

(xiv) such contract provides that (I) payments 14

to providers specified in section 1902(a)(13)(C) for 15

primary care services defined in section 1902(jj) 16

that are furnished during a period specified in sec-17

tion 1902(a)(13)(C) and section 1905(dd) are at 18

least equal to the amounts set forth and required by 19

the Secretary by regulation, (II) the entity shall, 20

upon request, provide documentation to the State, 21

sufficient to enable the State and the Secretary to 22

ensure compliance with subclause (I), and (III) the 23

Secretary shall approve payments described in sub-24

clause (I) that are furnished through an agreed 25

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upon capitation, partial capitation, or other value- 1

based payment arrangement if the capitation, partial 2

capitation, or other value-based payment arrange-3

ment is based on a reasonable methodology and the 4

entity provides documentation to the State sufficient 5

to enable the State and the Secretary to ensure com-6

pliance with subclause (I).. 7

(2) CONFORMING AMENDMENT.Section 8

1932(f) of the Social Security Act (42 U.S.C. 9

1396u2(f)) is amended by inserting and clause 10

(xiv) of section 1903(m)(2)(A) before the period. 11

SEC. l03. INCREASING ACCESS TO SAFETY-NET PRO-12

VIDERS. 13

Title X of the Public Health Service Act (42 U.S.C. 14

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

the following: 16

SEC. 1003A. GRANTS FOR FACILITIES IMPROVEMENTS. 17

(a) IN GENERAL.The Secretary is authorized to 18

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

nonprofit private entities to plan, develop, or make im-20

provements to facilities carrying out family planning serv-21

ice projects, and to expand preventive health services, 22

under section 1001. 23

(b) FUNDING.There is authorized to be appro-24

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

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the Treasury not otherwise appropriated, $500,000,000 1

for each of fiscal years 2016 through 2019, to enable the 2

Secretary to expand access to family planning services and 3

to provide enhanced funding for the family planning pro-4

gram under section 1001.. 5

SEC. l04. STRENGTHENING AND IMPROVING COMMUNITY 6

HEALTH CENTERS, THE NATIONAL HEALTH 7

SERVICE CORPS, AND TEACHING HEALTH 8

CENTERS. 9

(a) IN GENERAL.The Medicare Access and CHIP 10

Reauthorization Act of 2015 is amended by striking sec-11

tion 221. 12

(b) FUNDING FOR COMMUNITY HEALTH CENTERS 13

AND THE NATIONAL HEALTH SERVICE CORPS. 14

(1) COMMUNITY HEALTH CENTERS.Section 15

10503(b)(1)(E) of the Patient Protection and Af-16

fordable Care Act (42 U.S.C. 254b-2(b)(1)(E)) is 17

amended by striking for fiscal year 2015 and in-18

serting for each of fiscal years 2015 through 19

2019. 20

(2) NATIONAL HEALTH SERVICE CORPS.Sec-21

tion 10503(b)(2)(E) of the Patient Protection and 22

Affordable Care Act (42 U.S.C. 254b-2(b)(2)(E)) is 23

amended by striking for fiscal year 2015 and in-24

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serting for each of fiscal years 2015 through 1

2019. 2

(c) EXTENSION OF TEACHING HEALTH CENTERS 3

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

Act (42 U.S.C. 256h(g)) is amended by inserting , and 5

$100,000,000 for each of fiscal years 2016 through 2019 6

before the period. 7

SEC. l05. INVESTING IN PRIMARY CARE, NURSE PRACTI-8

TIONERS. 9

Part B of title VIII of the Public Health Service Act 10

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

the following: 12

SEC. 812. DEMONSTRATION GRANTS FOR NURSE PRACTI-13

TIONER TRAINING PROGRAM. 14

(a) ESTABLISHMENT OF PROGRAM.The Secretary 15

shall establish a demonstration program (referred to in 16

this section as the program) to award grants to eligible 17

entities for the training of nurse practitioners specializing 18

in womens health care for careers as providers in health 19

centers that receive assistance under title X (referred to 20

in this section as health centers). 21

(b) PURPOSE.The purpose of the program is to 22

enable each grant recipient to 23

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(1) provide new nurse practitioners with clin-1

ical training to enable such practitioners to serve as 2

providers in health centers; 3

(2) train new nurse practitioners to work 4

under a model of care that is consistent with the 5

principles set forth by the Report Providing Quality 6

Family Planning Services of the Centers for Disease 7

Control and Prevention; and 8

(3) establish a model of training for nurse 9

practitioners that specialize in womens health care 10

that may be replicated nationwide. 11

(c) GRANTS.Under the program, the Secretary 12

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

requirements established by the Secretary, for the purpose 14

of operating the nurse practitioner programs described in 15

subsection (a) at such entities. 16

(d) ELIGIBLE ENTITIES.To be eligible to receive 17

a grant under this section, an entity shall be 18

(1) a health center that receives funding under 19

section 1001; and 20

(2) submit to the Secretary an application at 21

such time, in such manner, and containing such in-22

formation as the Secretary may require. 23

(e) ELIGIBILITY OF NURSE PRACTITIONERS. 24

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(1) IN GENERAL.To be eligible for accept-1

ance into a training program carried out by an eligi-2

ble entity under a grant under this section, an indi-3

vidual shall 4

(A) be licensed, or eligible for licensure, 5

in the State in which the program is being car-6

ried out as an advanced practice registered 7

nurse or advanced practice nurse and be eligible 8

or board-certified as a nurse practitioner; and 9

(B) demonstrate commitment to a career 10

as a provider in a health center. 11

(2) PREFERENCE.In accepting individuals 12

into a training program under this section, a grant 13

recipient shall give preference to bilingual applicants 14

that meet the requirements described in paragraph 15

(1). 16

(f) GRANT AMOUNT.Each grant awarded under 17

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

per year. A grant recipient may carry over funds from 1 19

fiscal year to another without obtaining approval from the 20

Secretary. 21

(g) TECHNICAL ASSISTANCE GRANTS.The Sec-22

retary may award technical assistance grants to 1 or more 23

health centers that have demonstrated expertise in estab-24

lishing a nurse practitioner residency training program. 25

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Such technical assistance grants shall be for the purpose 1

of providing technical assistance to other recipients of 2

grants under subsection (c). 3

(h) AUTHORIZATION OF APPROPRIATIONS.To 4

carry out this section, there is authorized to be appro-5

priated $10,000,000 for each of fiscal years 2016 through 6

2019.. 7