COMMUNITY HEALTH CENTERS AND RURAL HEALTH CLINICS.

SEC. 4161. COMMUNITY HEALTH CENTERS AND RURAL HEALTH CLINICS. (a) Community Health Centers.— (1) Coverage.—Section 1861(s)(2)(E) of the Social Security Act (42 U.S.C. 1395x(s)(2)(E)) is amended by inserting “and Federally qualified health center services” after “rural health clinic services”. (2) Services defined.— Section 1861(aa) of such Act is amended— (A) in the heading, by adding at the end the following: “and Federally Qualified Health Center Services”, (B) in paragraph (3), by striking “paragraphs (1) and (2)” and inserting “the previous provisions of this subsection” and by redesignating such paragraph and paragraph (4) as paragraph (5) and (6), respectively, and (C) by inserting after paragraph (2) the following new paragraphs: “(3) The term ‘Federally qualified health center services’ means— “(A) services of the type described in subparagraphs (A) through (C) of paragraph (1), and “(B) preventive primary health services that a center is required to provide under sections 329, 330, and 340 of the Public Health Service Act, when furnished to an individual as an outpatient of a Federally qualified health center and, for this purpose, any reference to a rural health clinic or a physician described in paragraph (2 MB) is deemed a reference to a Federally qualified health center or a physician at the center, respectively. “(4) The term ‘Federally qualified health center’ means an entity which— “(A) (i) is receiving a grant under section 329, 330, or 340 of the Public Health Service Act, or “(ii) (I) is receiving funding from such a grant under a contract with the recipient of such a grant, and (II) meets the requirements to receive a grant under section 329, 330, or 340 of such Act; “(B) based on the recommendation of the Health Resources and Services Administration within the Public Health Service, is determined by the Secretary to meet the requirements for receiving such a grant; or “(C) was treated by the Secretary, for purposes of part B, as a comprehensive Federally funded health center as of January 1, 1990.”. (3) Payments.— (A) In general.—Section 1832(a)(2)(D) of such Act (42 U.S.C. 1395k(a)(2)(D)) is amended by inserting “(i)” after “(D)” and by inserting “and (ii) Federally qualified health center services” after “rural health clinic services”. (B) Deductible does not apply.— The first sentence of section 1833(b) of such Act (42 U.S.C. 13951(b)) is amended— (i) by striking “and” before “(4)”, (ii) by inserting before the period at the end the following: “, and (5) such deductible shall not apply to Federally qualified health center services”. 104 STAT. 1388–94 (C) Exclusion from payment removed.— Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is amended— (i) in paragraph (2), by inserting “, except in the case of Federally qualified health center services” before the semicolon at the end, and (ii) in paragraph (3), by inserting “, in the case of Federally qualified health center services, as defined in section 1861(aa)(3),” after ‘T861(aa)(D,”, and (iii) by adding at the end the following new sentence: “Paragraph (7) shall not apply to Federally qualified health center services described in section 1861(aa)(3)(B).”. (4) Waiver of anti-kickback requirement.— Section 1128B(b)(3) of such Act (42 U.S.C. 1320a-7b(b)(3)) is amended— (A) by striking “and” at the end of subparagraph (C), (B) by redesignating subparagraph (D) as subparagraph (E), and (C) by inserting after subparagraph (C) the following new subparagraph: “(D) a waiver of any coinsurance under part B of title XVIII by a Federally qualified health care center with respect to an individual who qualifies for subsidized services under a provision of the Public Health Service Act; and”. (5) Conforming amendments.— Section 1861 of such Act (42 U.S.C. 1395x) is further amended— (A) in subsections (s)(2)(H)(i) and (s)(2)(K), by striking “subsection (aa)(3)” and “subsection (aa)(4)” each place either appears inserting “subsection (aa)(5)” and “subsection (aa)(6)”, respectively, and (B) in subsection (aa)(U(B), by striking “paragraph (3)” and inserting “paragraph (5)”. (6) PRRB review of cost reports for federally qualified health centers.—Section 1878 of the Social Security Act (42 U.S.C. 1395oo) is amended by adding at the end the following new subsection: “(j) In this section, the term ‘provider of services’ includes a Federally qualified health center.”. (7) GAO study of hospital staff privileges for physicians practicing in community health centers.— (A) Study.—The Comptroller General shall conduct a study of whether physicians practicing in community and migrant health centers are able to obtain admitting privileges at local hospitals. The study shall review— (i) how many physicians practicing in such centers are without hospital admitting privileges or have been denied admitting privileges at a local hospital, and (i) (I) the criteria hospitals use in deciding whether to grant admitting privileges and (H) whether such criteria act as significant barriers to health center physicians obtaining hospital privileges. (B) Report.—By not later than 18 months after the date of the enactment of this Act, the Comptroller General shall submit a report on the study under subparagraph (A) to the Committees on Ways and Means and Energy and Commerce of the House of Representatives and shall include in such report such recommendations as the Comptroller General deems appropriate. 104 STAT. 1388–95 (8) Effective date.— (A) Subject to subparagraphs (B) and (C), the amendments made by this section shall apply to services furnished on or after October 1, 1991. (B) In the case of a Federally qualified health care center that has elected, as of January 1, 1990, under part B of title XVIII of the Social Security Act, to have the amount of payments for services under such part determined on a reasonable-charge basis, the amendment made by paragraph (3)(A) shall only apply on and after such date (not earlier than October 1, 1991) as the center may elect. (C) The amendment made by paragraph (6) shall apply to cost reports for periods beginning on or after October 1, 1991. (b) Rural Health Clinic Services.— (1) Expedited certification.— Section 1861(aa)(2) of the Social Security Act (42 U.S.C. 1395x(aa)(2)) is amended by adding at the end the following: “If a State agency has determined under section 1864(a) that a facility is a rural health clinic and the facility has applied to the Secretary for certification as such a clinic, the Secretary shall notify the facility of the the Secretary’s approval or disapproval of the certification not later than 60 days after the date of the State agency determination or the application (whichever is later).”. (2) Temporary waiver of staffing requirements.— Section 1861(aa) of such Act, as amended by subsection (a), is further amended by adding at the end the following new paragraph: “(7) (A) The Secretary shall waive for a 1-year period the requirements of paragraph (2) that a rural health clinic employ a physician assistant, nurse practitioner or certified nurse midwife or that such clinic require such providers to furnish services at least 50 percent of the time that the clinic operates for any facility that requests such waiver if the facility demonstrates that the facility has been unable, despite reasonable efforts, to hire a physician assistant, nurse practitioner, or certified nurse-midwife in the previous 90-day period. “(B) The Secretary may not grant such a waiver under subparagraph (A) to a facility if the request for the waiver is made less than 6 months after the date of the expiration of any previous such waiver for the facility. “(C) A waiver which is requested under this paragraph shall be deemed granted unless such request is denied by the Secretary within 60 days after the date such request is received.”. (3) Productivity screens.—In employing any screening guideline in determining the productivity of physicians, physician assistants, nurse practitioners, and certified nurse-mid-wives in a rural health clinic, the Secretary of Health and Human Services shall provide that the guideline shall take into account the combined services of such staff (and not merely the service within each class of practitioner). (4) PRRB review of cost reports for rural health centers.—Section 1878(j) of the Social Security Act (42 U.S.C. 1395oo(j)), as added by subsection (a)(6), is amended by inserting “a rural health clinic and” after “includes”. (5) Effective date.—This subsection shall take effect on October 1, 1991, except that the amendment made by paragraph (4) shall apply to cost reports for periods beginning on or after October 1, 1991.