,,ii #aaith ,,congress #ast ,session ,s4 #bgic ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,september #aa1 #bjbe,mr4 ,cassidy 7for himself and ,mr4 ,lujn7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to require ,medicare ,advantage plans to cover items and services furnished by certain essential community providers within a service area1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,ensuring ,access to ,essential ,providers ,act of #bjbe4 #b4 ,medicare ,advantage ,essential ,community ,providers ,section #aheb7;d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7;d77 is amended-- 7#a7 in paragraph 7#a7-- 7,a7 in subparagraph 7,d71 by striking and at the end2 7,b7 in subparagraph 7,e71 by striking the period at the end and inserting 2 and2 and 7,c7 by adding at the end the following new subparagraph3 7,f7 the organization meets the essential community provider standard1 as described in paragraph 7#g74 2 and 7#b7 by adding at the end the following new paragraph3 7#g7 ,essential community provider standard 7,a7 ,in general ,for purposes of paragraph 7#a77;,f7 and subject to subparagraph 7,b71 in order to meet the essential community provider standard1 an ,,ma organization shall-- 7i7 include an amount 7determined by the ,secretary7 of available essential community providers 7as described in subparagraph 7,e77 in each ,,ma plan's service area in the provider network and offer to contract with each essential community provider in the service area of each plan2 7ii7 include in its provider network a sufficient number and a geographic distribution1 as determined by the ,secretary1 of available essential community providers1 where available1 to ensure low-income individuals1 individuals residing in rural areas1 or individuals residing in areas designated as health professional shortage areas under section #ccb7;a77#a77;,a7 of the ,public ,health ,service ,act within the service area of the ,,ma organization have reasonable and timely access to a broad range of such providers2 and 7iii7 meet the payment requirements to ,federally qualified health centers1 as described in subparagraph 7,c74 7,b7 ,justification for not meeting standard 7i7 ,in general ,if an ,,ma plan does not meet the essential community provider standard described in subparagraph 7,a71 the ,,ma organization offering such plan shall include as part of the information required to be submitted under section #ahed7;a7-- 7,i7 an explanation regarding why the plan was unable to meet such standard2 and 7,,ii7 a narrative justification describing how the provider network of such plan-- 7aa7 provides an adequate level of service for low-income enrollees or individuals residing in areas designated as health professional shortage areas within the service area of such plan2 and 7bb7 will move toward satisfaction of the essential community provider standard prior to the start of the next plan year4 7ii7 ,insufficient justification ,if the ,secretary determines that the ,,ma organization does not sufficiently explain why the applicable ,,ma plan does not meet the essential community provider standard in the information described in clause 7i71 the ,secretary shall not approve such plan4 7,c7 ,payment to ,federally qualified health centers ,an ,,ma organization shall pay a ,federally qualified health center for an item or service an amount consistent with section #aheg7;e77#c74 7,d7 ,clarification ,nothing in this paragraph may be construed to require an ,,ma plan to provide coverage for a specific medical procedure4 7,e7 ,essential ,community ,provider ,for purposes of this paragraph1 the term essential community provider means a provider that serves predominantly low-income1 medically underserved individuals1 including-- 7i7 a ,federally qualified health center and any similar clinic2 7ii7 a facility funded by the program under title ,,xxvi of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;ff-#aa et seq42 commonly referred to as the ,ryan ,white ,,hiv_/,,aids ,program72 7iii7 a facility operated by the ,indian ,health ,service1 an ,indian tribe or tribal organization1 or an urban ,indian organization 7as defined in section #d of the ,indian ,health ,care ,improvement ,act72 7iv7 a hospital1 including an inpatient hospital1 a hospital receiving or eligible to receive disproportionate share hospital payments under section #ahhf7;d77#e77;,f71 a hospital classified as a rural referral center under section #ahhf7;d77#e77;,c71 a sole community hospital 7as defined in section #ahhf7;d77#e77;,d77iii771 a free-standing cancer hospital 7as described in section #ahhf7;d77#a77;,b77v771 and a critical access hospital 7as defined in section #ahfa7mm77#a772 7v7 a mental health or substance use treatment facility2 7vi7 any other entity that serves predominantly low-income1 medically underserved individuals1 including-- 7,i7 an entity receiving funds under section #cah of the ,public ,health ,service ,act 7relating to treatment of sexually transmitted diseases7 through a ,state or unit of local government1 but only if the entity is certified by the ,secretary pursuant to section #cdj;,b7a77#g7 of such ,act2 7,,ii7 a tuberculosis clinic2 7,,iii7 a comprehensive hemophilia diagnostic treatment center receiving a grant under section #eja7;a77#b72 and 7,,iv7 a black lung clinic receiving funds under section #dbg7;a7 of the ,black ,lung ,benefits ,act2 7vii7 a medicare-dependent1 small rural hospital 7as defined in section #ahhf7;d77#d77;,g77iv772 and 7viii7 any provider determined appropriate by the ,secretary1 which may include any provider determined by the ,secretary to be an essential community provider under section #acaa7;c77#a77;,c7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;c77#a77;,c774 4