F:\P11\NHI\TRICOMM\AAHCA09_001.

XML

777
1 the following: ‘‘and provide for making medical
2 assistance available to individuals described in
3 subsection (a) of section 1920C during a pre-
4 sumptive eligibility period in accordance with
5 such section’’.
6 (B) Section 1903(u)(1)(D)(v) of such Act
7 (42 U.S.C. 1396b(u)(1)(D)(v)) is amended—
8 (i) by striking ‘‘or for’’ and inserting
9 ‘‘for’’; and
10 (ii) by inserting before the period the
11 following: ‘‘, or for medical assistance pro-
12 vided to an individual described in sub-
13 section (a) of section 1920C during a pre-
14 sumptive eligibility period under such sec-
15 tion’’.
16 (c) CLARIFICATION OF COVERAGE OF FAMILY PLAN-
17 NING SERVICES AND SUPPLIES.—Section 1937(b) of the
18 Social Security Act (42 U.S.C. 1396u–7(b)) is amended
19 by adding at the end the following:
20 ‘‘(5) COVERAGE OF FAMILY PLANNING SERV-

21 ICES AND SUPPLIES.—Notwithstanding the previous

22 provisions of this section, a State may not provide
23 for medical assistance through enrollment of an indi-
24 vidual with benchmark coverage or benchmark-equiv-
25 alent coverage under this section unless such cov-

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00777 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

778
1 erage includes for any individual described in section
2 1905(a)(4)(C), medical assistance for family plan-
3 ning services and supplies in accordance with such
4 section.’’.
5 (d) EFFECTIVE DATE.—The amendments made by
6 this section take effect on the date of the enactment of
7 this Act and shall apply to items and services furnished
8 on or after such date.
9 Subtitle C—Access
10 SEC. 1721. PAYMENTS TO PRIMARY CARE PRACTITIONERS.

11 (a) IN GENERAL.—
12 (1) FEE-FOR-SERVICE PAYMENTS.—Section

13 1902(a)(13) of the Social Security Act (42 U.S.C.

14 1396b(a)(13)) is amended—
15 (A) by striking ‘‘and’’ at the end of sub-
16 paragraph (A);
17 (B) by adding ‘‘and’’ at the end of sub-
18 paragraph (B); and
19 (C) by adding at the end the following new
20 subparagraph:
21 ‘‘(C) payment for primary care services (as
22 defined in section 1848(j)(5)(A), but applied
23 without regard to clause (ii) thereof) furnished
24 by physicians (or for services furnished by other
25 health care professionals that would be primary

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00778 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

779
1 care services under such section if furnished by
2 a physician) at a rate not less than 80 percent
3 of the payment rate applicable to such services
4 and physicians or professionals (as the case
5 may be) under part B of title XVIII for services
6 furnished in 2010, 90 percent of such rate for
7 services and physicians (or professionals) fur-
8 nished in 2011, and 100 percent of such pay-
9 ment rate for services and physicians (or pro-
10 fessionals) furnished in 2012 or a subsequent
11 year;’’.
12 (2) UNDER MEDICAID MANAGED CARE

13 PLANS.—Section 1923(f) of such Act (42 U.S.C.

14 1396u–2(f)) is amended—
15 (A) in the heading, by adding at the end
16 the following: ‘‘; ADEQUACY OF PAYMENT FOR

17 PRIMARY CARE SERVICES’’; and

18 (B) by inserting before the period at the
19 end the following: ‘‘and, in the case of primary
20 care services described in section
21 1902(a)(13)(C), consistent with the minimum
22 payment rates specified in such section (regard-
23 less of the manner in which such payments are
24 made, including in the form of capitation or
25 partial capitation)’’.

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00779 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

780
1 (b) INCREASE IN PAYMENT USING 100% FMAP.—
2 Section 1905(y), as added by section 1701(a)(2)(B) and
3 as amended by section 1701(c)(2), is amended by adding
4 at the end the following:
5 ‘‘(3)(A) The portion of the amounts expended
6 for medical assistance for services described in sec-
7 tion 1902(a)(13)(C) furnished on or after January
8 1, 2010, that is attributable to the amount by which
9 the minimum payment rate required under such sec-
10 tion (or, by application, section 1932(f)) exceeds the
11 payment rate applicable to such services under the
12 State plan as of June 16, 2009.
13 ‘‘(B) Subparagraphs (A) shall not be construed
14 as preventing the payment of Federal financial par-
15 ticipation based on the Federal medical assistance
16 percentage for amounts in excess of those specified
17 under such subparagraphs.’’.
18 (c) EFFECTIVE DATE.—The amendments made by
19 this section shall apply to services furnished on or after
20 January 1, 2010.
21 SEC. 1722. MEDICAL HOME PILOT PROGRAM.

