text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Comprehensive Health Access District 
  Act''.
  
  SEC. 2. DEFINITIONS.
  
      (a) Comprehensive Health Access District.--In this Act, the term 
  ``comprehensive health access district'' means a community in which 
  unemployment and the percentage of residents with incomes below the 
  poverty line are greater than the national average, and in which a 
  majority of the following conditions occur at rates greater than the 
  national average:
              (1) Infant mortality and low birth-weight babies.
              (2) Proportion of children below the age of 5 who have not 
          received age-appropriate routine child-hood immunizations.
              (3) Hospitalization for preventable illnesses and 
          conditions that may be managed successfully on an outpatient 
          basis, such as otitis media, diabetes, and hypertension.
              (4) Emergency room visits for nonemergency conditions.
              (5) Accidental injury.
              (6) Incidence of tuberculosis, acquired immune deficiency 
          syndrome, Black Lung disease, or cancer.
              (7) Incidence of violent crimes.
      (b) Comprehensive Community-Based Health Access Plan.--In this Act, 
  the terms ``comprehensive community-based health access plan'' and 
  ``health access plan'' mean an entity that provides health care 
  services on a prepaid, capitated basis or any other risk basis and that 
  the Secretary has certified meets all the requirements contained in 
  section 5.
      (c) Secretary.--In this Act, the term ``Secretary'' means the 
  Secretary of Health and Human Services.
  
  SEC. 3. MEDICAID STATE PLAN REQUIREMENTS FOR COMPREHENSIVE HEALTH 
                ACCESS DISTRICTS.
  
      Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)) is 
  amended--
              (1) by striking the period at the end of paragraph (65) and 
          inserting ``; and'', and
              (2) by inserting after paragraph (65) the following new 
          paragraph:
              ``(66) provide that each comprehensive health access 
          district located within the State is served by a comprehensive 
          community-based health access district plan (as such terms are 
          defined in section 2 of the Comprehensive Health Access 
          District Act).''.
  
  SEC. 4. HEALTH ALLIANCE OBLIGATIONS WITH RESPECT TO COMPREHENSIVE 
                HEALTH ACCESS DISTRICTS.
  
      Each Health Alliance or other health insurance purchasing 
  cooperative created as a result of the enactment of comprehensive 
  health care reform legislation that receives premiums on behalf of 
  persons formerly insured under title XIX of the Social Security Act and 
  whose boundaries encompass a comprehensive health access district shall 
  insure that a least one comprehensive community-based health access 
  plan is available to persons living in such district.
  
  SEC 5. COMPREHENSIVE COMMUNITY-BASED HEALTH ACCESS PLANS.
  
