Title II: Rural Health - Subtitle A: Rural Health Care Services Outreach, Rural Health Network Development, and Small Health Care Provider Quality Improvement Grant Programs - Revises provisions concerning the rural health outreach, network development, and telemedicine grant program to state that their purpose is to provide grants for expanded delivery of health care services in rural areas, for the planning and implementation of integrated health care networks in rural areas, and for the planning and implementation of small health care provider quality improvement activities.
States that the rural health care services outreach, rural health network development, and small health care provider quality improvement grant programs shall be administered by the Director of the Office of Rural Health Policy of the Health Resources and Services Administration, in consultation with State offices of rural health or other appropriate State government entities. Authorizes the Director to award rural health care services outreach grants, rural health network development grants, and small health care provider quality improvement grants to expand access to, coordinate, and improve the quality of essential health care services, and enhance the delivery of health care, in rural areas. Authorizes appropriations.
Subtitle B: Telehealth Grant Consolidation Act of 2001 - Requires the Secretary to establish telehealth network and resource centers grant programs. Establishes in the Health and Resources and Services Administration an Office for the Advancement of Telehealth to be headed by a Director and shall be administered by such Director, in consultation with the State offices of rural health, State offices concerning primary care, or other appropriate State government entities.
Authorizes the Director, in carrying out the telehealth network grant program, to award grants to eligible entities for projects to demonstrate how telehealth technologies can be used through telehealth networks in rural areas, frontier communities, and medically underserved areas, and for medically underserved populations, to: (1) expand access to, coordinate, and improve the quality of health care services; (2) improve and expand the training of health care providers; and (3) expand and improve the quality of health information available to health care providers, and patients and their families, for decisionmaking. Sets forth provisions concerning the granting, receipt, and use of such grants and reporting requirements. Authorizes appropriations.
Subtitle C: Mental Health Services Telehealth Program and Rural Emergency Medical Service Training and Equipment Assistance Program - Requires the Secretary, acting through the Administrator of the Health Resources and Services Administration, to award grants to eligible entities to enable such entities to provide for improved emergency medical services in rural areas. Requires entities receiving grants to meet a 25 percent matching requirement. Authorizes appropriations.
Requires the Secretary, acting through the Director of the Office for the Advancement of Telehealth of the Health Resources and Services Administration, to award grants to eligible entities to establish demonstration projects for the provision of mental health services to special populations as delivered remotely by qualified mental health professionals using telehealth. Requires a report. Authorizes appropriations.
Title III: National Health Service Corps Program - (Sec. 301) Amends provisions concerning the National Health Service Corps to define the terms "behavioral and mental health professionals" and "graduate program of behavioral and mental health."
Authorizes the Secretary to carry out demonstration projects so that individuals who are obligated to a period of service under the Loan Repayment Program may receive waivers to satisfy the requirement for providing clinical service at a selected entity on a less than full-time basis.
(Sec. 302) Requires all federally qualified health centers and rural health clinics that meet cost sharing requirements to be automatically designated as having such a health professional shortage.
Includes in the list of populations that the Secretary may designate as a health manpower shortage area, seasonal agricultural workers and migratory agricultural workers and residents of public housing.
Requires the Secretary, in consultation with organizations representing individuals in the dental field and organizations representing publicly funded health care providers, to develop and implement a plan to increase the level of participation by dentists and dental hygienists in the Scholarship Program and the Loan Repayment Program.
Directs the Comptroller General of the United States to submit to Congress a report on the appropriateness of the criteria established by the Secretary for the designation of health professional shortage areas and on whether the deeming of federally qualified health centers and rural health clinics as such areas is appropriate and necessary.
(Sec. 303) Authorizes the Secretary to assign Corps members to any public or private entity. (Currently, Corps members are assigned to only public and non-profit private entities.)
Requires (currently, permits) the Secretary to provide technical assistance to entities that are located in health professional shortage areas and desire to apply for the assignment of a Corps member.
(Sec. 304) Repeals requirements that the Secretary consider only certain factors for determining priority assignments of Corps personnel to health professional shortage areas with the greatest shortages.
Requires the Secretary to publish a proposed list of health professional shortage areas and entities that would receive priority for the assignment of Corps members.
(Sec. 305) Revises provisions concerning charges for services by entities using Corps members, including prohibiting entities to which a Corps member is assigned from denying health services to individuals or discriminating in the provision of services because of inability to pay, or because payment for services would be made under Medicare, Medicaid, or SCHIP.
(Sec. 306) Makes ineligible to receive SCHIP funds (in addition to Medicare and Medicaid funds) any hospital refusing admitting privileges to a Corps member.
(Sec. 307) Substitutes the term ``health professional shortage areas'' for the term ``health manpower shortage areas."
(Sec. 308) Authorizes appropriations for the National Health Service Corps Program.
(Sec. 309) Includes behavioral and mental health professionals as eligible participants under the Corps Scholarship Program.
Requires a Corps scholarship individual to agree, if pursuing a degree in medicine or osteopathic medicine, to complete a residency in a specialty that the Secretary determines is consistent with the needs of the Corps.
(Sec. 310) Includes behavioral and mental health professionals as eligible participants under the Corps Loan Repayment Program.
(Sec. 311) Revises provisions that specify dates when obligated service must begin for Scholarship recipients.
Repeals the provision that allowed Corps personnel to fulfill their period of obligation by working as researchers at the National Institutes of Health.
(Sec. 312) Revises requirements concerning: (1) individuals fulfilling their Service obligation through private practice; and (2) breach of scholarship or loan repayment contract.
(Sec. 314) Authorizes appropriations for the Scholarship program.
(Sec. 315) Authorizes appropriations for the grants program to States for loan repayments.
(Sec. 316) Directs the Secretary to establish a demonstration project to provide for the participation of chiropractic doctors and pharmacists in the Corps loan repayment program.
Title IV: Additional Provisions - (Sec. 401) Authorizes the Secretary to make up to 35 grants to eligible entities for demonstration projects to improve services for uninsured and underinsured individuals. Defines "eligible entity" as a public or private entity such as: (1) a federally qualified health center; (2) certain hospitals; (3) a public health department; and (4) certain consortia of providers and, as appropriate, related agencies or entities that provide a broad range of coordinated health care services. Specifies elements grant applications shall contain.
Sets forth provisions concerning priorities in awarding grants, use of funds, grantee requirements, reporting requirements, and authorizing appropriations.
(Sec. 402) Authorizes the Secretary, acting through the Administrator of the Health Resources and Services Administration, to award grants to States for the purpose of helping States develop and implement innovative programs to address the dental workforce needs of designated dental health professional shortage areas in a manner that is appropriate to the States' individual needs.
Sets forth provisions concerning permitted use of funds by a State receiving a grant, grant applications, matching requirements, reporting requirements, and authorizing appropriations.
(Sec. 403) Directs the Secretary to conduct a study of the problems experienced by farmworkers and their families under Medicaid and SCHIP. Specifies problems the study shall examine, as well as possible solutions. Directs the Secretary to submit a report to the President and Congress on the study.
(Sec. 404) Requires that private entities that are not nonprofit entities must be the only provider of quality health services in the geographic area involved to be selected for certain grants, contracts, or cooperative agreements under this Act.
[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3450 Introduced in House (IH)]
107th CONGRESS
1st Session
H. R. 3450
To amend the Public Health Service Act to reauthorize and strengthen
the health centers program and the National Health Service Corps, and
for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
December 11, 2001
Mr. Bilirakis (for himself, Mr. Brown of Ohio, Mr. Tauzin, Mr. Dingell,
Mr. Barrett of Wisconsin, Mr. Bryant, Mr. Burr of North Carolina, Mr.
Tom Davis of Virginia, Mr. Deal of Georgia, Mr. Ehrlich, Mr. Green of
Texas, Mr. Greenwood, Mr. Gordon, Ms. Harman, Mr. Kennedy of Minnesota,
Mr. Markey, Ms. McCarthy of Missouri, Mr. Norwood, Mr. Pallone, Mr.
Pickering, Mr. Rush, Mr. Shimkus, Mr. Strickland, Mr. Towns, Mr. Upton,
Mr. Waxman, Mr. Whitfield, and Mr. Wicker) introduced the following
bill; which was referred to the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend the Public Health Service Act to reauthorize and strengthen
the health centers program and the National Health Service Corps, and
for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Health Care Safety
Net Improvement Act''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--CONSOLIDATED HEALTH CENTER PROGRAM AMENDMENTS
Sec. 101. Health centers.
Sec. 102. Migratory and seasonal agricultural workers.
TITLE II--RURAL HEALTH
Subtitle A--Rural Health Care Services Outreach, Rural Health Network
Development, and Small Health Care Provider Quality Improvement Grant
Programs
Sec. 201. Grant programs.
Subtitle B--Telehealth Grant Consolidation
Sec. 211. Short title.
Sec. 212. Consolidation and reauthorization of provisions.
Subtitle C--Mental Health Services Telehealth Program and Rural
Emergency Medical Service Training and Equipment Assistance Program
Sec. 221. Programs.
TITLE III--NATIONAL HEALTH SERVICE CORPS PROGRAM
Sec. 301. National Health Service Corps.
Sec. 302. Designation of health professional shortage areas.
Sec. 303. Assignment of Corps personnel.
Sec. 304. Priorities in assignment of Corps personnel.
Sec. 305. Cost-sharing.
Sec. 306. Eligibility for Federal funds.
Sec. 307. Facilitation of effective provision of Corps services.
Sec. 308. Authorization of appropriations.
Sec. 309. National Health Service Corps Scholarship Program.
Sec. 310. National Health Service Corps Loan Repayment Program.
Sec. 311. Obligated service.
Sec. 312. Private practice.
Sec. 313. Breach of scholarship contract or loan repayment contract.
Sec. 314. Authorization of appropriations.
Sec. 315. Grants to States for loan repayment programs.
Sec. 316. Demonstration grants to States for community scholarship
programs.
TITLE IV--ADDITIONAL PROVISIONS
Sec. 401. Community access demonstration program.
Sec. 402. Expanding availability of dental services.
Sec. 403. Study regarding barriers to participation of farmworkers in
health programs.
Sec. 404. Eligibility of certain entities for grants.
Sec. 405. Conforming amendments.
TITLE I--CONSOLIDATED HEALTH CENTER PROGRAM AMENDMENTS
SEC. 101. HEALTH CENTERS.
(a) Increase of Authorization of Appropriations From $802,124,000
for Fiscal Year 1997 to $1,293,000,000 for Fiscal Year 2002.--Section
330(l)(1) of the Public Health Service Act (42 U.S.C. 254b(l(1))) is
amended by striking ``$802,124,000'' and all that follows and inserting
``$1,293,000,000 for fiscal year 2002, and such sums as may be
necessary for each of the fiscal years 2003 through 2006.''.
(b) Additional Amendments.--Section 330 of the Public Health
Service Act (42 U.S.C. 254b) is amended--
(1) in subsection (b)(1)(A)--
(A) in clause (i)(III)(bb), by striking ``screening
for breast and cervical cancer'' and inserting
``appropriate cancer screening'';
(B) in clause (ii), by inserting ``(including
specialty referral when medically indicated)'' after
``medical services''; and
(C) in clause (iii), by inserting ``housing,''
after ``social,'';
(2) in subsection (b)(2)--
(A) by redesignating subparagraphs (A) and (B) as
subparagraphs (B) and (C), respectively; and
(B) by inserting before subparagraph (B) (as so
redesignated) the following:
``(A) behavioral and mental health and substance
abuse services;'';
(3) in subsection (c)(1)--
(A) in subparagraph (B)--
(i) in the heading, by striking
``Comprehensive service delivery'' and
inserting ``Managed care'';
(ii) in the matter preceding clause (i), by
striking ``network or plan'' and all that
follows to the period and inserting ``managed
care network or plan.''; and
(iii) in the matter following clause (ii),
by striking ``Any such grant may include'' and
all that follows through the period; and
(B) by adding at the end the following:
``(C) Practice management networks.--The Secretary
may make grants to health centers that receive
assistance under this section to enable the centers to
plan and develop practice management networks that will enable the
centers to--
``(i) reduce costs associated with the
provision of health care services;
``(ii) improve access to, and availability
of, health care services provided to
individuals served by the centers;
``(iii) enhance the quality and
coordination of health care services; or
``(iv) improve the health status of
communities.
