text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Community Coalitions for Access and 
  Quality Improvement Act of 2009''.
  
  SEC. 2. PURPOSE.
  
      The purpose of this Act is to provide assistance to community 
  health coalitions as described in section 3(b) with a clearly defined 
  local need to increase access to and improve the quality of health care 
  services through activities which--
              (1) develop or strengthen coordination of services to allow 
          all individuals, including the uninsured and low-income, to 
          receive efficient and higher quality care and to gain entry 
          into and receive services from a comprehensive system of 
          medical, dental, pharmaceutical, and behavioral health care;
              (2) develop efficient and sustainable infrastructure for a 
          health care delivery system characterized by effective 
          collaboration, information sharing, and clinical and financial 
          coordination among all types of providers of care in the 
          community; and
              (3) develop or strengthen activities related to providing 
          coordinated care for individuals with chronic conditions.
  
  SEC. 3. GRANTS TO STRENGTHEN THE EFFECTIVENESS, EFFICIENCY, AND 
                COORDINATION OF SERVICES.
  
      (a) In General.--The Secretary of Health and Human Services (in 
  this Act referred to as the ``Secretary'') shall award grants to assist 
  in the development of integrated health care delivery systems to serve 
  defined communities of individuals--
              (1) to improve the efficiency of and coordination among the 
          providers providing services through such systems;
              (2) to assist local communities in developing programs 
          targeted toward preventing and managing chronic diseases; and
              (3) to expand and enhance the services provided through 
          such systems.
      (b) Eligible Entities.--To be eligible to receive a grant under 
  this section, an entity shall be an entity that--
              (1) represents a balanced consortium--
                      (A) whose principal purpose is to ensure the 
                  sustainable capacity for the provision of a broad range 
                  of coordinated services for all residents within a 
                  community defined in the entity's grant application as 
                  described in paragraph (2); and
                      (B) that includes at least one of each of the 
                  following providers that serve the community (unless 
                  such provider does not exist within the community, 
                  declines or refuses to participate, or places 
                  unreasonable conditions on their participation)--
                              (i) a federally qualified health center (as 
                          defined in section 1861(aa) of the Social 
                          Security Act (42 U.S.C. 1395x(aa)));
                              (ii) rural health clinics and rural health 
                          networks (as defined in sections 1861(aa) and 
                          1820(d) of the Social Security Act, 
                          respectively (42 U.S.C. 1395x(aa), 1395i-
                          4(d)));
                              (iii) a hospital with a low-income 
                          utilization rate that is greater than 25 
                          percent (as defined in section 1923(b)(3) of 
                          the Social Security Act (42 U.S.C. 1396r-
                          4(b)(3))) or a critical access hospital (as 
                          defined in section 1820(c)(2) of the Social 
                          Security Act (42 U.S.C. 1395i-4(c)(2)));
                              (iv) a public health department; and
                              (v) an interested public or private sector 
                          health care provider or an organization that 
                          has traditionally served the medically 
                          uninsured and low-income individuals; and
              (2) submits to the Secretary an application, in such form 
          and manner as the Secretary shall prescribe, that--
                      (A) clearly defines the community to be served;
                      (B) identifies the providers who will participate 
                  in the community coalition under the grant and 
                  specifies each provider's contribution to the care of 
                  individuals in the community;
                      (C) describes the activities that the applicant and 
                  the community coalition propose to perform under the 
                  grant to further the objectives of this section;
                      (D) demonstrates that it is an established 
                  coalition with ability to build on the current system 
                  for serving the community by involving providers who 
                  have traditionally provided a significant volume of 
                  care for uninsured and low-income individuals for that 
                  community;
                      (E) demonstrates the coalition's ability to develop 
                  coordinated systems of care that either directly 
                  provide or ensure the prompt provision of a broad range 
                  of high-quality, accessible services, including, as 
                  appropriate, primary, secondary, and tertiary services 
                  as well as pharmacy, substance abuse, behavioral health 
                  and oral health services, in a manner that ensures 
                  continuity of care in the community;
                      (F) provides evidence of community involvement, 
                  including the business community, in the development, 
                  implementation, and direction of the system of care 
                  that the coalition proposes to ensure;
                      (G) demonstrates the coalition's ability to ensure 
                  that participating individuals are enrolled in health 
                  care coverage programs, both public and private, for 
                  which the individuals are eligible;
                      (H) presents a plan for leveraging other sources of 
                  revenue, which may include State and local sources and 
