text: SECTION 1. SHORT TITLE; REFERENCES.
  
      (a) Short Title.--This Act may be cited as the ``Federally 
  Supported Health Centers Assistance Act of 1995''.
      (b) References.--Except as otherwise expressly provided, whenever 
  in this Act an amendment or repeal is expressed in terms of an 
  amendment to, or repeal of, a section or other provision, the reference 
  shall be considered to be made to a section or other provision of the 
  Public Health Service Act.
  
  SEC. 2. PERMANENT EXTENSION OF PROGRAM.
  
      (a) In General.--Section 224(g)(3) (42 U.S.C. 233(g)(3)) is amended 
  by striking the last sentence.
      (b) Conforming Amendments.--Section 224(k) (42 U.S.C. 233(k)) is 
  amended--
          (1) in paragraph (1)(A)--
              (A) by striking ``For each of the fiscal years 1993, 1994, 
          and 1995'' and inserting ``For each fiscal year''; and
              (B) by striking ``(except'' and all that follows through 
          ``thereafter)''; and
          (2) in paragraph (2), by striking ``for each of the fiscal 
      years 1993, 1994, and 1995'' and inserting ``for each fiscal 
      year''.
  
  SEC. 3. CLARIFICATION OF COVERAGE.
  
      Section 224 (42 U.S.C. 233) is amended--
          (1) in subsection (g)(1), by striking ``an entity described in 
      paragraph (4)'' in the first sentence and all that follows through 
      ``contractor'' in the second sentence and inserting the following: 
      ``an entity described in paragraph (4), and any officer, governing 
      board member, or employee of such an entity, and any contractor of 
      such an entity who is a physician or other licensed or certified 
      health care practitioner (subject to paragraph (5)), shall be 
      deemed to be an employee of the Public Health Service for a 
      calendar year that begins during a fiscal year for which a transfer 
      was made under subsection (k)(3) (subject to paragraph (3)). The 
      remedy against the United States for an entity described in 
      paragraph (4) and any officer, governing board member, employee, or 
      contractor''; and
          (2) in subsection (k)(3), by inserting ``governing board 
      member,'' after ``officer,''.
  
  SEC. 4. COVERAGE FOR SERVICES FURNISHED TO INDIVIDUALS OTHER THAN 
                CENTER PATIENTS.
  
      Section 224(g)(1) (42 U.S.C. 233(g)) is amended--
          (1) by redesignating paragraph (1) as paragraph (1)(A); and
          (2) by adding at the end thereof the following:
      ``(B) The deeming of any entity or officer, governing board member, 
  employee, or contractor of the entity to be an employee of the Public 
  Health Service for purposes of this section shall apply with respect to 
  services provided--
          ``(i) to all patients of the entity, and
          ``(ii) subject to subparagraph (C), to individuals who are not 
      patients of the entity.
      ``(C) Subparagraph (B)(ii) applies to services provided to 
  individuals who are not patients of an entity if the Secretary 
  determines, after reviewing an application submitted under subparagraph 
  (D), that the provision of the services to such individuals--
          ``(i) benefits patients of the entity and general populations 
      that could be served by the entity through community-wide 
      intervention efforts within the communities served by such entity;
          ``(ii) facilitates the provision of services to patients of the 
      entity; or
          ``(iii) are otherwise required under an employment contract (or 
      similar arrangement) between the entity and an officer, governing 
      board member, employee, or contractor of the entity.''.
  
  SEC. 5. APPLICATION PROCESS.
  