``(D) Use of funds.--The activities for which a
grant may be made under subparagraph (B) or (C) may
include the purchase or lease of equipment, which may
include data and information systems (including paying
for the costs of amortizing the principal of, and
paying the interest on, loans for equipment), the
provision of training and technical assistance related
to the provision of health care services on a prepaid
basis or under another managed care arrangement, and
other activities that promote the development of
practice management or managed care networks and
plans.'';
(4) in subsection (d)--
(A) by striking the subsection heading and
inserting ``Loan Guarantee Program.--'';
(B) in paragraph (1)--
(i) in subparagraph (A), by striking ``the
principal and interest on loans'' and all that
follows through the period and inserting ``the
principal and interest on loans made by non-
Federal lenders to health centers, funded under
this section, for the costs of developing and
operating managed care networks or plans
described in subsection (c)(1)(B), or practice
management networks described in subsection
(c)(1)(C), and for the costs of acquiring or
leasing buildings, or purchasing or leasing
equipment.'';
(ii) in subparagraph (B)--
(I) in clause (i), by striking
``or'';
(II) in clause (ii), by striking
the period and inserting ``; or''; and
(III) by adding at the end the
following:
``(iii) to refinance a loan to the center
or centers, if the Secretary determines that--
``(I) such refinancing will result
in more favorable terms;
``(II) the savings resulting from
the refinancing will be beneficial to
both the center (or centers) and the
Government; and
``(III) the center (or centers) can
demonstrate an ability to repay the
refinanced loan equal to or greater
than the ability of the center (or
centers) to repay the original loan on
the date the original loan was made.'';
and
(iii) by adding at the end the following:
``(D) Provision directly to networks or plans.--At
the request of health centers receiving assistance
under this section, loan guarantees provided under this
paragraph may be made directly to networks or plans
that are at least majority controlled and, as
applicable, at least majority owned by those health
centers.''; and
(C)(i) by striking paragraphs (6) and (7); and
(ii) by redesignating paragraph (8) as paragraph
(6);
(5) in subsection (e)--
(A) in paragraph (1), by adding at the end the
following:
``(C) Operation of networks and plans.--
``(i) In general.--The Secretary may make
grants to health centers that receive
assistance under this section, or at the
request of the health centers, directly to a
network or plan (as described in subparagraphs
(B) and (C) of subsection (c)(1)) that is at
least majority controlled and, as applicable,
at least majority owned by such health centers
receiving assistance under this section, for
the costs associated with the operation of such
network or plan, including the purchase or
lease of equipment (including the costs of
amortizing the principal of, and paying the
interest on, loans for equipment).
``(ii) Certain requirements.--Subsection
(j) applies with respect to grants under clause
(i) to the same extent and in the same manner
as such subsection applies with respect to
grants under subparagraph (A) or (B), except to
the extent that as applied to clause (i) the
Secretary waives any requirement under
subsection (j) on the basis that the
requirement is not necessary with respect to
the purposes for which grants under clause (i)
are made.''; and
(B) in paragraph (5)--
(i) in subparagraph (A), by inserting
``subparagraphs (A) and (B) of'' after ``any
fiscal year under'';
(ii) by redesignating subparagraphs (B) and
(C) as subparagraphs (C) and (D), respectively;
and
(iii) by inserting after subparagraph (A)
the following:
``(B) Networks and plans.--The total amount of
grant funds made available for any fiscal year under
paragraph (1)(C) and subparagraphs (B) and (C) of subsection (c)(1) to
a health center shall be determined by the Secretary, but may not
exceed 2 percent of the total amount appropriated under this section
for such fiscal year.'';
(6) in subsection (h)--
(A) in paragraph (1), by striking ``homeless
children and children at risk of homelessness'' and
inserting ``homeless children and youth and children
and youth at risk of homelessness'';
(B)(i) by redesignating paragraph (4) as paragraph
(5); and
(ii) by inserting after paragraph (3) the
following:
``(4) Temporary continued provision of services to certain
former homeless individuals.--If any grantee under this
subsection has provided services described in this section
under the grant to a homeless individual, such grantee may,
notwithstanding that the individual is no longer homeless as a
result of becoming a resident in permanent housing, expend the
grant to continue to provide such services to the individual
for not more than 12 months.''; and
(C) in paragraph (5)(C) (as redesignated by
subparagraph (B)), by striking ``and residential
treatment'' and inserting ``, risk reduction,
outpatient treatment, residential treatment, and
rehabilitation'';
(7) in subsection (j)(3)--
(A) in subparagraph (E)--
(i) in clause (i)--
(I) by striking ``(i)'' and
inserting ``(i)(I)'';
(II) by striking ``plan; or'' and
inserting ``plan; and''; and
(III) by adding at the end the
following:
``(II) has or will have a
contractual or other arrangement with
the State agency administering the
program under title XXI of such Act (42
U.S.C. 1397aa et seq.) with respect to
individuals who are State children's
health insurance program beneficiaries;
or''; and
(ii) by striking clause (ii) and inserting
the following:
``(ii) has made or will make every
reasonable effort to enter into arrangements
described in subclauses (I) and (II) of clause
(i);'';
(B) in subparagraph (G)--
(i) in clause (ii)(II), by striking ``;
and'' and inserting ``;'';
(ii) by redesignating clause (iii) as
clause (iv); and
(iii) by inserting after clause (ii) the
following:
``(iii)(I) will assure that no patient will
be denied health care services due to an
individual's inability to pay for such
services; and
``(II) will assure that any fees or
payments required by the center for such
services will be reduced or waived to enable
the center to fulfill the assurance described
in subclause (I); and'';
(C) in subparagraph (K)(ii), by striking ``and''
after the semicolon at the end;
(D) in subparagraph (L), by striking the period at
the end and inserting ``; and''; and
(E) by adding at the end the following
subparagraph:
``(M) the center encourages persons receiving or
seeking health services from the center to participate
in any public or private (including employer-offered)
health programs or plans for which the persons are
eligible.'';
(8) by striking subsection (k) and inserting the following:
``(k) Technical Assistance.--The Secretary shall establish a
program through which the Secretary shall provide technical and other
assistance to eligible entities to assist such entities to meet the
requirements of paragraphs (2) and (3) of subsection (j) and in
developing plans for, and operating health centers. Services provided
through the program may include necessary technical and nonfinancial
assistance, including fiscal and program management assistance,
training in program management, operational and administrative support,
and the provision of information to the entities of the variety of
resources available under this title and how those resources can be
best used to meet the health needs of the communities served by the
entities.'';
(9)(A) in subsection (l) (as amended by subsection (a) of
this section), by striking ``(l) Authorization'';
(B) by transferring such undesignated subsection to the end
of the section;
(C) by redesignating subsections (m) through (q) as
subsections (l) through (p), respectively; and
(D) in the subsection transferred by subparagraph (B), by
inserting ``(q) Authorization'' before ``of Appropriations.--
''; and
(10) in subsection (q) (as transferred and redesignated by
paragraph (9)), in paragraph (2)--
(A) in subparagraph (A), by striking
``(j)(3)(G)(ii)'' and inserting ``(j)(3)(H)''; and
(B) by striking subparagraph (B) and inserting the
following:
``(B) Distribution of grants.--For fiscal year 2002
and each of the following fiscal years, the Secretary,
in awarding grants under this section, shall ensure
that the proportion of the amount made available under
each of subsections (g), (h), and (i), relative to the
total amount appropriated to carry out this section for
that fiscal year, is equal to the proportion of the
amount made available under that subsection for fiscal
year 2001, relative to the total amount appropriated to
carry out this section for fiscal year 2001.''.
(c) Telemedicine; Incentive Grants Regarding Coordination Among
States.--
(1) In general.--The Secretary of Health and Human Services
may make grants to State professional licensing boards to carry
out programs under which such licensing boards of various
States cooperate to develop and implement State policies that
will reduce statutory and regulatory barriers to telemedicine.
(2) Authorization of appropriations.--For the purpose of
carrying out paragraph (1), there are authorized to be
appropriated $10,000,000 for fiscal year 2002, and such sums as
may be necessary for each of the fiscal years 2002 through
2006.
SEC. 102. MIGRATORY AND SEASONAL AGRICULTURAL WORKERS.
Section 330(g) of the Public Health Service Act (42 U.S.C. 254b(g))
is amended--
(1) in paragraph (2)--
(A) in subparagraph (A), by inserting ``and
seasonal agricultural worker'' after ``agricultural
worker''; and
(B) in subparagraph (B), by striking ``and members
of their families'' and inserting ``and seasonal
agricultural workers, and members of their families,'';
and
(2) in paragraph (3)(A), by striking ``on a seasonal
basis''.
TITLE II--RURAL HEALTH
Subtitle A--Rural Health Care Services Outreach, Rural Health Network
Development, and Small Health Care Provider Quality Improvement Grant
Programs
SEC. 201. GRANT PROGRAMS.
Section 330A of the Public Health Service Act (42 U.S.C. 254c) is
amended to read as follows:
``SEC. 330A. RURAL HEALTH CARE SERVICES OUTREACH, RURAL HEALTH NETWORK
DEVELOPMENT, AND SMALL HEALTH CARE PROVIDER QUALITY
IMPROVEMENT GRANT PROGRAMS.
``(a) Purpose.--The purpose of this section is to provide grants
for expanded delivery of health care services in rural areas, for the
planning and implementation of integrated health care networks in rural
areas, and for the planning and implementation of small health care
provider quality improvement activities.
``(b) Definitions.--
``(1) Director.--The term `Director' means the Director
specified in subsection (d).
``(2) Federally qualified health center; rural health
clinic.--The terms `Federally qualified health center' and
`rural health clinic' have the meanings given the terms in
section 1861(aa) of the Social Security Act (42 U.S.C.
1395x(aa)).
``(3) Health professional shortage area.--The term `health
professional shortage area' means a health professional
shortage area designated under section 332.
``(4) Medically underserved community.--The term `medically
underserved community' has the meaning given the term in
section 799B.
``(5) Medically underserved population.--The term
`medically underserved population' has the meaning given the
term in section 330(b)(3).
``(c) Program.--The Secretary shall establish, under section 301, a
small health care provider quality improvement grant program.
``(d) Administration.--
``(1) Programs.--The rural health care services outreach,
rural health network development, and small health care
provider quality improvement grant programs established under
section 301 shall be administered by the Director of the Office
of Rural Health Policy of the Health Resources and Services
Administration, in consultation with State offices of rural
health or other appropriate State government entities.
``(2) Grants.--
``(A) In general.--In carrying out the programs
described in paragraph (1), the Director may award
grants under subsections (e), (f), and (g) to expand
access to, coordinate, and improve the quality of
essential health care services, and enhance the
delivery of health care, in rural areas.
``(B) Types of grants.--The Director may award the
grants--
``(i) to promote expanded delivery of
health care services in rural areas under
subsection (e);
``(ii) to provide for the planning and
implementation of integrated health
care networks in rural areas under subsection (f); and
``(iii) to provide for the planning and
implementation of small health care provider
quality improvement activities under subsection
(g).