                  private grant funds, and integrating current and 
                  proposed new funding sources in a manner to ensure 
                  long-term sustainability of the system of care;
                      (I) describes a plan for evaluation of the 
                  activities carried out under the grant, including 
                  measurement of progress toward the goals and objectives 
                  of the program and the use of evaluation findings to 
                  improve system performance;
                      (J) demonstrates fiscal responsibility through the 
                  use of appropriate accounting procedures and management 
                  systems;
                      (K) demonstrates commitment to serve the community 
                  without regard to the ability of an individual or 
                  family to pay by arranging for or providing free or 
                  reduced charge care for the poor; and
                      (L) includes such other information as the 
                  Secretary may prescribe.
      (c) Limitations.--
              (1) In general.--An eligible entity may receive a grant 
          under this section for 3 consecutive fiscal years and may 
          receive such a grant award for 2 additional years if--
                      (A) the eligible entity submits to the Secretary a 
                  request for a grant for such additional years;
                      (B) the Secretary determines that current 
                  performance justifies the granting of such a request; 
                  and
                      (C) the Secretary determines that granting such 
                  request is necessary to further the objectives 
                  described in subsection (a).
      (d) Priorities.--In awarding grants under this section, the 
  Secretary--
              (1) may accord priority to applicants that demonstrate the 
          greatest extent of unmet need in the community for a more 
          coordinated system of care; and
              (2) shall accord priority to applicants that best promote 
          the objectives of this section, taking into consideration the 
          extent to which the applicant--
                      (A) identifies a community whose geographical area 
                  has a high or increasing percentage of individuals who 
                  are uninsured or low-income;
                      (B) demonstrates that the applicant has included in 
                  its community coalition providers, support systems, and 
                  programs that have a tradition of serving individuals 
                  and families in the community who are uninsured or earn 
                  below 200 percent of the Federal poverty level;
                      (C) shows evidence that the proposed coalition 
                  activities would expand utilization of preventive and 
                  primary care services for uninsured and underinsured 
                  individuals and families in the community, including 
                  pharmaceuticals, behavioral and mental health services, 
                  oral health services, or substance abuse services;
                      (D) proposes approaches that would improve 
                  coordination between health care providers and 
                  appropriate social service providers;
                      (E) demonstrates collaboration with State and local 
                  governments;
                      (F) demonstrates that the applicant makes use of 
                  non-Federal contributions to the greatest extent 
                  possible; or
                      (G) demonstrates likelihood that the proposed 
                  activities will lead to sustainable integrated delivery 
                  system as additional efforts of health systems 
                  development evolve.
      (e) Use of Funds.--
              (1) Use by grantees.--
                      (A) In general.--Except as provided in paragraphs 
                  (2) and (3), a grantee may use amounts provided under 
                  this section only for--
                              (i) direct expenses associated with 
                          achieving the greater integration of a health 
                          care delivery system so that the system either 
                          directly provides or ensures the provision of a 
                          broad range of culturally competent services, 
                          including as appropriate primary, secondary, 
                          and tertiary care and oral health, substance 
                          abuse, behavioral and mental health, and 
                          pharmaceutical services; and
                              (ii) direct patient care and service 
                          expansions to fill identified or documented 
                          gaps within an integrated delivery system.
                      (B) Specific uses.--The following are examples of 
                  purposes for which a grantee may use grant funds under 
                  this section, when such use meets the conditions stated 
                  in subparagraph (A):
                              (i) Increases in outreach activities and 
                          closing gaps in health care service, including 
                          referral to specialty services and prescription 
                          drugs and conducting ongoing outreach to health 
                          disparity populations.
                              (ii) Improvements to care management and 
                          delivery of patient-centered care, including 
                          patient navigation services.
                              (iii) Improvements to coordination of 
                          transportation to health care facilities.
                              (iv) Development of provider networks and 
                          other innovative models to engage physicians in 
                          voluntary efforts to serve the medically 
                          underserved within a community.
                              (v) Recruitment, training, and compensation 
                          of necessary personnel.
                              (vi) Coordinate the acquisition or 
                          interconnected use of technology within a 