      (a) Application Requirement.--Section 224(g)(1) (42 U.S.C. 
  233(g)(1)) (as amended by section 4) is further amended--
          (1) in subparagraph (A), by inserting after ``For purposes of 
      this section'' the following: ``and subject to the approval by the 
      Secretary of an application under subparagraph (D)''; and
          (2) by adding at the end thereof the following:
      ``(D) The Secretary may not under subparagraph (A) deem an entity 
  or an officer, governing board member, employee, or contractor of the 
  entity to be an employee of the Public Health Service for purposes of 
  this section, and may not apply such deeming to services described in 
  subparagraph (B)(ii), unless the entity has submitted an application 
  for such deeming to the Secretary in such form and such manner as the 
  Secretary shall prescribe. The application shall contain detailed 
  information, along with supporting documentation, to verify that the 
  entity, and the officer, governing board member, employee, or 
  contractor of the entity, as the case may be, meets the requirements of 
  subparagraphs (B) and (C) of this paragraph and that the entity meets 
  the requirements of paragraphs (1) through (4) of subsection (h).
      ``(E) The Secretary shall make a determination of whether an entity 
  or an officer, governing board member, employee, or contractor of the 
  entity is deemed to be an employee of the Public Health Service for 
  purposes of this section within 30 days after the receipt of an 
  application under subparagraph (D). The determination of the Secretary 
  that an entity or an officer, governing board member, employee, or 
  contractor of the entity is deemed to be an employee of the Public 
  Health Service for purposes of this section shall apply for the period 
  specified by the Secretary under subparagraph (A).
      ``(F) Once the Secretary makes a determination that an entity or an 
  officer, governing board member, employee, or contractor of an entity 
  is deemed to be an employee of the Public Health Service for purposes 
  of this section, the determination shall be final and binding upon the 
  Secretary and the Attorney General and other parties to any civil 
  action or proceeding. Except as provided in subsection (i), the 
  Secretary and the Attorney General may not determine that the provision 
  of services which are the subject of such a determination are not 
  covered under this section.
      ``(G) In the case of an entity described in paragraph (4) that has 
  not submitted an application under subparagraph (D):
          ``(i) The Secretary may not consider the entity in making 
      estimates under subsection (k)(1).
          ``(ii) This section does not affect any authority of the entity 
      to purchase medical malpractice liability insurance coverage with 
      Federal funds provided to the entity under section 329, 330, 340, 
      or 340A.
      ``(H) In the case of an entity described in paragraph (4) for which 
  an application under subparagraph (D) is in effect, the entity may, 
  through notifying the Secretary in writing, elect to terminate the 
  applicability of this subsection to the entity. With respect to such 
  election by the entity:
          ``(i) The election is effective upon the expiration of the 30-
      day period beginning on the date on which the entity submits such 
      notification.
          ``(ii) Upon taking effect, the election terminates the 
      applicability of this subsection to the entity and each officer, 
      governing board member, employee, and contractor of the entity.
          ``(iii) Upon the effective date for the election, clauses (i) 
      and (ii) of subparagraph (G) apply to the entity to the same extent 
      and in the same manner as such clauses apply to an entity that has 
      not submitted an application under subparagraph (D).
          ``(iv) If after making the election the entity submits an 
      application under subparagraph (D), the election does not preclude 
      the Secretary from approving the application (and thereby restoring 
      the applicability of this subsection to the entity and each 
      officer, governing board member, employee, and contractor of the 
      entity, subject to the provisions of this subsection and the 
      subsequent provisions of this section.''.
      (b) Approval Process.--Section 224(h) (42 U.S.C. 233(h)) is 
  amended--
          (1) in the matter preceding paragraph (1), by striking 
      ``Notwithstanding'' and all that follows through ``entity--'' and 
      inserting the following: ``The Secretary may not approve an 
      application under subsection (g)(1)(D) unless the Secretary 
      determines that the entity--''; and
          (2) by striking ``has fully cooperated'' in paragraph (4) and 
      inserting ``will fully cooperate''.
      (c) Delayed Applicability for Current Participants.--If, on the day 
  before the date of the enactment of this Act, an entity was deemed to 
  be an employee of the Public Health Service for purposes of section 
  224(g) of the Public Health Service Act, the condition under paragraph 
  (1)(D) of such section (as added by subsection (a) of this section) 
  that an application be approved with respect to the entity does not 
  apply until the expiration of the 180-day period beginning on such 
  date.
  
  SEC. 6. TIMELY RESPONSE TO FILING OF ACTION OR PROCEEDING.
  