``(e) Rural Health Care Services Outreach Grants.--
``(1) Grants.--The Director may award grants to eligible
entities to promote rural health care services outreach by
expanding the delivery of health care services to include new
and enhanced services in rural areas. The Director may award
the grants for periods of not more than 3 years.
``(2) Eligibility.--To be eligible to receive a grant under
this subsection for a project, an entity--
``(A) shall be a rural public or private entity;
``(B) shall represent a consortium composed of
members--
``(i) that include 3 or more health care
providers; and
``(ii) that may be nonprofit or for-profit
entities; and
``(C) shall not previously have received a grant
under this subsection for the same or a similar
project, unless the entity is proposing to expand the
scope of the project or the area that will be served
through the project.
``(3) Applications.--To be eligible to receive a grant
under this subsection, an eligible entity, in consultation with
the appropriate State office of rural health or another
appropriate State entity, shall prepare and submit to the
Secretary an application, at such time, in such manner, and
containing such information as the Secretary may require,
including--
``(A) a description of the project that the
eligible entity will carry out using the funds provided
under the grant;
``(B) a description of the manner in which the
project funded under the grant will meet the health
care needs of rural underserved populations in the
local community or region to be served;
``(C) a description of how the local community or
region to be served will be involved in the development
and ongoing operations of the project;
``(D) a plan for sustaining the project after
Federal support for the project has ended; and
``(E) a description of how the project will be
evaluated.
``(f) Rural Health Network Development Grants.--
``(1) Grants.--
``(A) In general.--The Director may award rural
health network development grants to eligible entities
to promote, through planning and implementation, the
development of integrated health care networks that
have combined the functions of the entities
participating in the networks in order to--
``(i) achieve efficiencies;
``(ii) expand access to, coordinate, and
improve the quality of essential health care
services; and
``(iii) strengthen the rural health care
system as a whole.
``(B) Grant periods.--The Director may award such a
rural health network development grant for
implementation activities for a period of 3 years. The
Director may also award such a rural health network
development grant for planning activities for a period
of 1 year, to assist in the development of an
integrated health care network, if the proposed
participants in the network do not have a history of
collaborative efforts and a 3-year grant would be
inappropriate.
``(2) Eligibility.--To be eligible to receive a grant under
this subsection, an entity--
``(A) shall be a rural public or private entity;
``(B) shall represent a network composed of
participants--
``(i) that include 3 or more health care
providers; and
``(ii) that may be nonprofit or for-profit
entities; and
``(C) shall not previously have received a grant
under this subsection (other than a grant for planning
activities) for the same or a similar project.
``(3) Applications.--To be eligible to receive a grant
under this subsection, an eligible entity, in consultation with
the appropriate State office of rural health or another
appropriate State entity, shall prepare and submit to the
Secretary an application, at such time, in such manner, and
containing such information as the Secretary may require,
including--
``(A) a description of the project that the
eligible entity will carry out using the funds provided
under the grant;
``(B) an explanation of the reasons why Federal
assistance is required to carry out the project;
``(C) a description of--
``(i) the history of collaborative
activities carried out by the participants in
the network;
``(ii) the degree to which the participants
are ready to integrate their functions; and
``(iii) how the local community or region
to be served will benefit from and be involved
in the activities carried out by the network;
``(D) a description of how the local community or
region to be served will experience increased access to
quality health care services across the continuum of
care as a result of the integration activities carried
out by the network;
``(E) a plan for sustaining the project after
Federal support for the project has ended; and
``(F) a description of how the project will be
evaluated.
``(g) Small Health Care Provider Quality Improvement Grants.--
``(1) Grants.--The Director may award grants to provide for
the planning and implementation of small health care provider
quality improvement activities. The Director may award the
grants for periods of 1 to 3 years.
``(2) Eligibility.--To be eligible for a grant under this
subsection, an entity--
``(A)(i) shall be a rural public or rural nonprofit
private health care provider or provider of health care
services, such as a critical access hospital or a rural
health clinic; or
``(ii) shall be another rural provider or network
of small rural providers identified by the Secretary as
a key source of local care; and
``(B) shall not previously have received a grant
under this subsection for the same or a similar
project.
``(3) Applications.--To be eligible to receive a grant
under this subsection, an eligible entity, in consultation with
the appropriate State office of rural health, another
appropriate State entity, or a hospital association, shall
prepare and submit to the Secretary an application, at such
time, in such manner, and containing such information as the
Secretary may require, including--
``(A) a description of the project that the
eligible entity will carry out using the funds provided
under the grant;
``(B) an explanation of the reasons why Federal
assistance is required to carry out the project;
``(C) a description of the manner in which the
project funded under the grant will assure continuous
quality improvement in the provision of services by the
entity;
``(D) a description of how the local community or
region to be served will experience increased access to
quality health care services across the continuum of
care as a result of the activities carried out by the
entity;
``(E) a plan for sustaining the project after
Federal support for the project has ended; and
``(F) a description of how the project will be
evaluated.
``(4) Expenditures for small health care provider quality
improvement grants.--In awarding a grant under this subsection,
the Director shall ensure that the funds made available through
the grant will be used to provide services to residents of
rural areas. The Director shall award not less than 50 percent
of the funds made available under this subsection to providers
located in and serving rural areas.
``(h) General Requirements.--
``(1) Prohibited uses of funds.--An entity that receives a
grant under this section may not use funds provided through the
grant--
``(A) to build or acquire real property; or
``(B) for construction, except that such funds may
be expended for minor renovations relating to the
installation of equipment.
``(2) Coordination with other agencies.--The Secretary
shall coordinate activities carried out under grant programs
described in this section, to the extent practicable, with
Federal and State agencies and nonprofit organizations that are
operating similar grant programs, to maximize the effect of
public dollars in funding meritorious proposals.
``(3) Preference.--In awarding grants under this section,
the Secretary shall give preference to entities that--
``(A) are located in health professional shortage
areas or medically underserved communities, or serve
medically underserved populations; or
``(B) propose to develop projects with a focus on
primary care, and wellness and prevention strategies.
``(i) Report.--Not later than September 30, 2005, the Secretary
shall prepare and submit to the appropriate committees of Congress a
report on the progress and accomplishments of the grant programs
described in subsections (e), (f), and (g).
``(j) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section $40,000,000 for fiscal year
2002, and such sums as may be necessary for each of fiscal years 2003
through 2006.''.
Subtitle B--Telehealth Grant Consolidation
SEC. 211. SHORT TITLE.
This subtitle may be cited as the ``Telehealth Grant Consolidation
Act of 2001''.
SEC. 212. CONSOLIDATION AND REAUTHORIZATION OF PROVISIONS.
Subpart I of part D of title III of the Public Health Service Act
(42 U.S.C. 254b et seq) is amended by adding at the end the following:
``SEC. 330I. TELEHEALTH NETWORK AND TELEHEALTH RESOURCE CENTERS GRANT
PROGRAMS.
``(a) Definitions.--In this section:
``(1) Director; office.--The terms `Director' and `Office'
mean the Director and Office specified in subsection (c).
``(2) Federally qualified health center and rural health
clinic.--The term `Federally qualified health center' and
`rural health clinic' have the meanings given the terms in
section 1861(aa) of the Social Security Act (42 U.S.C.
1395x(aa)).
``(3) Frontier community.--The term `frontier community'
means an area with fewer than 6 residents per square mile,
based on the latest population data published by the Bureau of
the Census.
``(4) Medically underserved area.--The term `medically
underserved area' has the meaning given the term `medically
underserved community' in section 799B.
``(5) Medically underserved population.--The term
`medically underserved population' has the meaning given the
term in section 330(b)(3).
``(6) Telehealth services.--The term `telehealth services'
means services provided through telehealth technologies.
``(7) Telehealth technologies.--The term `telehealth
technologies' means technologies relating to the use of
electronic information, and telecommunications technologies, to
support and promote, at a distance, health care, patient and
professional health-related education, health administration,
and public health.
``(b) Programs.--The Secretary shall establish, under section 301,
telehealth network and telehealth resource centers grant programs.
``(c) Administration.--
``(1) Establishment.--There is established in the Health
and Resources and Services Administration an Office for the
Advancement of Telehealth. The Office shall be headed by a
Director.
``(2) Duties.--The telehealth network and telehealth
resource centers grant programs established under section 301
shall be administered by the Director, in consultation with the
State offices of rural health, State offices concerning primary
care, or other appropriate State government entities.
``(d) Grants.--
``(1) Telehealth network grants.--The Director may, in
carrying out the telehealth network grant program referred to
in subsection (b), award grants to eligible entities for
projects to demonstrate how telehealth technologies can be used
through telehealth networks in rural areas, frontier
communities, and medically underserved areas, and for medically
underserved populations, to--
``(A) expand access to, coordinate, and improve the
quality of health care services;
``(B) improve and expand the training of health
care providers; and
``(C) expand and improve the quality of health
information available to health care providers, and
patients and their families, for decisionmaking.
``(2) Telehealth resource centers grants.--The Director
may, in carrying out the telehealth resource centers grant
program referred to in subsection (b), award grants to eligible
entities for projects to demonstrate how telehealth
technologies can be used in the areas and communities, and for
the populations, described in paragraph (1), to establish
telehealth resource centers.
``(e) Grant Periods.--The Director may award grants under this
section for periods of not more than 4 years.
``(f) Eligible Entities.--
``(1) Telehealth network grants.--
``(A) Grant recipient.--To be eligible to receive a
grant under subsection (d)(1), an entity shall be a
nonprofit entity.
``(B) Telehealth networks.--
``(i) In general.--To be eligible to
receive a grant under subsection (d)(1), an
entity shall demonstrate that the entity will
provide services through a telehealth network.
``(ii) Nature of entities.--Each entity
participating in the telehealth network may be
a nonprofit or for-profit entity.
``(iii) Composition of network.--The
telehealth network shall include at least 2 of
the following entities (at least 1 of which
shall be a community-based health care
provider):
``(I) Community or migrant health
centers or other Federally qualified
health centers.
``(II) Health care providers,
including pharmacists, in private
practice.
``(III) Entities operating clinics,
including rural health clinics.
``(IV) Local health departments.
``(V) Nonprofit hospitals,
including community access hospitals.
``(VI) Other publicly funded health
or social service agencies.
``(VII) Long-term care providers.
``(VIII) Providers of health care
services in the home.
``(IX) Providers of outpatient
mental health services and entities
operating outpatient mental health
facilities.
``(X) Local or regional emergency
health care providers.
``(XI) Institutions of higher
education.
``(XII) Entities operating dental
clinics.
``(2) Telehealth resource centers grants.--To be eligible
to receive a grant under subsection (d)(2), an entity shall be
a nonprofit entity.
``(g) Applications.--To be eligible to receive a grant under
subsection (d), an eligible entity, in consultation with the
appropriate State office of rural health or another appropriate State
entity, shall prepare and submit to the Secretary an application, at
such time, in such manner, and containing such information as the
Secretary may require, including--
``(1) a description of the project that the eligible entity
will carry out using the funds provided under the grant;
``(2) a description of the manner in which the project
funded under the grant will meet the health care needs of rural
or other populations to be served through the project, or
improve the access to services of, and the quality of the services
received by, those populations;
``(3) evidence of local support for the project, and a
description of how the areas, communities, or populations to be
served will be involved in the development and ongoing
operations of the project;
``(4) a plan for sustaining the project after Federal
support for the project has ended;
``(5) information on the source and amount of non-Federal
funds that the entity will provide for the project;
``(6) information demonstrating the long-term viability of
the project, and other evidence of institutional commitment of
the entity to the project; and
``(7) in the case of an application for a project involving
a telehealth network, information demonstrating how the project
will promote the integration of telehealth technologies into
the operations of health care providers, to avoid redundancy,
and improve access to and the quality of care.
