Sec. 614. Payments for community-Based primary health services
350 words·~2 min read·
/bill/113/hr/1200/ih/section-614·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
In the case of community-based primary health services, subject to subsection (b), payments under a State health security program shall— be based on a global budget described in section 611; be based on the basic primary care capitation amount described in subsection
(c)for each individual enrolled with the provider of such services; or be made on a fee-for-service basis under section 612. Payments under subsection
(a)may include, consistent with the budgets developed under this title— an additional amount, as set by the State health security program, to cover the costs incurred by a provider which serves persons not covered by this Act whose health care is essential to overall community health and the control of communicable disease, and for whom the cost of such care is otherwise uncompensated; an additional amount, as set by the State health security program, to cover the reasonable costs incurred by a provider that furnishes case management services (as defined in section 1915(g)(2) of the Social Security Act ), transportation services, and translation services; and an additional amount, as set by the State health security program, to cover the costs incurred by a provider in conducting health professional education programs in connection with the provision of such services. The basic primary care capitation amount described in this subsection for an enrollee with a provider of community-based primary health services shall be determined by the State health security program on the basis of the average amount of expenditures that is estimated would be made under the State health security program for such an enrollee, based on actuarial characteristics (as defined by the State health security program). The State health security program shall adjust such average amounts to take into account the special health needs, including a disproportionate number of medically underserved individuals, of populations served by the provider. The State health security program shall adjust such average amounts to take into account the cost of community-based primary health services that are not provided by the provider. In this section, the term community-based primary health services has the meaning given such term in section 202(a).