      (a) Organizational Requirements.--
              (1) In general.--A health access plan must--
                      (A) be a public or private organization, organized 
                  under the laws of any State;
                      (B) locate its primary place of business in the 
                  comprehensive health access district it serves;
                      (C) give preference in hiring to otherwise 
                  qualified individuals who live within the comprehensive 
                  health access district; and
                      (D) have made adequate provision against the risk 
                  of insolvency, which provision is satisfactory to the 
                  State and which assures that individuals enrolled in a 
                  plan are in no case liable for debt of the plan in case 
                  of the plan's insolvency.
              (2) Methods of providing against risk of insolvency.--The 
          provisions against the risk of insolvency under paragraph 
          (1)(D) may include--
                      (A) escrow or similar arrangements to ensure that 
                  funds for the payment of providers are available only 
                  for such payments and cannot be otherwise used by the 
                  plan;
                      (B) reinsurance purchased by the plan of an amount 
                  which is reasonably adequate to insure against 
                  unexpected costs;
                      (C) a demonstration of financial viability, as 
                  evidenced by the plan's obtaining a significant amount 
                  of reinsurance, line of credit, or performance bond; or
                      (D) such other mechanisms and requirements as the 
                  State finds appropriate.
      (b) Service Requirements.--
              (1) Basic benefits.--A health access plan shall provide, 
          either directly or through arrangements with providers, the 
          following basic benefits:
                      (A) Hospital services, including inpatient, 
                  outpatient and 24-hour emergency services.
                      (B) Emergency and ambulatory medical and surgical 
                  services.
                      (C) Physicians' services.
                      (D) Medical care other than physicians' services 
                  recognized under State law and furnished by licensed 
                  practitioners within the scope of their practice as 
                  defined by State law.
                      (E) Dental services.
                      (F) Vision services.
                      (G) Preventive health care services (including 
                  children's eye and ear examinations to determine the 
                  need for vision and hearing correction, well child 
                  services, immunizations against vaccine-preventable 
                  diseases, and screening for elevated blood lead 
                  levels).
                      (H) Outpatient laboratory, radiology, and 
                  diagnostic services.
                      (I) Ambulance services.
                      (J) Mental health and substance abuse services.
                      (K) Family planning services and services for 
                  pregnant women.
                      (L) Outpatient prescription drugs and biologicals.
              (2) Community-based health services.--In addition to 
          providing the services described in paragraph (1), a health 
          access plan shall--
                      (A) identify the most frequent causes of morbidity 
                  and mortality in the comprehensive health access 
                  district (such as acquired immune deficiency syndrome, 
                  tuberculosis, mental illness, substance abuse and 
                  addiction, childhood developmental disorders 
                  (particularly those caused by children's exposure to 
                  violence), asthma, teen pregnancy, unhealthy behaviors 
                  (such as smoking and high-fat diets), and lead 
                  poisoning); and
                      (B) design and implement programs of prevention, 
                  early intervention, or treatment intended to ameliorate 
                  or eliminate the factors identified in subparagraph 
                  (A).
                      (3) Coordination of services.--In addition to 
                  providing the services described in paragraphs (1) and 
                  (2), a health access plan must promote its enrollees' 
                  access to social, educational or economic services 
                  (such as child day care, nutritional services, 
                  vocational training, and adult literacy programs).
      (c) Service Network Requirements.--
              (1) Basic service network.--A health access plan shall 
          enter into arrangements with a sufficient number and variety of 
          providers to guarantee that--
                      (A) the plan's enrollees have access to the 
                  services described in subsection (b); and
                      (B) the provider network takes into account and is 
                  representative of the cultural identity and diversity 
                  of the community being served.
              (2) Traditional community providers.--A health access plan 
          shall, to the extent feasible, draw upon health care providers 
          currently serving the community, including health centers (as 
          defined in section 330(a) of the Public Health Service Act) and 
          hospitals operated by units of local government, in developing 
          its service network.
              (3) Development of new health resources.--A health access 
          plan shall develop new health resources in the community (such 
          as schoolbased clinics, mobile screening programs, and clinics 
          based in public housing) to meet needs that are not met by 
          existing community resources.
      (d) Access Standards.--A health access plan shall insure that each 
  individual enrolled in it--
              (1) is linked with the primary care physician within the 
          health access plan's provider network of the individual's 
          choice and has access to that doctor on a 24-hour a day, 7-day 
          a week basis;
              (2) has round-the-clock telephone access to a central 
          program office for information purposes as well as to voice 
          grievances; and
              (3) has access to interpreter services as necessary (where 
          a significant proportion of the population in the community 
          health access district is non-English speaking, the health 
          access plan shall insure that a corresponding proportion of its 
          health care providers have multilingual capability).
      (e) Quality Assurance Standards.--A health access plan shall 
  establish and maintain a quality assurance program that includes at 
  least the following activities:
              (1) Treatment standards.--A health access plan shall 
          establish--
                      (A) minimum standards for treating patients that 
                  participating providers must satisfy;
                      (B) a program of ongoing medical record reviews and 
                  other provider audits to insure compliance with the 
                  plan's treatment standards; and
                      (C) a system of sanctions to insure that providers 
                  who do not comply with the plan's treatment standards 
                  will be penalized and, if found to be repeatedly out of 
                  compliance, terminated from participation in the health 
                  access plan service network.
              (2) Data collection.--A health access plan shall monitor 
          morbidity and mortality within the comprehensive health access 
          district and identify the leading causes of death and disease.
              (3) Member surveys.--A health access plan shall survey its 
          enrollees on a regular basis to determine their satisfaction 
          with the quality of services received.
              (4) Independent quality audits.--A health access plan shall 
          be evaluated on a regular basis by an independent health care 
          accrediting organization.
      (f) Effective Grievance Procedures.--A health access plan must 
  provide for effective procedures for hearing and resolving grievances 
  between the plan and individuals enrolled in the plan.
      (g) Confidentiality of Enrollee Records.--
              (1) A health access plan shall ensure that information 
          concerning its enrollees is protected from unauthorized 
          disclosure by the plan, its employees or its providers.
              (2) To promote the coordination of benefits to health plan 
          enrollees, a health access plan may disclose information about 
          its enrollees to the extent necessary to facilitate the 
          enrollee's receipt of services and assistance from other 
          entities.
  