``(h) Terms; Conditions; Maximum Amount of Assistance.--The
Secretary shall establish the terms and conditions of each grant
program described in subsection (b) and the maximum amount of a grant
to be awarded to an individual recipient for each fiscal year under
this section. The Secretary shall publish, in a publication of the
Health Resources and Services Administration, notice of the application
requirements for each grant program described in subsection (b) for
each fiscal year.
``(i) Preferences.--
``(1) Telehealth networks.--In awarding grants under
subsection (d)(1) for projects involving telehealth networks,
the Secretary shall give preference to an eligible entity that
meets at least 1 of the following requirements:
``(A) Organization.--The eligible entity is a rural
community-based organization or another community-based
organization.
``(B) Services.--The eligible entity proposes to
use Federal funds made available through such a grant
to develop plans for, or to establish, telehealth
networks that provide mental health, public health,
long-term care, home care, preventive, or case
management services.
``(C) Coordination.--The eligible entity
demonstrates how the project to be carried out under
the grant will be coordinated with other relevant
federally funded projects in the areas, communities,
and populations to be served through the grant.
``(D) Network.--The eligible entity demonstrates
that the project involves a telehealth network that
includes an entity that--
``(i) provides clinical health care
services, or educational services for health
care providers and for patients or their
families; and
``(ii) is--
``(I) a public school;
``(II) a public library;
``(III) an institution of higher
education; or
``(IV) a local government entity.
``(E) Connectivity.--The eligible entity proposes a
project that promotes local connectivity within areas,
communities, or populations to be served through the
project.
``(F) Integration.--The eligible entity
demonstrates that health care information has been
integrated into the project.
``(2) Telehealth resource centers.--In awarding grants
under subsection (d)(2) for projects involving telehealth
resource centers, the Secretary shall give preference to an
eligible entity that meets at least 1 of the following
requirements:
``(A) Provision of services.--The eligible entity
has a record of success in the provision of telehealth
services to medically underserved areas or medically
underserved populations.
``(B) Collaboration and sharing of expertise.--The
eligible entity has a demonstrated record of
collaborating and sharing expertise with providers of
telehealth services at the national, regional, State,
and local levels.
``(C) Broad range of telehealth services.--The
eligible entity has a record of providing a broad range
of telehealth services, which may include--
``(i) a variety of clinical specialty
services;
``(ii) patient or family education;
``(iii) health care professional education;
and
``(iv) rural residency support programs.
``(j) Distribution of Funds.--
``(1) In general.--In awarding grants under this section,
the Director shall ensure, to the greatest extent possible,
that such grants are equitably distributed among the
geographical regions of the United States.
``(2) Telehealth networks.--In awarding grants under
subsection (d)(1) for a fiscal year, the Director shall ensure
that--
``(A) not less than 50 percent of the funds awarded
shall be awarded for projects in rural areas; and
``(B) the total amount of funds awarded for such
projects for that fiscal year shall be not less than
the total amount of funds awarded for such projects for
fiscal year 2001 under section 330A (as in effect on
the day before the date of enactment of the Health Care
Safety Net Improvement Act).
``(k) Use of Funds.--
``(1) Telehealth network program.--The recipient of a grant
under subsection (d)(1) may use funds received through such
grant for salaries, equipment, and operating or other costs,
including the cost of--
``(A) developing and delivering clinical telehealth
services that enhance access to community-based health
care services in rural areas, frontier communities, or
medically underserved areas, or for medically
underserved populations;
``(B) developing and acquiring, through lease or
purchase, computer hardware and software, audio and
video equipment, computer network equipment,
interactive equipment, data terminal equipment, and
other equipment that furthers the objectives of the
telehealth network grant program;
``(C)(i) developing and providing distance
education, in a manner that enhances access to care in
rural areas, frontier communities, or medically
underserved areas, or for medically underserved
populations; or
``(ii) mentoring, precepting, or supervising health
care providers and students seeking to become health
care providers, in a manner that enhances access to
care in the areas and communities, or for the
populations, described in clause (i);
``(D) developing and acquiring instructional
programming;
``(E)(i) providing for transmission of medical
data, and maintenance of equipment; and
``(ii) providing for compensation (including travel
expenses) of specialists, and referring health care
providers, who are providing telehealth services
through the telehealth network, if no third party
payment is available for the telehealth services
delivered through the telehealth network;
``(F) developing projects to use telehealth
technology to facilitate collaboration between health
care providers;
``(G) collecting and analyzing usage statistics and
data to document the cost-effectiveness of the
telehealth services; and
``(H) carrying out such other activities as are
consistent with achieving the objectives of this
section, as determined by the Secretary.
``(2) Telehealth resource centers.--The recipient of a
grant under subsection (d)(2) may use funds received through
such grant for salaries, equipment, and operating or other
costs for--
``(A) providing technical assistance, training, and
support, and providing for travel expenses, for health
care providers and a range of health care entities that
provide or will provide telehealth services;
``(B) disseminating information and research
findings related to telehealth services;
``(C) promoting effective collaboration among
telehealth resource centers and the Office;
``(D) conducting evaluations to determine the best
utilization of telehealth technologies to meet health
care needs;
``(E) promoting the integration of the technologies
used in clinical information systems with other
telehealth technologies;
``(F) fostering the use of telehealth technologies
to provide health care information and education for
health care providers and consumers in a more effective
manner; and
``(G) implementing special projects or studies
under the direction of the Office.
``(l) Prohibited Uses of Funds.--An entity that receives a grant
under this section may not use funds made available through the grant--
``(1) to acquire real property;
``(2) for expenditures to purchase or lease equipment, to
the extent that the expenditures would exceed 40 percent of the
total grant funds;
``(3) in the case of a project involving a telehealth
network, to purchase or install transmission equipment (such as
laying cable or telephone lines, or purchasing or installing
microwave towers, satellite dishes, amplifiers, or digital
switching equipment);
``(4) to pay for any equipment or transmission costs not
directly related to the purposes for which the grant is
awarded;
``(5) to purchase or install general purpose voice
telephone systems;
``(6) for construction, except that such funds may be
expended for minor renovations relating to the installation of
equipment; or
``(7) for expenditures for indirect costs (as determined by
the Secretary), to the extent that the expenditures would
exceed 10 percent of the total grant funds.
``(m) Collaboration.--In providing services under this section, an
eligible entity shall collaborate, if feasible, with entities that--
``(1)(A) are private or public organizations, that receive
Federal or State assistance; or
``(B) are public or private entities that operate centers,
or carry out programs, that receive Federal or State
assistance; and
``(2) provide telehealth services or related activities.
``(n) Coordination With Other Agencies.--The Secretary shall
coordinate activities carried out under grant programs described in
subsection (b), to the extent practicable, with Federal and State
agencies and nonprofit organizations that are operating similar
programs, to maximize the effect of public dollars in funding
meritorious proposals.
``(o) Outreach Activities.--The Secretary shall establish and
implement procedures to carry out outreach activities to advise
potential end users of telehealth services in rural areas, frontier
communities, medically underserved areas, and medically underserved
populations in each State about the grant programs described in
subsection (b).
``(p) Telehealth.--It is the sense of Congress that, for purposes
of this section, States should develop reciprocity agreements so that a
provider of services under this section who is a licensed or otherwise
authorized health care provider under the law of 1 or more States, and
who, through telehealth technology, consults with a licensed or
otherwise authorized health care provider in another State, is exempt,
with respect to such consultation, from any State law of the other
State that prohibits such consultation on the basis that the first
health care provider is not a licensed or authorized health care
provider under the law of that State.
``(q) Report.--Not later than September 30, 2005, the Secretary
shall prepare and submit to the appropriate committees of Congress a
report on the progress and accomplishments of the grant programs
described in subsection (b).
``(r) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section--
``(1) for grants under subsection (d)(1), $40,000,000 for
fiscal year 2002, and such sums as may be necessary for each of
fiscal years 2003 through 2006; and
``(2) for grants under subsection (d)(2), $20,000,000 for
fiscal year 2002, and such sums as may be necessary for each of
fiscal years 2003 through 2006.''.
Subtitle C--Mental Health Services Telehealth Program and Rural
Emergency Medical Service Training and Equipment Assistance Program
SEC. 221. PROGRAMS.
Subpart I of part D of title III of the Public Health Service Act
(42 U.S.C. 254b et seq.) (as amended by section 212) is further amended
by adding at the end the following:
``SEC. 330J. RURAL EMERGENCY MEDICAL SERVICE TRAINING AND EQUIPMENT
ASSISTANCE PROGRAM.
``(a) Grants.--The Secretary, acting through the Administrator of
the Health Resources and Services Administration (referred to in this
section as the `Secretary') shall award grants to eligible entities to
enable such entities to provide for improved emergency medical services
in rural areas.
``(b) Eligibility.--To be eligible to receive a grant under this
section, an entity shall--
``(1) be--
``(A) a State emergency medical services office;
``(B) a State emergency medical services
association;
``(C) a State office of rural health;
``(D) a local government entity;
``(E) a State or local ambulance provider; or
``(F) any other entity determined appropriate by
the Secretary; and
``(2) prepare and submit to the Secretary an application at
such time, in such manner, and containing such information as
the Secretary may require, that includes--
``(A) a description of the activities to be carried
out under the grant; and
``(B) an assurance that the eligible entity will
comply with the matching requirement of subsection (e).
``(c) Use of Funds.--An entity shall use amounts received under a
grant made under subsection (a), either directly or through grants to
emergency medical service squads that are located in, or that serve
residents of, a nonmetropolitan statistical area, an area designated as
a rural area by any law or regulation of a State, or a rural census
tract of a metropolitan statistical area (as determined under the most
recent Goldsmith Modification, originally published in a notice of
availability of funds in the Federal Register on February 27, 1992, 57
Fed. Reg. 6725), to--
``(1) recruit emergency medical service personnel;
``(2) recruit volunteer emergency medical service
personnel;
``(3) train emergency medical service personnel in
emergency response, injury prevention, safety awareness, and
other topics relevant to the delivery of emergency medical
services;
``(4) fund specific training to meet Federal or State
certification requirements;
``(5) develop new ways to educate emergency health care
providers through the use of technology-enhanced educational
methods (such as distance learning);
``(6) acquire emergency medical services equipment,
including cardiac defibrillators;
``(7) acquire personal protective equipment for emergency
medical services personnel as required by the Occupational
Safety and Health Administration; and
``(8) educate the public concerning cardiopulmonary
resuscitation, first aid, injury prevention, safety awareness,
illness prevention, and other related emergency preparedness
topics.
``(d) Preference.--In awarding grants under this section the
Secretary shall give preference to--
``(1) applications that reflect a collaborative effort by 2
or more of the entities described in subparagraphs (A) through
(F) of subsection (b)(1); and
``(2) applications submitted by entities that intend to use
amounts provided under the grant to fund activities described
in any of paragraphs (1) through (5) of subsection (c).
``(e) Matching Requirement.--The Secretary may not award a grant
under this section to an entity unless the entity agrees that the
entity will make available (directly or through contributions from
other public or private entities) non-Federal contributions toward the
activities to be carried out under the grant in an amount equal to 25
percent of the amount received under the grant.