22 (a) IN GENERAL.—The Secretary of Health and

23 Human Services shall establish under this section a med-
24 ical home pilot program under which a State may apply
25 to the Secretary for approval of a medical home pilot

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00780 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

781
1 project described in subsection (b) (in this section referred
2 to as a ‘‘pilot project’’) for the application of the medical
3 home concept under title XIX of the Social Security Act.
4 The pilot program shall operate for a period of up to 5
5 years.
6 (b) PILOT PROJECT DESCRIBED.—
7 (1) IN GENERAL.—A pilot project is a project
8 that applies one or more of the medical home models
9 described in section 1866E(a)(3) of the Social Secu-
10 rity Act (as inserted by section 1302(a)) or such
11 other model as the Secretary may approve, to high
12 need beneficiaries (including medically fragile chil-
13 dren and high-risk pregnant women) who are eligible
14 for medical assistance under title XIX of the Social
15 Security Act. The Secretary shall provide for appro-
16 priate coordination of the pilot program under this
17 section with the medical home pilot program under
18 section 1866E of such Act.
19 (2) LIMITATION.—A pilot project shall be for a
20 duration of not more than 5 years.
21 (c) ADDITIONAL INCENTIVES.—In the case of a pilot
22 project, the Secretary may—
23 (1) waive the requirements of section
24 1902(a)(1) of the Social Security Act (relating to

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00781 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

782
1 statewideness) and section 1902(a)(10)(B) of such
2 Act (relating to comparability); and
3 (2) increase to up to 90 percent (for the first
4 2 years of the pilot program) or 75 percent (for the
5 next 3 years) the matching percentage for adminis-
6 trative expenditures (such as those for community
7 care workers).
8 (d) MEDICALLY FRAGILE CHILDREN.—In the case of
9 a model involving medically fragile children, the model
10 shall ensure that the patient-centered medical home serv-
11 ices received by each child, in addition to fulfilling the re-
12 quirements under 1866E(b)(1) of the Social Security Act,
13 provide for continuous involvement and education of the
14 parent or caregiver and for assistance to the child in ob-
15 taining necessary transitional care if a child’s enrollment
16 ceases for any reason.
17 (e) EVALUATION; REPORT.—
18 (1) EVALUATION.—The Secretary, using the
19 criteria described in section 1866E(g)(1) of the So-
20 cial Security Act (as inserted by section 1123), shall
21 conduct an evaluation of the pilot program under
22 this section.
23 (2) REPORT.—Not later than 60 days after the
24 date of completion of the evaluation under para-
25 graph (1), the Secretary shall submit to Congress

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00782 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

783
1 and make available to the public a report on the
2 findings of the evaluation under such paragraph.
3 (f) FUNDING.—The additional Federal financial par-
4 ticipation resulting from the implementation of the pilot
5 program under this section may not exceed in the aggre-
6 gate $1,235,000,000 over the 5-year period of the pro-
7 gram.
8 SEC. 1723. TRANSLATION OR INTERPRETATION SERVICES.

9 (a) IN GENERAL.—Section 1903(a)(2)(E) of the So-

10 cial Security Act (42 U.S.C. 1396b(a)(2)), as added by
11 section 201(b)(2)(A) of the Children’s Health Insurance
12 Program Reauthorization Act of 2009 (Public Law 111–
13 3), is amended by inserting ‘‘and other individuals’’ after
14 ‘‘children of families’’.
15 (b) EFFECTIVE DATE.—The amendment made by
16 subsection (a) shall apply to payment for translation or
17 interpretation services furnished on or after January 1,
18 2010.
19 SEC. 1724. OPTIONAL COVERAGE FOR FREESTANDING

20 BIRTH CENTER SERVICES.

21 (a) IN GENERAL.—Section 1905 of the Social Secu-

22 rity Act (42 U.S.C. 1396d), as amended by section
23 1713(a), is amended—
24 (1) in subsection (a)—

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00783 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
 F:\P11\NHI\TRICOMM\AAHCA09_001.XML

784
1 (A) by redesignating paragraph (29) as
2 paragraph (30);
3 (B) in paragraph (28), by striking at the
4 end ‘‘and’’; and
5 (C) by inserting after paragraph (28) the
6 following new paragraph:
7 ‘‘(29) freestanding birth center services (as de-
8 fined in subsection (l)(3)(A)) and other ambulatory
9 services that are offered by a freestanding birth cen-
10 ter (as defined in subsection (l)(3)(B)) and that are
11 otherwise included in the plan; and’’; and
12 (2) in subsection (l), by adding at the end the
13 following new paragraph:
14 ‘‘(3)(A) The term ‘freestanding birth center services’
15 means services furnished to an individual at a freestanding
16 birth center (as defined in subparagraph (B)), including
17 by a licensed birth attendant (as defined in subparagraph
18 (C)) at such center.
19 ‘‘(B) The term ‘freestanding birth center’ means a
20 health facility—
21 ‘‘(i) that is not a hospital; and
22 ‘‘(ii) where childbirth is planned to occur away
23 from the pregnant woman’s residence.
24 ‘‘(C) The term ‘licensed birth attendant’ means an
25 individual who is licensed or registered by the State in-

f:\VHLC\071409\071409.140.xml (444390|2)
July 14, 2009 (12:51 p.m.)
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00784 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC