text: SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
  
      (a) Short Title.--This Act may be cited as the ``Medicare Safety 
  Net Access Act of 2002''.
      (b) Table of Contents.--The table of contents of this Act is as 
  follows:
  
  Sec. 1. Short title; table of contents.
  Sec. 2. Supplemental reimbursement for Federally qualified health 
                              centers participating in medicare managed 
                              care.
  Sec. 3. Revision of Federally qualified health center payment limits.
  Sec. 4. Coverage of additional Federally qualified health center 
                              services.
  Sec. 5. Providing safe harbor for certain collaborative efforts that 
                              benefit medically underserved populations.
  
  SEC. 2. SUPPLEMENTAL REIMBURSEMENT FOR FEDERALLY QUALIFIED HEALTH 
                CENTERS PARTICIPATING IN MEDICARE MANAGED CARE.
  
      (a) Supplemental Reimbursement.--
              (1) In general.--Section 1833(a)(3) of the Social Security 
          Act (42 U.S.C. 1395l(a)(3)) is amended to read as follows:
              ``(3) in the case of services described in section 
          1832(a)(2)(D)--
                      ``(A) except as provided in subparagraph (B), the 
                  costs which are reasonable and related to the cost of 
                  furnishing such services or which are based on such 
                  other tests of reasonableness as the Secretary may 
                  prescribe in regulations, including those authorized 
                  under section 1861(v)(1)(A), less the amount a provider 
                  may charge as described in clause (ii) of section 
                  1866(a)(2)(A), but in no case may the payment for such 
                  services (other than for items and services described 
                  in section 1861(s)(10)(A)) exceed 80 percent of such 
                  costs; or
                      ``(B) with respect to the services described in 
                  clause (ii) of section 1832(a)(2)(D) that are furnished 
                  to an individual enrolled with a Medicare+Choice 
                  organization under part C pursuant to a written 
                  agreement described in section 1853(j), the amount by 
                  which--
                              ``(i) the amount of payment that would have 
                          otherwise been provided under subparagraph (A) 
                          (calculated as if `100 percent' were 
                          substituted for `80 percent' in such 
                          subparagraph) for such services if the 
                          individual had not been so enrolled; exceeds
                              ``(ii) the amount of the payments received 
                          under such written agreement for such services 
                          (not including any financial incentives 
                          provided for in such agreement such as risk 
                          pool payments, bonuses, or withholds),
                  less the amount the Federally qualified health center 
                  may charge as described in section 1857(e)(3)(C);''.
      (b) Continuation of Medicare+Choice Monthly Payments.--
              (1) In general.--Section 1853 of the Social Security Act 
          (42 U.S.C. 1395w-23) is amended by adding at the end the 
          following new subsection:
      ``(j) Special Payment Rule for Federally Qualified Health Center 
  Services.--If an individual who is enrolled with a Medicare+Choice 
  organization under this part receives a service from a Federally 
  qualified health center that has a written agreement with such 
  organization for providing such a service (including any agreement 
  required under section 1857(e)(3))--
              ``(1) the Secretary shall pay the amount determined under 
          section 1833(a)(3)(B) directly to the Federally qualified 
          health center not less frequently than quarterly; and
              ``(2) the Secretary shall not reduce the amount of the 
          monthly payments to the Medicare+Choice organization made under 
          section 1853(a) as a result of the application of paragraph 
          (1).''.
              (2) Conforming amendments.--
                      (A) Paragraphs (1) and (2) of section 1851(i) of 
                  the Social Security Act (42 U.S.C. 1395w-21(i)(1)) are 
                  each amended by inserting ``1853(j),'' after 
                  ``1853(h),''.
                      (B) Section 1853(c)(5) is amended by striking 
                  ``subsections (a)(3)(C)(iii) and (i)'' and inserting 
                  ``subsections (a)(3)(C)(iii), (i), and (j)(1)''.
      (c) Additional Medicare+Choice Contract Requirements.--Section 
  1857(e) of the Social Security Act (42 U.S.C. 1395w-27(e)) is amended 
  by adding at the end the following new paragraph:
              ``(3) Agreements with federally qualified health centers.--
                      ``(A) Ensuring equal access to services of fqhcs.--
                  A contract under this part shall require the 
                  Medicare+Choice organization to enter into (and to 
                  demonstrate to the Secretary that it has entered into) 
                  a sufficient number of written agreements with 
                  Federally qualified health centers providing Federally 
                  qualified health center services for which payment may 
                  be made under this title in the service area of each 
                  Medicare+Choice plan offered by such organization so 
                  that such services are reasonably available to 
                  individuals enrolled in the plan.
                      ``(B) Ensuring equal payment levels and amounts.--A 
                  contract under this part shall require the 
                  Medicare+Choice organization to provide a level and 
                  amount of payment to each Federally qualified health 
                  center for services provided by such health center that 
                  are covered under the written agreement described in 
                  subparagraph (A) that is not less than the level and 
                  amount of payment that the organization would make for 
                  such services if the services had been furnished by a 
                  provider of services that was not a Federally qualified 
                  health center.
                      ``(C) Cost-sharing.--Under the written agreement 
                  described in subparagraph (A), a Federally qualified 
                  health center must accept the Medicare+Choice contract 
                  price plus the Federal payment as payment in full for 
                  services covered by the contract, except that such a 
                  health center may collect any amount of cost-sharing 
                  permitted under the contract under this part, so long 
                  as the amounts of any deductible, coinsurance, or 
                  copayment comply with the requirements under section 
                  1854(e) and do not result in a total payment to the 
                  center in excess of the amount determined under section 
                  1833(a)(3)(A) (calculated as if `100 percent' were 
                  substituted for `80 percent' in such section).''.
      (d) Safe Harbor From Antikickback Prohibition.--Section 1128B(b)(3) 
  of the Social Security Act (42 U.S.C. 1320a-7b(b)(3)) is amended--
              (1) in subparagraph (E), by striking ``and'' after the 
          semicolon at the end;
              (2) in subparagraph (F), by striking the period at the end 
          and inserting ``; and''; and
              (3) by adding at the end the following new subparagraph:
                      ``(G) any remuneration between a Federally 
                  qualified health center (or an entity controlled by 
                  such a health center) and a Medicare+Choice 
                  organization pursuant to the written agreement 
                  described in section 1853(j).''.
      (e) Effective Date.--The amendments made by this section shall 
  apply to services provided on or after January 1, 2003, and contract 
  years beginning on or after such date.
  