``(f) Emergency Medical Services.--In this section, the term
`emergency medical services'--
``(1) means resources used by a qualified public or private
nonprofit entity, or by any other entity recognized as
qualified by the State involved, to deliver medical care
outside of a medical facility under emergency conditions that
occur--
``(A) as a result of the condition of the patient;
or
``(B) as a result of a natural disaster or similar
situation; and
``(2) includes services delivered by an emergency medical
services provider (either compensated or volunteer) or other
provider recognized by the State involved that is licensed or
certified by the State as an emergency medical technician or
its equivalent (as determined by the State), a registered
nurse, a physician assistant, or a physician that provides
services similar to services provided by such an emergency
medical services provider.
``(g) Authorization of Appropriations.--
``(1) In general.--There are authorized to be appropriated
to carry out this section such sums as may be necessary for
each of fiscal years 2002 through 2006.
``(2) Administrative costs.--The Secretary may use not more
than 10 percent of the amount appropriated under paragraph (1)
for a fiscal year for the administrative expenses of carrying
out this section.
``SEC. 330K. MENTAL HEALTH SERVICES DELIVERED VIA TELEHEALTH.
``(a) Definitions.--In this section:
``(1) Eligible entity.--The term `eligible entity' means a
public or nonprofit private telehealth provider network that
offers services that include mental health services provided by
qualified mental health providers.
``(2) Qualified mental health professionals.--The term
`qualified mental health professionals' refers to providers of
mental health services reimbursed under the medicare program
carried out under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) who have additional training in the
treatment of mental illness in children and adolescents or who
have additional training in the treatment of mental illness in
the elderly.
``(3) Special populations.--The term `special populations'
refers to the following 2 distinct groups:
``(A) Children and adolescents in mental health
underserved rural areas or in mental health underserved
urban areas.
``(B) Elderly individuals located in long-term care
facilities in mental health underserved rural areas or
in mental health underserved urban areas.
``(4) Telehealth.--The term `telehealth' means the use of
electronic information and telecommunications technologies to
support long distance clinical health care, patient and
professional health-related education, public health, and
health administration.
``(b) Program Authorized.--
``(1) In general.--The Secretary, acting through the
Director of the Office for the Advancement of Telehealth of the
Health Resources and Services Administration, shall award
grants to eligible entities to establish demonstration projects
for the provision of mental health services to special
populations as delivered remotely by qualified mental health
professionals using telehealth and for the provision of
education regarding mental illness as delivered remotely by
qualified mental health professionals and qualified mental
health education professionals using telehealth.
``(2) Populations served.--The Secretary shall award the
grants under paragraph (1) in a manner that distributes the
grants so as to serve equitably the populations described in
subparagraphs (A) and (B) of subsection (a)(4).
``(c) Use of Funds.--
``(1) In general.--An eligible entity that receives a grant
under this section shall use the grant funds--
``(A) for the populations described in subsection
(a)(3)(A)--
``(i) to provide mental health services,
including diagnosis and treatment of mental
illness, in public elementary and public
secondary schools as delivered remotely by
qualified mental health professionals using
telehealth; and
``(ii) to collaborate with local public
health entities to provide the mental health
services; and
``(B) for the populations described in subsection
(a)(3)(B)--
``(i) to provide mental health services,
including diagnosis and treatment of mental
illness, in long-term care facilities as
delivered remotely by qualified mental health
professionals using telehealth; and
``(ii) to collaborate with local public
health entities to provide the mental health
services.
``(2) Other uses.--An eligible entity that receives a grant
under this section may also use the grant funds to--
``(A) pay telecommunications costs; and
``(B) pay qualified mental health professionals on
a reasonable basis as determined by the Secretary for
services rendered.
``(3) Prohibited uses.--An eligible entity that receives a
grant under this section shall not use the grant funds to--
``(A) purchase or install transmission equipment
(other than such equipment used by qualified mental
health professionals to deliver mental health services
using telehealth under the project involved); or
``(B) build upon or acquire real property.
``(d) Equitable Distribution.--In awarding grants under this
section, the Secretary shall ensure, to the greatest extent possible,
that such grants are equitably distributed among geographical regions
of the United States.
``(e) Application.--An entity that desires a grant under this
section shall submit an application to the Secretary at such time, in
such manner, and containing such information as the Secretary
determines to be reasonable.
``(f) Report.--Not later than 4 years after the date of enactment
of the Health Care Safety Net Improvement Act, the Secretary shall
prepare and submit to the appropriate committees of Congress a report
that shall evaluate activities funded with grants under this section.
``(g) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, $20,000,000 for fiscal year
2002 and such sums as may be necessary for fiscal years 2003 through
2006.''.
TITLE III--NATIONAL HEALTH SERVICE CORPS PROGRAM
SEC. 301. NATIONAL HEALTH SERVICE CORPS.
(a) In General.--Section 331 of the Public Health Service Act (42
U.S.C. 254d) is amended--
(1) by adding at the end of subsection (a)(3) the
following:
``(E)(i) The term `behaviorial and mental health
professionals' means health service psychologists, licensed
clinical social workers, licensed professional counselors,
marriage and family therapists, psychiatric nurse specialists,
and psychiatrists.
``(ii) The term `graduate program of behavioral and mental
health' means a program that trains behavorial and mental
health professionals.'';
(2) in subsection (b)--
(A) in paragraph (1), by striking ``health
professions'' and inserting ``health professions,
including schools at which graduate programs of
behavioral and mental health are offered,''; and
(B) in paragraph (2), by inserting ``behavioral and
mental health professionals,'' after ``dentists,''; and
(3) by striking subsection (c) and inserting the following:
``(c)(1) The Secretary may reimburse an applicant for a position in
the Corps (including an individual considering entering into a written
agreement pursuant to section 338D) for the actual and reasonable
expenses incurred in traveling to and from the applicant's place of
residence to an eligible site to which the applicant may be assigned
under section 333 for the purpose of evaluating such site with regard
to being assigned at such site. The Secretary may establish a maximum
total amount that may be paid to an individual as reimbursement for
such expenses.
``(2) The Secretary may also reimburse the applicant for the actual
and reasonable expenses incurred for the travel of 1 family member to
accompany the applicant to such site. The Secretary may establish a
maximum total amount that may be paid to an individual as reimbursement
for such expenses.
``(3) In the case of an individual who has entered into a contract
for obligated service under the Scholarship Program or under the Loan
Repayment Program, the Secretary may reimburse such individual for all
or part of the actual and reasonable expenses incurred in transporting
the individual to the site of the individual's assignment under section
333. The Secretary may establish a maximum total amount that may be
paid to an individual as reimbursement for such expenses.''.
(b) Demonstration Projects.--Section 331 of the Public Health
Service Act (42 U.S.C. 254d) is amended--
(1) by redesignating subsection (i) as subsection (j); and
(2) by inserting after subsection (h) the following:
``(i)(1) In carrying out subpart III, the Secretary may, in
accordance with this subsection, carry out demonstration projects in
which individuals who have entered into a contract for obligated
service under the Loan Repayment Program receive waivers under which
the individuals are authorized to satisfy the requirement of obligated
service through providing clinical service that is not full-time.
``(2) A waiver described in paragraph (1) may be provided by the
Secretary only if--
``(A) the entity for which the service is to be performed--
``(i) has been approved under section 333A for
assignment of a Corps member; and
``(ii) has requested in writing assignment of a
health professional who would serve less than full
time;
``(B) the Secretary has determined that assignment of a
health professional who would serve less than full time would
be appropriate for the area where the entity is located;
``(C) a Corps member who is required to perform obligated
service has agreed in writing to be assigned for less than
full-time service to an entity described in subparagraph (A);
``(D) the entity and the Corps member agree in writing that
the less than full-time service provided by the Corps member
will not be less than 16 hours of clinical service per week;
``(E) the Corps member agrees in writing that the period of
obligated service pursuant to section 338B will be extended so
that the aggregate amount of less than full-time service
performed will equal the amount of service that would be
performed through full-time service under section 338C; and
``(F) the Corps member agrees in writing that if the Corps
member begins providing less than full-time service but fails
to begin or complete the period of obligated service, the
method stated in 338E(c) for determining the damages for breach
of the individual's written contract will be used after
converting periods of obligated service or of service performed
into their full-time equivalents.''.
SEC. 302. DESIGNATION OF HEALTH PROFESSIONAL SHORTAGE AREAS.
(a) In General.--Section 332 of the Public Health Service Act (42
U.S.C. 254e) is amended--
(1) in subsection (a)--
(A) in paragraph (1), by inserting after the first
sentence the following: ``All Federally qualified
health centers and rural health clinics, as defined in
section 1861(aa) of the Social Security Act (42 U.S.C.
1395x(aa)), that meet the requirements of section 334
shall be automatically designated as having such a
shortage. Not earlier than 6 years after such date of
enactment, and every 6 years thereafter, each such
center or clinic shall demonstrate that the center or
clinic meets the applicable requirements of the Federal
regulations, issued after the date of enactment of this
Act, that revise the definition of a health
professional shortage area for purposes of this
section.''; and
(B) in paragraph (3), by striking ``340(r)) may be
a population group'' and inserting ``330(h)(4)),
seasonal agricultural workers (as defined in section
330(g)(3)) and migratory agricultural workers (as so
defined)), and residents of public housing (as defined
in section 3(b)(1) of the United States Housing Act of
1937 (42 U.S.C. 1437a(b)(1))) may be population
groups'';
(2) in subsection (b)(2), by striking ``with special
consideration to the indicators of'' and all that follows
through ``services.'' and inserting a period; and
(3) in subsection (c)(2)(B), by striking ``XVIII or XIX''
and inserting ``XVIII, XIX, or XXI''.
(b) Regulations.--
(1) Report.--
(A) In general.--The Secretary shall submit the
report described in subparagraph (B) if the Secretary,
acting through the Administrator of the Health
Resources and Services Administration, issues--
(i) a regulation that revises the
definition of a health professional shortage
area for purposes of section 332 of the Public
Health Service Act (42 U.S.C. 254e); or
(ii) a regulation that revises the
standards concerning priority of such an area
under section 333A of that Act (42 U.S.C. 254f-1).
(B) Report.--On issuing a regulation described in
subparagraph (A), the Secretary shall prepare and
submit to the Committee on Energy and Commerce of the
House of Representatives and the Committee on Health,
Education, Labor, and Pensions of the Senate a report
that describes the regulation.
(2) Effective date.--Each regulation described in paragraph
(1)(A) shall take effect 180 days after the committees
described in paragraph (1)(B) receive a report referred to in
paragraph (1)(B) describing the regulation.
(c) Scholarship and Loan Repayment Programs.--The Secretary of
Health and Human Services, in consultation with organizations
representing individuals in the dental field and organizations
representing publicly funded health care providers, shall develop and
implement a plan for increasing the participation of dentists and
dental hygienists in the National Health Service Corps Scholarship
Program under section 338A of the Public Health Service Act (42 U.S.C.
254l) and the Loan Repayment Program under section 338B of such Act (42
U.S.C. 254l-1).
(d) Site Designation Process.--
(1) Improvement of designation process.--The Administrator
of the Health Resources and Services Administration, in
consultation with appropriate State and territorial dental
directors, dental societies, and other interested parties,
shall revise the criteria on which the designations of dental
health professional shortage areas are based so that such
criteria provide a more accurate reflection of oral health care
need, particularly in rural areas.
(2) Public health service act.--Section 332 of the Public
Health Service Act (42 U.S.C. 254e) is amended by adding at the
end the following:
``(i) Dissemination.--The Administrator of the Health Resources and
Services Administration shall disseminate information concerning the
designation criteria described in subsection (b) to--
``(1) the Governor of each State;
``(2) the representative of any area, population group, or
facility selected by any such Governor to receive such
information;
``(3) the representative of any area, population group, or
facility that requests such information; and
``(4) the representative of any area, population group, or
facility determined by the Administrator to be likely to meet
the criteria described in subsection (b).''.
(e) GAO Study.--Not later than February 1, 2005, the Comptroller
General of the United States shall submit to the Congress a report on
the appropriateness of the criteria, including but not limited to
infant mortality rates, access to health services taking into account
the distance to primary health services, the rate of poverty and
ability to pay for health services, and low birth rates, established by
the Secretary of Health and Human Services for the designation of
health professional shortage areas and whether the deeming of Federally
qualified health centers and rural health clinics as such areas is
appropriate and necessary.
SEC. 303. ASSIGNMENT OF CORPS PERSONNEL.
Section 333 of the Public Health Service Act (42 U.S.C. 254f) is
amended--
(1) in subsection (a)--
(A) in paragraph (1)--
(i) in the matter before subparagraph (A),
by striking ``(specified in the agreement
described in section 334)'';
(ii) in subparagraph (A), by striking
``nonprofit''; and
(iii) by striking subparagraph (C) and
inserting the following:
``(C) the entity agrees to comply with the
requirements of section 334; and''; and
(B) in paragraph (3), by adding at the end ``In
approving such applications, the Secretary shall give
preference to applications in which a nonprofit entity
or public entity shall provide a site to which Corps
members may be assigned.''; and
(2) in subsection (d)--
(A) in paragraphs (1), (2), and (4), by striking
``nonprofit'' each place it appears; and
(B) in paragraph (1)--
(i) in the second sentence--
(I) in subparagraph (C), by
striking ``and'' at the end; and
(II) by striking the period and
inserting ``, and (E) developing long-
term plans for addressing health
professional shortages and improving
access to health care.''; and
(ii) by adding at the end the following:
``The Secretary shall encourage entities that
receive technical assistance under this
paragraph to communicate with other
communities, State Offices of Rural Health,
State Primary Care Associations and Offices,
and other entities concerned with site
development and community needs assessment.''.
SEC. 304. PRIORITIES IN ASSIGNMENT OF CORPS PERSONNEL.
Section 333A of the Public Health Service Act (42 U.S.C. 254f-1) is
amended--
(1) in subsection (a)(1)(A), by striking ``, as determined
in accordance with subsection (b)'';
(2) by striking subsection (b);
(3) in subsection (c), by striking the second sentence;
(4) in subsection (d)--
(A) by redesignating paragraphs (1) through (3) as
paragraphs (2) through (4), respectively;
(B) by inserting before paragraph (2) (as
redesignated by subparagraph (A)) the following:
``(1) Proposed list.--The Secretary shall prepare and
publish a proposed list of health professional shortage areas
and entities that would receive priority under subsection
(a)(1) in the assignment of Corps members. The list shall
contain the information described in paragraph (2), and the
relative scores and relative priorities of the entities
submitting applications under section 333, in a proposed
format. All such entities shall have 30 days after the date of
publication of the list to provide additional data and
information in support of inclusion on the list or in support
of a higher priority determination and the Secretary shall
reasonably consider such data and information in preparing the
final list under paragraph (2).'';
(C) in paragraph (2) (as redesignated by
subparagraph (A)), in the matter before subparagraph
(A)--
(i) by striking ``paragraph (2)'' and
inserting ``paragraph (3)'';
(ii) by striking ``prepare a list of health
professional shortage areas'' and inserting
``prepare and, as appropriate, update a list of
health professional shortage areas and
entities''; and
(iii) by striking ``for the period
applicable under subsection (f)'';
(D) by striking paragraph (3) (as redesignated by
subparagraph (A)) and inserting the following:
``(3) Notification of affected parties.--
``(A) Entities.--Not later than 30 days after the
Secretary has added to a list under paragraph (2) an
entity specified as described in subparagraph (A) of
such paragraph, the Secretary shall notify such entity
that the entity has been provided an authorization to
receive assignments of Corps members in the event that
Corps members are available for the assignments.
``(B) Individuals.--In the case of an individual
obligated to provide service under the Scholarship
Program, not later than 3 months before the date
described in section 338C(b)(5), the Secretary shall
provide to such individual the names of each of the
entities specified as described in paragraph (2)(B)(i)
that is appropriate for the individual's medical
specialty and discipline.''; and
(E) by striking paragraph (4) (as redesignated by
subparagraph (A)) and inserting the following:
``(4) Revisions.--If the Secretary proposes to make a
revision in the list under paragraph (2), and the revision
would adversely alter the status of an entity with respect to
the list, the Secretary shall notify the entity of the
revision. Any entity adversely affected by such a revision
shall be notified in writing by the Secretary of the reasons
for the revision and shall have 30 days to file a written
appeal of the determination involved which shall be reasonably
considered by the Secretary before the revision to the list
becomes final. The revision to the list shall be effective with
respect to assignment of Corps members beginning on the date
that the revision becomes final.'';
(5) by striking subsection (e) and inserting the following:
``(e) Limitation on Number of Entities Offered as Assignment
Choices in Scholarship Program.--
``(1) Determination of available corps members.--By April 1
of each calendar year, the Secretary shall determine the number
of participants in the Scholarship Program who will be
available for assignments under section 333 during the program
year beginning on July 1 of that calendar year.
``(2) Determination of number of entities.--At all times
during a program year, the number of entities specified under
subsection (c)(2)(B)(i) shall be--
``(A) not less than the number of participants
determined with respect to that program year under
paragraph (1); and
``(B) not greater than twice the number of
participants determined with respect to that program
year under paragraph (1).'';
(6) by striking subsection (f); and
(7) by redesignating subsections (c), (d), and (e) as
subsections (b), (c), and (d) respectively.
SEC. 305. COST-SHARING.
Subpart II of part D of title III of the Public Health Service Act
(42 U.S.C. 254d et seq.) is amended by striking section 334 and
inserting the following:
``SEC. 334. CHARGES FOR SERVICES BY ENTITIES USING CORPS MEMBERS.
``(a) Availability of Services Regardless of Ability To Pay or
Payment Source.--An entity to which a Corps member is assigned shall
not deny requested health care services, and shall not discriminate in
the provision of services to an individual--
``(1) because the individual is unable to pay for the
services; or
``(2) because payment for the services would be made
under--
``(A) the medicare program under title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.);
``(B) the medicaid program under title XIX of such
Act (42 U.S.C. 1396 et seq.); or
``(C) the State children's health insurance program
under title XXI of such Act (42 U.S.C. 1397aa et seq.).
``(b) Charges for Services.--The following rules shall apply to
charges for health care services provided by an entity to which a Corps
member is assigned:
``(1) In general.--
``(A) Schedule of fees or payments.--Except as
provided in paragraph (2), the entity shall prepare a
schedule of fees or payments for the entity's services,
consistent with locally prevailing rates or charges and
designed to cover the entity's reasonable cost of
operation.
``(B) Schedule of discounts.--Except as provided in
paragraph (2), the entity shall prepare a corresponding
schedule of discounts (including, in appropriate cases,
waivers) to be applied to such fees or payments. In
preparing the schedule, the entity shall adjust the
discounts on the basis of a patient's ability to pay.
``(C) Use of schedules.--The entity shall make
every reasonable effort to secure from patients fees
and payments for services in accordance with such
schedules, and fees or payments shall be sufficiently
discounted in accordance with the schedule described in
subparagraph (B).
``(2) Services to beneficiaries of federal and federally
assisted programs.--In the case of health care services
furnished to an individual who is a beneficiary of a program
listed in subsection (a)(2), the entity--
``(A) shall accept an assignment pursuant to
section 1842(b)(3)(B)(ii) of the Social Security Act
(42 U.S.C. 1395u(b)(3)(B)(ii)) with respect to an
individual who is a beneficiary under the medicare
program; and
``(B) shall enter into an appropriate agreement
with--
``(i) the State agency administering the
program under title XIX of such Act with
respect to an individual who is a beneficiary
under the medicaid program; and
``(ii) the State agency administering the
program under title XXI of such Act with
respect to an individual who is a beneficiary
under the State children's health insurance
program.
``(3) Collection of payments.--The entity shall take
reasonable and appropriate steps to collect all payments due
for health care services provided by the entity, including
payments from any third party (including a Federal, State, or
local government agency and any other third party) that is
responsible for part or all of the charge for such services.''.
SEC. 306. ELIGIBILITY FOR FEDERAL FUNDS.
Section 335(e)(1)(B) of the Public Health Service Act (42 U.S.C.
254h(e)(1)(B)) is amended by striking ``XVIII or XIX'' and inserting
``XVIII, XIX, or XXI''.
SEC. 307. FACILITATION OF EFFECTIVE PROVISION OF CORPS SERVICES.
(a) Health Professional Shortage Areas.--Section 336 of the Public
Health Service Act (42 U.S.C. 254h-1) is amended--
(1) in subsection (c), by striking ``health manpower'' and
inserting ``health professional''; and
(2) in subsection (f)(1), by striking ``health manpower''
and inserting ``health professional''.
(b) Technical Amendment.--Section 336A(8) of the Public Health
Service Act (42 U.S.C. 254i(8)) is amended by striking ``agreements
under''.
SEC. 308. AUTHORIZATION OF APPROPRIATIONS.
Section 338(a) of the Public Health Service Act (42 U.S.C. 254k(a))
is amended--
(1) by striking ``(1) For'' and inserting ``For'';
(2) by striking ``1991 through 2000'' and inserting ``2002
through 2006''; and
(3) by striking paragraph (2).
SEC. 309. NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP PROGRAM.
Section 338A of the Public Health Service Act (42 U.S.C. 254l) is
amended--
(1) in subsection (a)(1), by inserting ``behavioral and
mental health professionals,'' after ``dentists,'';
(2) in subsection (b)(1)(B), by inserting ``, or an
appropriate degree from a graduate program of behavioral and
mental health'' after ``other health profession'';
(3) in subsection (c)(1)--
(A) in subparagraph (A), by striking ``338D'' and
inserting ``338E''; and
(B) in subparagraph (B), by striking ``338C'' and
inserting ``338D'';
(4) in subsection (d)(1)--
(A) in subparagraph (A), by striking ``and'' at the
end;
(B) by redesignating subparagraph (B) as
subparagraph (C); and
(C) by inserting after subparagraph (A) the
following:
``(B) the Secretary, in considering applications
from individuals accepted for enrollment or enrolled in
dental school, shall consider applications from all
individuals accepted for enrollment or enrolled in any
accredited dental school in a State; and'';
(5) in subsection (f)--
(A) in paragraph (1)(B)--
(i) in clause (iii), by striking ``and''
after the semicolon;
(ii) by redesignating clause (iv) as clause
(v); and
(iii) by inserting after clause (iii) the
following new clause:
``(iv) if pursuing a degree from a school
of medicine or osteopathic medicine, to
complete a residency in a specialty that the
Secretary determines is consistent with the
needs of the Corps; and''; and
(B) in paragraph (3), by striking ``338D'' and
inserting ``338E''; and
(6) by striking subsection (i).
SEC. 310. NATIONAL HEALTH SERVICE CORPS LOAN REPAYMENT PROGRAM.
Section 338B of the Public Health Service Act (42 U.S.C. 254l-1) is
amended--
(1) in subsection (a)--
(A) in paragraph (1), by inserting ``behavioral and
mental health professionals,'' after ``dentists,''; and
(B) in paragraph (2), by striking ``(including
mental health professionals)'';
(2) in subsection (b)(1), by striking subparagraph (A) and
inserting the following:
``(A) have a degree in medicine, osteopathic medicine,
dentistry, or another health profession, or an appropriate
degree from a graduate program of behavioral and mental health,
or be certified as a nurse midwife, nurse practitioner, or
physician assistant;'';
(3) in subsection (e), by striking ``(1) In general.--'';
and
(4) by striking subsection (i).
SEC. 311. OBLIGATED SERVICE.
Section 338C of the Public Health Service Act (42 U.S.C. 254m) is
amended--
(1) in subsection (b)--
(A) in paragraph (1), in the matter preceding
subparagraph (A), by striking ``section
338A(f)(1)(B)(iv)'' and inserting ``section
338A(f)(1)(B)(v)''; and
(B) in paragraph (5)--
(i) by striking all that precedes
subparagraph (C) and inserting the following:
``(5)(A) In the case of the Scholarship Program, the date referred
to in paragraphs (1) through (4) shall be the date on which the
individual completes the training required for the degree for which the
individual receives the scholarship, except that--
``(i) for an individual receiving such a degree after
September 30, 2000, from a school of medicine or osteopathic
medicine, such date shall be the date the individual completes
a residency in a specialty that the Secretary determines is
consistent with the needs of the Corps; and
``(ii) at the request of an individual, the Secretary may,
consistent with the needs of the Corps, defer such date until
the end of a period of time required for the individual to
complete advanced training (including an internship or
residency).'';
(ii) by striking subparagraph (D);
(iii) by redesignating subparagraphs (C)
and (E) as subparagraphs (B) and (C),
respectively; and
(iv) in clause (i) of subparagraph (C) (as
redesignated by clause (iii)) by striking
``subparagraph (A), (B), or (D)'' and inserting
``subparagraph (A)''; and
(2) by striking subsection (e).
SEC. 312. PRIVATE PRACTICE.
Section 338D of the Public Health Service Act (42 U.S.C. 254n) is
amended by striking subsection (b) and inserting the following:
``(b)(1) The written agreement described in subsection (a) shall--
``(A) provide that, during the period of private practice
by an individual pursuant to the agreement, the individual
shall comply with the requirements of section 334 that apply to
entities; and
``(B) contain such additional provisions as the Secretary
may require to carry out the objectives of this section.
``(2) The Secretary shall take such action as may be appropriate to
ensure that the conditions of the written agreement prescribed by this
subsection are adhered to.''.
SEC. 313. BREACH OF SCHOLARSHIP CONTRACT OR LOAN REPAYMENT CONTRACT.
(a) In General.--Section 338E of the Public Health Service Act (42
U.S.C. 254o) is amended--
(1) in subsection (a)(1)--
(A) in subparagraph (A), by striking the comma and
inserting a semicolon;
(B) in subparagraph (B), by striking the comma and
inserting ``; or'';
(C) in subparagraph (C), by striking ``or'' at the
end; and
(D) by striking subparagraph (D);
(2) in subsection (b)--
(A) in paragraph (1)(A)--
(i) by striking ``338F(d)'' and inserting
``338G(d)'';
(ii) by striking ``either'';
(iii) by striking ``338D or'' and inserting
``338D,''; and
(iv) by inserting ``or to complete a
required residency as specified in section
338A(f)(1)(B)(iv),'' before ``the United
States''; and
(B) by adding at the end the following new
paragraph:
``(3) The Secretary may terminate a contract with an individual
under section 338A if, not later than 30 days before the end of the
school year to which the contract pertains, the individual--
``(A) submits a written request for such termination; and
``(B) repays all amounts paid to, or on behalf of, the
individual under section 338A(g).'';
(3) in subsection (c)--
(A) in paragraph (1)--
(i) in the matter preceding subparagraph
(A), by striking ``338F(d)'' and inserting
``338G(d)''; and
(ii) by striking subparagraphs (A) through
(C) and inserting the following:
``(A) the total of the amounts paid by the United States
under section 338B(g) on behalf of the individual for any
period of obligated service not served;
``(B) an amount equal to the product of the number of
months of obligated service that were not completed by the
individual, multiplied by $7,500; and
``(C) the interest on the amounts described in
subparagraphs (A) and (B), at the maximum legal prevailing
rate, as determined by the Treasurer of the United States, from the
date of the breach;
except that the amount the United States is entitled to recover under
this paragraph shall not be less than $31,000.'';
(B) by striking paragraphs (2) and (3) and
inserting the following:
``(2) The Secretary may terminate a contract with an individual
under section 338B if, not later than 45 days before the end of the
fiscal year in which the contract was entered into, the individual--
``(A) submits a written request for such termination; and
``(B) repays all amounts paid on behalf of the individual
under section 338B(g).''; and
(C) by redesignating paragraph (4) as paragraph
(3);
(4) in subsection (d)(3)(A), by striking ``only if such
discharge is granted after the expiration of the five-year
period'' and inserting ``only if such discharge is granted
after the expiration of the 7-year period''; and
(5) by adding at the end the following new subsection:
``(e) Notwithstanding any other provision of Federal or State law,
there shall be no limitation on the period within which suit may be
filed, a judgment may be enforced, or an action relating to an offset
or garnishment, or other action, may be initiated or taken by the
Secretary, the Attorney General, or the head of another Federal agency,
as the case may be, for the repayment of the amount due from an
individual under this section.''.
(b) Effective Date.--The amendment made by subsection (a)(4) shall
apply to any obligation for which a discharge in bankruptcy has not
been granted before the date that is 31 days after the date of
enactment of this Act.
SEC. 314. AUTHORIZATION OF APPROPRIATIONS.
Section 338H of the Public Health Service Act (42 U.S.C. 254q) is
amended to read as follows:
``SEC. 338H. AUTHORIZATION OF APPROPRIATIONS.
``(a) Authorization of Appropriations.--For the purposes of
carrying out this subpart, there are authorized to be appropriated
$146,250,000 for fiscal year 2002, and such sums as may be necessary
for each of fiscal years 2003 through 2006.
``(b) Scholarships and Loan Repayments.--With respect to
certification as a nurse practitioner, nurse midwife, or physician
assistant, the Secretary shall, from amounts appropriated under
subsection (a) for a fiscal year, obligate not less than a total of 10
percent for contracts for both scholarships under the Scholarship
Program under section 338A and loan repayments under the Loan Repayment
Program under section 338B to individuals who are entering the first
year of a course of study or program described in section 338A(b)(1)(B)
that leads to such a certification or individuals who are eligible for
the loan repayment program as specified in section 338B(b) for a loan
related to such certification.''.
SEC. 315. GRANTS TO STATES FOR LOAN REPAYMENT PROGRAMS.
Section 338I of the Public Health Service Act (42 U.S.C. 254q-1) is
amended--
(1) in subsection (a), by striking paragraph (1) and
inserting the following:
``(1) Authority for grants.--The Secretary, acting through
the Administrator of the Health Resources and Services
Administration, may make grants to States for the purpose of
assisting the States in operating programs described in
paragraph (2) in order to provide for the increased
availability of primary health care services in health
professional shortage areas. The National Advisory Council
established under section 337 shall advise the Administrator
regarding the program under this section.'';
(2) in subsection (e), by striking paragraph (1) and
inserting the following:
``(1) to submit to the Secretary such reports regarding the
States loan repayment program, as are determined to be
appropriate by the Secretary; and''; and
(3) in subsection (i), by striking paragraph (1) and
inserting the following:
``(1) In general.--For the purpose of making grants under
subsection (a), there are authorized to be appropriated
$12,000,000 for fiscal year 2002 and such sums as may be
necessary for each of fiscal years 2003 through 2006.''.
SEC. 316. DEMONSTRATION GRANTS TO STATES FOR COMMUNITY SCHOLARSHIP
PROGRAMS.
Section 338L of the Public Health Service Act (42 U.S.C. 254t) is
repealed.
TITLE IV--ADDITIONAL PROVISIONS
SEC. 401. COMMUNITY ACCESS DEMONSTRATION PROGRAM.
Part D of title III of the Public Health Service Act (42 U.S.C.
254b et seq.) is amended by inserting after subpart IV the following
new subpart:
``Subpart V--Community Access Demonstration Program
``SEC. 340. GRANTS TO STRENGTHEN EFFECTIVENESS, EFFICIENCY, AND
COORDINATION OF SERVICES FOR THE UNINSURED AND
UNDERINSURED.
``(a) In General.--
``(1) Grants.--The Secretary may make not more than 35
grants for the purpose of carrying out demonstration projects
to improve the effectiveness, efficiency, and coordination of
services for uninsured and underinsured individuals.
``(2) Project period.--A demonstration project under this
section may not receive funding under this section for more
than three fiscal years.
``(b) Eligible Entities.--To be eligible to receive a grant under
this section, an entity must--
``(1) be an entity that is a public or private entity such
as--
``(A) a Federally qualified health center (as
defined under section 1861(aa)(4) of the Social
Security Act);
``(B) a hospital that meets the requirements of
section 340B(a)(4)(L) (or, if none are available in the
area, a hospital that is a provider of a substantial
volume of non-emergency health services to uninsured
individuals and families without regard to their
ability to pay) without regard to 340B (a)(4)(L)(iii);
or
``(C) a public health department; or
``(2) represent a consortium of providers and, as
appropriate, related agencies or entities--
``(A) whose principal purpose is to provide a broad
range of coordinated health care services in a
geographic area defined in the entity's grant
application;
``(B) that includes health care providers that
serve such geographic area and that have traditionally
provided care (beyond emergency services) to uninsured
and underinsured individuals without regard to the
individuals' ability to pay; and
``(C) that may include other health care providers
and related agencies and organizations;
except that preference may be given to applicants that are health care
providers identified in paragraph (1).
``(c) Applications.--To be eligible to receive a grant under this
section, an eligible entity shall submit to the Secretary an
application, in such form and manner as the Secretary shall prescribe,
that shall--
``(1) define a geographic area of uninsured and
underinsured individuals;
``(2) identify the providers who will participate in the
consortium's program under the grant, and specify each one's
contribution to the care of uninsured and underinsured
individuals in such geographic area, including the volume of
care it provides to medicare and medicaid beneficiaries, to
individuals served by the program under title XXI of the Social
Security Act (relating to SCHIP), and to privately paid
patients;
``(3) describe the activities that the applicant and the
consortium propose to perform under the grant to further the
purposes of this section;
``(4) demonstrate the consortium's ability to build on the
current system for serving uninsured and underinsured
individuals by involving providers who have traditionally
provided a significant volume of care for that community;
``(5) demonstrate the consortium's ability to develop
coordinated systems of care that either directly provide or
ensure the prompt provision of a broad range of high-quality,
accessible services, including, as appropriate, primary,
secondary, and tertiary services, as well as substance abuse
treatment and mental health services in a manner which assures
continuity of care in the community;
``(6) provide evidence of community involvement in the
development, implementation, and direction of the program that
it proposes to operate;
``(7) demonstrate the consortium's ability to ensure that
individuals participating in the program are enrolled in public
insurance programs for which they are eligible (or know of
private insurance options available to them, if any);
``(8) present a plan for leveraging other sources of
revenue, which may include State and local sources and private
grant funds, and integrating current and proposed new funding
sources in a way to assure long-term sustainability;
``(9) describe a plan for evaluation of the activities
carried out under the grant, including measurement of progress
toward the goals and objectives of the program;
``(10) demonstrate fiscal responsibility through the use of
appropriate accounting procedures and appropriate management
systems;
``(11) include such other information as the Secretary may
prescribe; and
``(12) demonstrate the commitment to serve individuals in
the geographic area without regard to the ability of the
individual or family to pay by arranging for or providing free
or reduced charge care for the poor.