  SEC. 6. DESIGNATION OF COMPREHENSIVE HEALTH ACCESS DISTRICTS AND 
                CERTIFICATION OF COMPREHENSIVE COMMUNITY-BASED HEALTH 
                ACCESS PLANS.
  
      The Secretary shall designate a community that meets the criteria 
  set forth in section 2(a) as a comprehensive health access district and 
  shall certify an entity that meets the requirements set forth in 
  section 5 as a comprehensive community-based health access plan. Each 
  such certification and designation shall be reviewed every five years. 
  The Secretary may delegate all or part of the certification function 
  for health access plans to the State in which the health access plan 
  operates.
  
  SEC. 7. NATIONAL HEALTH OUTCOMES RESEARCH AND EVALUATION.
  
      (a) Provision of Information.--In order to evaluate the performance 
  of health access plans in improving the health status of persons living 
  in comprehensive health access districts, each health access plan shall 
  provide the Secretary, at a time and in a manner specified by the 
  Secretary, at least the following information:
              (1) Information on the characteristics of enrollees that 
          may affect their need for or use of health services.
              (2) Information on the types of treatments and services and 
          outcomes of treatments with respect to the clinical health, 
          functional status and well-being of enrollees.
              (3) Information on enrollee satisfaction.
              (4) Information on health care expenditures, volume and 
          prices of procedures, and use of specialized services.
      (b) Analysis of Information.--The Secretary shall analyze the 
  information reported by health access plans in order to report to 
  Congress, the plans and the public, not less often than annually, on 
  the following:
              (1) The health status of persons living in comprehensive 
          health access district (particularly those indicators listed in 
          section 2(a)).
              (2) The level and rate of expenditures by health access 
          plans on medical services and other programs to improve health 
          status.
              (3) The effectiveness of health access plans in improving 
          health outcomes (particularly outcomes related to health 
          indicators listed in section 2(a)).
      (c) Research.--
              (1) The Secretary shall examine the relationship between 
          socioeconomic factors and health status and, based on his 
          findings, suggest interventions appropriate to comprehensive 
          health access districts.
              (2) The Secretary may contract with non-governmental 
          entities to perform this research. Persons undertaking this 
          work shall have access to the information provided by the 
          health access plans to the Secretary.
  
  SEC. 8. REGULATIONS AND EFFECTIVE DATE.
  
      (a) In General.--The Secretary shall promulgate regulations 
  necessary to implement this Act.
      (b) Effective Date.--This Act shall take effect on July 1, 2000, 
  without regard to whether or not final regulations to carry out this 
  Act have been promulgated by such date.
target: Comprehensive Health Access District Act - Defines: (1) "comprehensive health access district" as a community in which unemployment and the percentage of residents with incomes below the poverty line are greater than the national average, and in which a majority of certain diseases and conditions occur at rates greater than the national average; and (2) "comprehensive community-based health access plan" as an entity that provides health care services on a prepaid, capitated basis, or any other risk basis, and that the Secretary of Health and Human Services has certified meets certain requirements. 
  (Sec. 3) Amends title XIX (Medicaid) of the Social Security Act to require, among other things, that each Medicaid State plan provide that each comprehensive health access district located within the State is served by a comprehensive community-based health access district plan. 
  (Sec. 4) Requires each Health Alliance or other health insurance purchasing cooperative created out of comprehensive health care reform legislation that receives premiums on behalf of persons formerly insured under Medicaid, and whose boundaries encompass a comprehensive health access district, to ensure that at least one comprehensive community-based health access plan is available to persons living in such district. 
  (Sec. 5) Sets forth specified requirements for an entity to be certified as a comprehensive community-based health access plan. 
  (Sec. 6) Requires the Secretary to designate a community a comprehensive health access district and to certify an entity as a comprehensive health access plan provided they meet certain criteria. 
  (Sec. 7) Requires each health access plan, in order to evaluate its performance in improving the health status of persons living in comprehensive health access districts, to provide the Secretary with specified health-related information.
feat_title: Comprehensive Health Access District Act