                          community for the purpose of coordinating care 
                          and improving provider communication, including 
                          implementation of shared information systems or 
                          shared clinical systems to improve the quality 
                          of health care.
                              (vii) Development of common processes such 
                          as mechanisms for determining eligibility for 
                          the programs provided through the system, 
                          common identification cards, sliding scale 
                          discounts, and monitoring and tracking of 
                          outcomes.
                              (viii) Development of specific prevention 
                          and disease management tools and processes.
                              (ix) Language access services.
                              (x) Facilitating the involvement of 
                          community organizations to provide better 
                          access to high-quality health care services to 
                          individuals at risk for or who have chronic 
                          diseases or cancer.
                              (xi) Helping patients overcome barriers 
                          within the health care system to ensure prompt 
                          diagnostic and treatment resolution of an 
                          abnormal finding of cancer or chronic disease.
              (2) Direct patient care limitation.--Not more than 20 
          percent of the funds provided under a grant awarded under this 
          section may be used for providing direct patient care and 
          services.
              (3) Reservation of funds for national program purposes.--
          The Secretary may use not more than 7 percent of funds 
          appropriated to carry out this section for providing technical 
          assistance to grantees, obtaining assistance of experts and 
          consultants, holding meetings, developing of tools, 
          disseminating of information, and evaluation.
      (f) Reporting by Grantee.--A grantee under this section shall 
  report to the Secretary annually regarding--
              (1) progress in meeting the goals and measurable objectives 
          set forth in the grant application submitted by the grantee 
          under subsection (b); and
              (2) the extent to which activities conducted by such 
          grantee have--
                      (A) improved the effectiveness, efficiency, and 
                  coordination of services for uninsured and low-income 
                  individuals in the community served by such grantee, 
                  using commonly accepted outcome measures;
                      (B) resulted in the provision of better quality 
                  health care for individuals and families in the 
                  community served; and
                      (C) resulted in the provision of health care to 
                  such individuals at lower cost than would have been 
                  possible in the absence of the activities conducted by 
                  such grantee.
      (g) Maintenance of Effort.--With respect to activities for which a 
  grant under this section is authorized, the Secretary may award such a 
  grant only if the applicant and each of the participating providers 
  agree that the grantee and each such provider will maintain its 
  expenditures of non-Federal funds for such activities at a level that 
  is not less then the level of such expenditures during the fiscal year 
  immediately preceding the fiscal year for which the applicant is 
  applying to receive such grant.
      (h) Technical Assistance.--The Secretary may provide any entity 
  that receives a grant under this section with technical and other 
  nonfinancial assistance necessary to meet the requirements of this 
  section. The Secretary may choose to provide such assistance by 
  awarding a grant to, or entering into a contract with, a State or 
  national not-for-profit organization with expertise in building 
  successful community coalitions.
      (i) Evaluation of Program.--Not later than September 30, 2014, the 
  Secretary shall prepare and submit to the appropriate committees of 
  Congress a report that describes the extent to which projects funded 
  under this section have been successful in improving the effectiveness, 
  efficiency, and coordination of services in the communities served by 
  such projects, including whether the projects resulted in the provision 
  of better quality health care for such individuals, and whether such 
  care was provided at lower costs than would have been provided in the 
  absence of such projects.
      (j) Authorization of Appropriations.--There are authorized to be 
  appropriated to carry out this section--
              (1) $75,000,000 for fiscal year 2010;
              (2) $100,000,000 for fiscal year 2011;
              (3) $125,000,000 for fiscal year 2012;
              (4) $150,000,000 for fiscal year 2013; and
              (5) $175,000,000 for fiscal year 2014.
target: Community Coalitions for Access and Quality Improvement Act of 2009 - Directs the Secretary of Health and Human Services to award grants to assist in developing integrated health care delivery systems to serve defined communities of individuals to: (1) improve efficiency and coordination among providers; (2) assist local communities in developing programs targeted toward preventing and managing chronic diseases; and (3) expand and enhance services provided.
  
  Authorizes the Secretary, in awarding grants, to accord priority to: (1) applicants that demonstrate the greatest unmet need for a more coordinated system of care; and (2) applicants that best promote the objectives of this Act.
  
  Authorizes a grantee to use amounts provided only for: (1) direct expenses associated with achieving greater integration of a health care delivery system to directly provide or ensure the provision of a broad range of culturally competent services; and (2) direct patient care and service expansions to fill identified or documented gaps within an integrated delivery system.
feat_title: A bill to authorize the Secretary of Health and Human Services to make grants to community health coalitions to assist in the development of integrated health care delivery, and for other purposes.