,,ii  #aadth ,,congress  #ast ,session  
,s4 #bjig  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,september #bi1
 #bjae ,ms4 ,baldwin introduced the     
following bill2 which was read twice and
 referred to the ,committee on ,finance 
,a ,,bill  ,to amend title ,,xix of the 
,social ,security ,act to provide for   
payment for ,medicaid services furnished
 by ,ryan ,white part ,c grantees under 
a cost-based prospective payment system4
  #a4 ,short title  ,this ,act may be   
cited as the ,,hiv ,clinical ,services  
,improvement ,act4  #b4 ,medicaid       
payment for services furnished by ,ryan 
,white part ,c grantees on a cost-based 
prospective payment system  7a7 ,in     
general ,section #aijb of the ,social   
,security ,act 7#db ,u4,s4,c4 #acif;a7  
is amended--  7#a7 in subsection        
7a77#ae71 by inserting before the       
semicolon at the end the following3 and 
provide for payment for services        
described in section #aije7;a7 provided 
by a recipient of a grant under part ,c 

of title ,,xxvi of the ,public ,health  
,service ,act in accordance with        
subsection 7ll72 and  7#b7 by adding at 
the end the following new subsection3   
7ll7 ,payment for services provided by  
,ryan ,white part ,c grantees  7#a7 ,in 
general ,beginning with fiscal year     
#bjaf with respect to services furnished
 on or after ,january #a1 #bjaf1 and    
each succeeding fiscal year1 the ,state 
plan shall provide for payment for      
services described in section #aije7;a7 
7in this subsection referred to as      
,medicaid covered services7 furnished by
 a recipient of a grant under part ,c of
 title ,,xxvi of the ,public ,health    
,service ,act 7in this subsection       
referred to as a grantee7 in accordance 
with the provisions of this subsection4 
7#b7 ,fiscal year #bjaf ,subject to     
paragraph 7#d71 for services furnished  
on and after ,january #a1 #bjaf1 during 
fiscal year #bjaf1 the ,state plan shall
 provide for payment for such services  
in an amount 7calculated on a per visit 

or similar basis as specified by the    
,secretary7 that is equal to #ajj       
percent of the average of the costs of  
the grantee of furnishing such services 
during fiscal years #bjad and #bjae     
which are reasonable and related to the 
cost of furnishing such services1 or    
based on such other tests of            
reasonableness as the ,secretary        
prescribes in regulations under section 
#ahcc7;a77#c71 or1 in the case of       
services to which such regulations do   
not apply1 the same methodology used    
under section #ahcc7;a77#c71 adjusted to
 take into account any increase or      
decrease in the scope of such services  
furnished by the grantee during fiscal  
year #bjaf4  7#c7 ,fiscal year #bjag and
 succeeding fiscal years ,subject to    
paragraph 7#d71 for services furnished  
during fiscal year #bjag or a succeeding
 fiscal year1 the ,state plan shall     
provide for payment for such services in
 an amount 7calculated on a per visit or
 similar basis7 that is equal to the    

amount calculated for such services     
under this subsection for the preceding 
fiscal year--  7,a7 increased by the    
percentage increase in the ,,mei 7as    
defined in section #ahdb7;i77#c77       
applicable to primary care services 7as 
defined in section #ahdb7;i77#d77 for   
that fiscal year2 and  7,b7 adjusted to 
take into account any increase or       
decrease in the scope of such services  
furnished by the grantee during that    
fiscal year4  7#d7 ,establishment of    
initial year payment amount for new     
grantees ,in any case in which an entity
 first becomes a grantee after fiscal   
year #bjae1 the ,state plan shall       
provide for payment for ,medicaid       
covered services furnished by the entity
 in the first fiscal year in which the  
entity so qualifies in an amount        
7calculated on a per visit or similar   
basis7 that is equal to #ajj percent of 
the costs of furnishing such services   
during such fiscal year based on the    
rates established under this subsection 

for the fiscal year for other such      
grantees located in the same or adjacent
 area with a similar case load or1 in   
the absence of such a grantee1 in       
accordance with the regulations and     
methodology referred to in paragraph    
7#b7 or based on such other tests of    
reasonableness as the ,secretary may    
specify4 ,for each fiscal year following
 the fiscal year in which the entity    
first qualifies1 the ,state plan shall  
provide for the payment amount to be    
calculated in accordance with paragraph 
7#c74  7#e7 ,administration in the case 
of managed care  7,a7 ,in general ,in   
the case of services furnished by a     
grantee pursuant to a contract between  
the grantee and a managed care entity   
7as defined in section                  
#aicb7;a77#a77;,b771 the ,state plan    
shall provide for payment to the grantee
 by the ,state of a supplemental payment
 equal to the amount 7if any7 by which  
the amount determined under paragraphs  
7#b71 7#c71 and 7#d7 exceeds the amount 

of the payments provided under the      
contract4  7,b7 ,payment schedule ,the  
supplemental payment required under     
subparagraph 7,a7 shall be made pursuant
 to a payment schedule agreed to by the 
,state and the grantee1 but in no case  
less frequently than every #d months4   
7#f7 ,alternative payment methodologies 
,notwithstanding any other provision of 
this section1 the ,state plan may       
provide for payment in any fiscal year  
to a grantee for ,medicaid covered      
services in an amount which is          
determined under an alternative payment 
methodology that--  7,a7 is agreed to by
 the ,state and the grantee2 and  7,b7  
results in payment to the grantee of an 
amount which is at least equal to the   
amount otherwise required to be paid to 
the grantee under this subsection4  7#g7
 ,quality management and reporting      
requirements ,the ,secretary shall      
require that1 as appropriate1 a grantee 
shall be subject to quality management  
and reporting requirements comparable to

 those imposed on federally qualified   
health centers1 including reporting of  
encounter data1 clinical outcomes data1 
quality data1 and such other data as the
 ,secretary shall require1 as a         
condition of such grantee receiving     
payment for ,medicaid covered services  
under this subsection4  4  7b7          
,effective date  7#a7 ,except as        
provided in paragraph 7#b71 the         
amendments made by subsection 7a7 shall 
apply to services furnished on or after 
,january #a1 #bjaf1 without regard to   
whether or not final regulations to     
carry out such amendment have been      
promulgated by such date4  7#b7 ,in the 
case of a ,state plan for medical       
assistance under title ,,xix of the     
,social ,security ,act which the        
,secretary of ,health and ,human        
,services determines requires ,state    
legislation 7other than legislation     
appropriating funds7 in order for the   
plan to meet the additional requirement 
imposed by the amendments made by       

subsection 7a71 the ,state plan shall   
not be regarded as failing to comply    
with the requirements of such title     
solely on the basis of its failure to   
meet this additional requirement before 
the first day of the first calendar     
quarter beginning after the close of the
 first regular session of the ,state    
legislature that begins after the date  
of the enactment of this ,act4 ,for     
purposes of the previous sentence1 in   
the case of a ,state that has a #b-year 
legislative session1 each year of such  
session shall be deemed to be a separate
 regular session of the ,state          
legislature4