      Section 224 (42 U.S.C. 233) is amended by adding at the end thereof 
  the following subsection:
      ``(l)(1) If a civil action or proceeding is filed in a State court 
  against any entity described in subsection (g)(4) or any officer, 
  governing board member, employee, or any contractor of such an entity 
  for damages described in subsection (a), the Attorney General, within 
  15 days after being notified of such filing, shall make an appearance 
  in such court and advise such court as to whether the Secretary has 
  determined under subsections (g) and (h), that such entity, officer, 
  governing board member, employee, or contractor of the entity is deemed 
  to be an employee of the Public Health Service for purposes of this 
  section with respect to the actions or omissions that are the subject 
  of such civil action or proceeding. Such advice shall be deemed to 
  satisfy the provisions of subsection (c) that the Attorney General 
  certify that an entity, officer, governing board member, employee, or 
  contractor of the entity was acting within the scope of their 
  employment or responsibility.
      ``(2) If the Attorney General fails to appear in State court within 
  the time period prescribed under paragraph (1), upon petition of any 
  entity or officer, governing board member, employee, or contractor of 
  the entity named, the civil action or proceeding shall be removed to 
  the appropriate United States district court. The civil action or 
  proceeding shall be stayed in such court until such court conducts a 
  hearing, and makes a determination, as to the appropriate forum or 
  procedure for the assertion of the claim for damages described in 
  subsection (a) and issues an order consistent with such 
  determination.''.
  
  SEC. 7. APPLICATION OF COVERAGE TO MANAGED CARE PLANS.
  
      Section 224 (42 U.S.C. 223) (as amended by section 6) is amended by 
  adding at the end thereof the following subsection:
      ``(m)(1) An entity or officer, governing board member, employee, or 
  contractor of an entity described in subsection (g)(1) shall, for 
  purposes of this section, be deemed to be an employee of the Public 
  Health Service with respect to services provided to individuals who are 
  enrollees of a managed care plan if the entity contracts with such 
  managed care plan for the provision of services.
      ``(2) Each managed care plan which enters into a contract with an 
  entity described in subsection (g)(4) shall deem the entity and any 
  officer, governing board member, employee, or contractor of the entity 
  as meeting whatever malpractice coverage requirements such plan may 
  require of contracting providers for a calendar year if such entity or 
  officer, governing board member, employee, or contractor of the entity 
  has been deemed to be an employee of the Public Health Service for 
  purposes of this section for such calendar year. Any plan which is 
  found by the Secretary on the record, after notice and an opportunity 
  for a full and fair hearing, to have violated this subsection shall 
  upon such finding cease, for a period to be determined by the 
  Secretary, to receive and to be eligible to receive any Federal funds 
  under titles XVIII or XIX of the Social Security Act.
      ``(3) For purposes of this subsection, the term `managed care plan' 
  shall mean health maintenance organizations and similar entities that 
  contract at-risk with payors for the provision of health services or 
  plan enrollees and which contract with providers (such as entities 
  described in subsection (g)(4)) for the delivery of such services to 
  plan enrollees.''.
  
  SEC. 8. COVERAGE FOR PART-TIME PROVIDERS UNDER CONTRACTS.
  
      Section 224(g)(5)(B) (42 U.S.C. 223(g)(5)(B)) is amended to read as 
  follows:
          ``(B) in the case of an individual who normally performs an 
      average of less than 32\1/2\ hours of services per week for the 
      entity for the period of the contract, the individual is a licensed 
      or certified provider of services in the fields of family practice, 
      general internal medicine, general pediatrics, or obstetrics and 
      gynecology.''.
  
  SEC. 9. DUE PROCESS FOR LOSS OF COVERAGE.
  
      Section 224(i)(1) (42 U.S.C. 233(i)(1)) is amended by striking 
  ``may determine, after notice and opportunity for a hearing'' and 
  inserting ``may on the record determine, after notice and opportunity 
  for a full and fair hearing''.
  
  SEC. 10. AMOUNT OF RESERVE FUND.
  
      Section 224(k)(2) (42 U.S.C. 223(k)(2)) is amended by striking 
  ``$30,000,000'' and inserting ``$10,000,000''.
  
  SEC. 11. REPORT ON RISK EXPOSURE OF COVERED ENTITIES.
  