  SEC. 3. REVISION OF FEDERALLY QUALIFIED HEALTH CENTER PAYMENT LIMITS.
  
      (a) Per Visit Payment Requirements for FQHCs.--Section 
  1833(a)(3)(A) of the Social Security Act (42 U.S.C. 1395l(a)(3)(A)), as 
  amended by section 2(a), is amended by adding ``(which regulations may 
  not limit the per visit payment amount, or a component of such amount, 
  for services described in section 1832(a)(2)(D)(ii))'' after ``the 
  Secretary may prescribe in regulations''.
      (b) Effective Date.--The amendment made by subsection (a) shall 
  apply to services provided on or after January 1, 2003.
  
  SEC. 4. COVERAGE OF ADDITIONAL FEDERALLY QUALIFIED HEALTH CENTER 
                SERVICES.
  
      (a) Coverage for FQHC Ambulatory Services.--Section 1861(aa)(3) of 
  the Social Security Act (42 U.S.C. 1395x(aa)(3)) is amended to read as 
  follows:
      ``(3) The term `Federally qualified health center services' means--
              ``(A) services of the type described in subparagraphs (A) 
          through (C) of paragraph (1), and such other services furnished 
          by a Federally qualified health center for which payment may 
          otherwise be made under this title if such services were 
          furnished by a health care provider or health care professional 
          other than a Federally qualified health center; and
              ``(B) preventive primary health services that a center is 
          required to provide under section 330 of the Public Health 
          Service Act,
  when furnished to an individual as a patient of a Federally qualified 
  health center.''.
      (b) Offsite FQHC Services.--
              (1) Patients of hospitals and critical access hospitals.--
          Section 1862(a)(14) of the Social Security Act (42 U.S.C. 
          1395y(a)) is amended by inserting ``Federally qualified health 
          center services,'' after ``qualified psychologist services,''.
              (2) Exclusion of federally qualified health center services 
          from the pps for skilled nursing facilities.--Section 1888(e) 
          of the Social Security Act (42 U.S.C. 1395yy(e)) is amended--
                      (A) in paragraph (2)(A)(i)(II), by striking 
                  ``clauses (ii) and (iii)'' and inserting ``clauses (ii) 
                  through (iv)''; and
                      (B) by adding at the end of paragraph (2)(A) the 
                  following new clause:
                              ``(iv) Exclusion of federally qualified 
                          health center services.--Services described in 
                          this clause are Federally qualified health 
                          center services (as defined in section 
                          1861(aa)(3)).''.
      (c) Technical Corrections.--
              (1) Section 1861(aa)(1)(B) of the Social Security Act (42 
          U.S.C. 1395x(aa)(1)(B)) is amended by striking ``subsection 
          (hh)(1)),,'' and inserting ``subsection (hh)(1)),''.
              (2) Clauses (i) and (ii)(II) of section 1861(aa)(4)(A) of 
          the Social Security Act (42 U.S.C. 1395x(aa)(4)(A)) are each 
          amended by striking ``(other than subsection (h))''.
      (d) Effective Dates.--The amendments made--
              (1) by subsections (a) and (b) shall apply to services 
          furnished on or after January 1, 2003; and
              (2) by subsection (c) shall take effect on the date of 
          enactment of this Act.
  