      Section 224 (as amended by section 7) is amended by adding at the 
  end thereof the following subsection:
      ``(n)(1) Not later than one year after the date of the enactment of 
  the Federally Supported Health Centers Assistance Act of 1995, the 
  Comptroller General of the United States shall submit to the Congress a 
  report on the following:
          ``(A) The medical malpractice liability claims experience of 
      entities that have been deemed to be employees for purposes of this 
      section.
          ``(B) The risk exposure of such entities.
          ``(C) The value of private sector risk-management services, and 
      the value of risk-management services and procedures required as a 
      condition of receiving a grant under section 329, 330, 340, or 
      340A.
          ``(D) A comparison of the costs and the benefits to taxpayers 
      of maintaining medical malpractice liability coverage for such 
      entities pursuant to this section, taking into account--
              ``(i) a comparison of the costs of premiums paid by such 
          entities for private medical malpractice liability insurance 
          with the cost of coverage pursuant to this section; and
              ``(ii) an analysis of whether the cost of premiums for 
          private medical malpractice liability insurance coverage is 
          consistent with the liability claims experience of such 
          entities.
      ``(2) The report under paragraph (1) shall include the following:
          ``(A) A comparison of--
              ``(i) an estimate of the aggregate amounts that such 
          entities (together with the officers, governing board members, 
          employees, and contractors of such entities who have been 
          deemed to be employees for purposes of this section) would have 
          directly or indirectly paid in premiums to obtain medical 
          malpractice liability insurance coverage if this section were 
          not in effect; with
              ``(ii) the aggregate amounts by which the grants received 
          by such entities under this Act were reduced pursuant to 
          subsection (k)(2).
          ``(B) A comparison of--
              ``(i) an estimate of the amount of privately offered such 
          insurance that such entities (together with the officers, 
          governing board members, employees, and contractors of such 
          entities who have been deemed to be employees for purposes of 
          this section) purchased during the three-year period beginning 
          on January 1, 1993; with
              ``(ii) an estimate of the amount of such insurance that 
          such entities (together with the officers, governing board 
          members, employees, and contractors of such entities who have 
          been deemed to be employees for purposes of this section) will 
          purchase after the date of the enactment of the Federally 
          Supported Health Centers Assistance Act of 1995.
          ``(C) An estimate of the medical malpractice liability loss 
      history of such entities for the 10-year period preceding October 
      1, 1996, including but not limited to the following:
              ``(i) Claims that have been paid and that are estimated to 
          be paid, and legal expenses to handle such claims that have 
          been paid and that are estimated to be paid, by the Federal 
          Government pursuant to deeming entities as employees for 
          purposes of this section.
              ``(ii) Claims that have been paid and that are estimated to 
          be paid, and legal expenses to handle such claims that have 
          been paid and that are estimated to be paid, by private medical 
          malpractice liability insurance.
        ``(D) An analysis of whether the cost of premiums for private 
      medical malpractice liability insurance coverage is consistent with 
      the liability claims experience of entities that have been deemed 
      as employees for purposes of this section.
      ``(3) In preparing the report under paragraph (1), the Comptroller 
  General of the United States shall consult with public and private 
  entities with expertise on the matters with which the report is 
  concerned.''.
  
                                 Speaker of the House of Representatives.
  
                              Vice President of the United States and    
                                                 President of the Senate.
target: Federally Supported Health Centers Assistance Act of 1995 - Amends the Public Health Service Act to remove provisions ending, on a specified date, the application of provisions:  (1) deeming health care practitioner officers, employees, or contractors of certain entities (migrant and community health centers and grant recipients for health services to the homeless and to residents of public housing) to be employees of the Public Health Service (PHS); and (2) making a malpractice action against the United States the sole remedy against such practitioners.  Adds governing board members to the list of practitioners deemed to be PHS employees. 
  Allows, in certain circumstances, deeming the practitioners to be PHS employees while treating individuals who are not patients of such entities. 
  Requires approval of an application for the deeming.  Sets forth an application process. 
  Directs the Attorney General to appear in State court actions to advise the court whether an officer, governing board member, employee, or contractor has been deemed to be an employee of the Public Health Service. 
  Provides for the application of coverage to managed care plans. 
  Revises the requirements:  (1) to be considered a contractor of such an entity; and (2) of due process regarding exclusion of specific individuals from coverage. 
  Reduces the maximum limit on the fund set up to cover annual estimated claims. 
  Requires the Comptroller General to report to the Congress on:  (1) the claims experience of entities deemed to be employees under this Act; (2) the risk exposure of those entities; (3) the value of private sector risk management services; and (4) certain comparisons, analyses, and estimates related to this Act.
feat_title: Federally Supported Health Centers Assistance Act of 1995