  SEC. 5. PROVIDING SAFE HARBOR FOR CERTAIN COLLABORATIVE EFFORTS THAT 
                BENEFIT MEDICALLY UNDERSERVED POPULATIONS.
  
      (a) In General.--Section 1128B(b)(3) of the Social Security Act (42 
  U.S.C. 1320a-7(b)(3)), as amended by section 2(d), is amended--
              (1) in subparagraph (F), by striking ``and'' after the 
          semicolon at the end;
              (2) in subparagraph (G), by striking the period at the end 
          and inserting ``; and''; and
              (3) by adding at the end the following new subparagraph:
                      ``(H) any remuneration between a public or 
                  nonprofit private health center entity described under 
                  clauses (i) and (ii) of section 1905(l)(2)(B) and any 
                  individual or entity providing goods, items, services, 
                  donations or loans, or a combination thereof, to such 
                  health center entity pursuant to a contract, lease, 
                  grant, loan, or other agreement, if such agreement 
                  produces a community benefit that will be used by the 
                  health center entity to maintain or increase the 
                  availability or accessibility, or enhance the quality, 
                  of services provided to a medically underserved 
                  population served by the health center entity.''.
      (b) Rulemaking for Exception for Health Center Entity 
  Arrangements.--
              (1) Establishment.--
                      (A) In general.--The Secretary of Health and Human 
                  Services (in this subsection referred to as the 
                  ``Secretary'') shall establish, on an expedited basis, 
                  standards relating to the exception for health center 
                  entity arrangements to the antikickback penalties 
                  described in section 1128B(b)(3)(F) of the Social 
                  Security Act, as added by subsection (a).
                      (B) Factors to consider.--In establishing standards 
                  relating to the exception for health center entity 
                  arrangements under subparagraph (A), the Secretary--
                              (i) shall extend the exception where the 
                          arrangement between the health center entity 
                          and the other party--
                                      (I) results in savings of Federal 
                                  grant funds or increased revenues to 
                                  the health center entity;
                                      (II) does not limit or restrict a 
                                  patient's freedom of choice; and
                                      (III) does not interfere with a 
                                  health care professional's independent 
                                  medical judgment regarding medically 
                                  appropriate treatment; and
                              (ii) may include other standards and 
                          criteria that are consistent with the intent of 
                          Congress in enacting the exception established 
                          under this subsection.
              (2) Interim final effect.--No later than 60 days after the 
          date of enactment of this Act, the Secretary shall publish a 
          rule in the Federal Register consistent with the factors under 
          paragraph (1)(B). Such rule shall be effective and final 
          immediately on an interim basis, subject to change and revision 
          after public notice and opportunity (for a period of not more 
          than 60 days) for public comment, provided that any change or 
          revision shall be consistent with this subsection.
target: Medicare Safety Net Access Act of 2002 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to revise the payment for certain Federally qualified health center (FQHC) services furnished to an individual enrolled with a Medicare+Choice organization under Medicare part C (Medicare+Choice), allowing for supplemental reimbursement, among other changes.Amends Medicare+Choice to add additional Medicare+Choice contract requirements.Amends SSA title XI with respect to criminal penalties for acts involving Federal health care programs, particularly illegal remunerations (kickbacks). Exempts from the prohibition against such remunerations any remuneration: (1) between a FQHC (or an entity controlled by such a health center) and a Medicare+Choice organization pursuant to a specified written agreement; and (2) between a certain kind of public or nonprofit private health center entity and any individual or entity providing goods, items, services, donations, loans, or a combination, to such health center entity pursuant to an agreement, if such agreement produces a community benefit that will be used by the health center entity to maintain or increase the availability or accessibility, or enhance the quality, of services provided to a medically underserved population served by the health center entity.Amends Medicare to provide for coverage of additional FQHC services.Directs the Secretary of Health and Human Services to establish standards relating to the exception for health center entity arrangements to specified anti-kickback penalties.
feat_title: A bill to amend title XVIII of the Social Security Act to enhance the access of medicare beneficiaries who live in medically underserved areas to critical primary and preventive health care benefits, to improve the Medicare+Choice program, and for other purposes.