``(d) Priorities.--In awarding grants under this section, the
Secretary may accord priority to applicants--
``(1) whose consortium includes public hospitals, Federally
qualified health centers (as defined in section 1905(l)(2)(B)
of the Social Security Act), and other providers that are
covered entities as defined by section 340B(a)(4) of this Act
(or that would be covered entities as so defined but for
subparagraph (L)(iii) of such section);
``(2) that identify a geographic area has a high or
increasing percentage of individuals who are uninsured;
``(3) whose consortium includes other health care providers
that have a tradition of serving uninsured individuals and
underinsured individuals in the community;
``(4) who show evidence that the program would expand
utilization of preventive and primary care services for
uninsured and underinsured individuals and families in the
community, including mental health services or substance abuse
services;
``(5) whose proposed program would improve coordination
between health care providers and appropriate social service
providers, including local and regional human services
agencies, school systems, and agencies on aging;
``(6) that demonstrate collaboration with State and local
governments;
``(7) that make use of non-Federal contributions to the
greatest extent possible; or
``(8) that demonstrate a significant likelihood that the
proposed program will continue after support under this section
ceases.
``(e) Use of Funds.--
``(1) Use by grantees.--
``(A) In general.--Except as provided in paragraphs
(2) and (3), a grantee may use amounts provided under
this section only for--
``(i) direct expenses associated with
operating the greater integration of a health
care delivery system so that it either directly
provides or ensures the provision of a broad
range of services, as appropriate, including
primary, secondary, and tertiary services, as
well as substance abuse treatment and mental
health services; and
``(ii) direct patient care and service
expansions to fill identified or documented
gaps within an integrated delivery system.
``(B) Specific uses.--The following are examples of
purposes for which a grantee may use grant funds, when
such use meets the conditions stated in subparagraph
(A):
``(i) Increase in outreach activities.
``(ii) Improvements to case management.
``(iii) Development of provider networks.
``(iv) Recruitment, training, and
compensation of necessary personnel.
``(v) Acquisition of technology for the
purpose of coordinating health care.
``(vi) Identifying and closing gaps in
health care services being provided.
``(vii) Improvements to provider
communication, including implementation of
shared information systems or shared clinical
systems.
``(viii) Other activities that may be
appropriate to a community that would increase
access to the uninsured.
``(2) Reservation of funds for national program purposes.--
The Secretary may use not more than 3 percent of funds
appropriated to carry out this section for technical assistance
to grantees, obtaining assistance of experts and consultants,
meetings, dissemination of information, evaluation, and
activities that will extend the benefits of funded programs to
communities other than the one funded.
``(f) Maintenance of Effort.--With respect to activities for which
a grant under this section is authorized, the Secretary may award such
a grant only if the recipient of the grant and each of the
participating providers agree that each one will maintain its
expenditures of non-Federal funds for such activities at a level that
is not less than the level of such expenditures during the year
immediately preceding the fiscal year for which the applicant is
applying to receive such grant.
``(g) Reports to the Secretary.--The recipient of a grant under
this section shall report to the Secretary annually regarding--
``(1) progress in meeting the goals stated in its grant
application; and
``(2) such additional information as the Secretary may
require.
The Secretary may not renew an annual grant under this section unless
the Secretary is satisfied that the consortium has made reasonable and
demonstrable progress in meeting the goals set forth in its grant
application for the preceding year.
``(h) Audits.--Each entity which receives a grant under this
section shall provide for an independent annual financial audit of all
records that relate to the disposition of funds received through this
grant.
``(i) Technical Assistance.--The Secretary may, either directly or
by grant or contract, provide any funded entity with technical and
other non-financial assistance necessary to meet the requirements of
this section.
``(j) Report.--Not later than September 30, 2005, the Secretary
shall submit to the Congress a report describing the extent to which
demonstration projects under this section have been successful in
improving the effectiveness, efficiency, and coordination of services
for uninsured and underinsured individuals in the geographic areas
served by such projects, including providing better quality health care
for such individuals, and at lower costs, than would have been the case
in the absence of such projects.
``(k) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated $40,000,000
for fiscal year 2002, and such sums as may be necessary for each of
fiscal years 2003 through 2006.''.
SEC. 402. EXPANDING AVAILABILITY OF DENTAL SERVICES.
Part D of title III of the Public Health Service Act (42 U.S.C.
254b et seq.) is amended by adding at the end the following:
``Subpart X--Primary Dental Programs
``SEC. 340F. DESIGNATED DENTAL HEALTH PROFESSIONAL SHORTAGE AREA.
``In this subpart, the term `designated dental health professional
shortage area' means an area, population group, or facility that is
designated by the Secretary as a dental health professional shortage
area under section 332 or designated by the applicable State as having
a dental health professional shortage.
``SEC. 340G. GRANTS FOR INNOVATIVE PROGRAMS.
``(a) Grant Program Authorized.--The Secretary, acting through the
Administrator of the Health Resources and Services Administration, is
authorized to award grants to States for the purpose of helping States
develop and implement innovative programs to address the dental
workforce needs of designated dental health professional shortage areas
in a manner that is appropriate to the States' individual needs.
``(b) State Activities.--A State receiving a grant under subsection
(a) may use funds received under the grant for--
``(1) loan forgiveness and repayment programs for dentists
who--
``(A) agree to practice in designated dental health
professional shortage areas;
``(B) are dental school graduates who agree to
serve as public health dentists for the Federal, State,
or local government; and
``(C) agree to--
``(i) provide services to patients
regardless of such patients' ability to pay;
and
``(ii) use a sliding payment scale for
patients who are unable to pay the total cost
of services;
``(2) dental recruitment and retention efforts;
``(3) grants and low-interest or no-interest loans to help
dentists who participate in the medicaid program under title
XIX of the Social Security Act (42 U.S.C. 1396 et seq.) to
establish or expand practices in designated dental health
professional shortage areas by equipping dental offices or
sharing in the overhead costs of such practices;
``(4) the establishment or expansion of dental residency
programs in coordination with accredited dental training
institutions in States without dental schools;
``(5) programs developed in consultation with State and
local dental societies to expand or establish oral health
services and facilities in designated dental health
professional shortage areas, including services and facilities
for children with special needs, such as--
``(A) the expansion or establishment of a
community-based dental facility, free-standing dental
clinic, consolidated health center dental facility,
school-linked dental facility, or United States dental
school-based facility;
``(B) the establishment of a mobile or portable
dental clinic; and
``(C) the establishment or expansion of private
dental services to enhance capacity through additional
equipment or additional hours of operation;
``(6) placement and support of dental students, dental
residents, and advanced dentistry trainees;
``(7) continuing dental education, including distance-based
education;
``(8) practice support through teledentistry conducted in
accordance with State laws;
``(9) community-based prevention services such as water
fluoridation and dental sealant programs;
``(10) coordination with local educational agencies within
the State to foster programs that promote children going into
oral health or science professions;
``(11) the establishment of faculty recruitment programs at
accredited dental training institutions whose mission includes
community outreach and service and that have a demonstrated
record of serving underserved States;
``(12) the development of a State dental officer position
or the augmentation of a State dental office to coordinate oral
health and access issues in the State; and
``(13) any other activities determined to be appropriate by
the Secretary.
``(c) Application.--
``(1) In general.--Each State desiring a grant under this
section shall submit an application to the Secretary at such
time, in such manner, and containing such information as the
Secretary may reasonably require.
``(2) Assurances.--The application shall include assurances
that the State will meet the requirements of subsection (d) and
that the State possesses sufficient infrastructure to manage
the activities to be funded through the grant and to evaluate
and report on the outcomes resulting from such activities.
``(d) Matching Requirement.--The Secretary may not make a grant to
a State under this section unless that State agrees that, with respect
to the costs to be incurred by the State in carrying out the activities
for which the grant was awarded, the State will provide non-Federal
contributions in an amount equal to not less than 40 percent of Federal
funds provided under the grant. The State may provide the contributions
in cash or in kind, fairly evaluated, including plant, equipment, and
services and may provide the contributions from State, local, or
private sources.
``(e) Report.--Not later than 5 years after the date of enactment
of the Health Care Safety Net Improvement Act, the Secretary shall
prepare and submit to the appropriate committees of Congress a report
containing data relating to whether grants provided under this section
have increased access to dental services in designated dental health
professional shortage areas.
``(f) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, $50,000,000 for the 5-fiscal
year period beginning with fiscal year 2002.''.
SEC. 403. STUDY REGARDING BARRIERS TO PARTICIPATION OF FARMWORKERS IN
HEALTH PROGRAMS.
(a) In General.--The Secretary shall conduct a study of the
problems experienced by farmworkers (including their families) under
Medicaid and SCHIP. Specifically, the Secretary shall examine the
following:
(1) Barriers to enrollment.--Barriers to their enrollment,
including a lack of outreach and outstationed eligibility
workers, complicated applications and eligibility determination
procedures, and linguistic and cultural barriers.
(2) Lack of portability.--The lack of portability of
Medicaid and SCHIP coverage for farmworkers who are determined
eligible in one State but who move to other States on a
seasonal or other periodic basis.
(3) Possible solutions.--The development of possible
solutions to increase enrollment and access to benefits for
farmworkers, because, in part, of the problems identified in
paragraphs (1) and (2), and the associated costs of each of the
possible solution described in subsection (b).
(b) Possible Solutions.--Possible solutions to be examined shall
include each of the following:
(1) Interstate compacts.--The use of interstate compacts
among States that establish portability and reciprocity for
eligibility for farmworkers under the Medicaid and SCHIP and
potential financial incentives for States to enter into such
compacts.
(2) Demonstration projects.--The use of multi-state
demonstration waiver projects under section 1115 of the Social
Security Act (42 U.S.C. 1315) to develop comprehensive migrant
coverage demonstration projects.
(3) Use of current law flexibility.--Use of current law
Medicaid and SCHIP State plan provisions relating to coverage
of residents and out-of-State coverage.
(4) National migrant family coverage.--The development of
programs of national migrant family coverage in which States
could participate.
(5) Public-private partnerships.--The provision of
incentives for development of public-private partnerships to
develop private coverage alternatives for farmworkers.
(6) Other possible solutions.--Such other solutions as the
Secretary deems appropriate.
(c) Consultations.--In conducting the study, the Secretary shall
consult with the following:
(1) Farmworkers affected by the lack of portability of
coverage under the Medicaid program or the State children's
health insurance program (under titles XIX and XXI of the
Social Security Act).
(2) Individuals with expertise in providing health care to
farmworkers, including designees of national and local
organizations representing migrant health centers and other
providers.
(3) Resources with expertise in health care financing.
(4) Representatives of foundations and other nonprofit
entities that have conducted or supported research on
farmworker health care financial issues.
(5) Representatives of Federal agencies which are involved
in the provision or financing of health care to farmworkers,
including the Health Care Financing Administration and the
Health Research and Services Administration.
(6) Representatives of State governments.
(7) Representatives from the farm and agricultural
industries.
(8) Designees of labor organizations representing
farmworkers.
(d) Definitions.--For purposes of this section:
(1) Farmworker.--The term ``farmworker'' means a migratory
agricultural worker or seasonal agricultural worker, as such
terms are defined in section 330(g)(3) of the Public Health
Service Act (42 U.S.C. 254c(g)(3)), and includes a family
member of such a worker.
(2) Medicaid.--The term ``Medicaid'' means the program
under title XIX of the Social Security Act.
(3) SCHIP.--The term ``SCHIP'' means the State children's
health insurance program under title XXI of the Social Security
Act.
(e) Report.--Not later than one year after the date of the
enactment of this Act, the Secretary shall transmit a report to the
President and the Congress on the study conducted under this section.
The report shall contain a detailed statement of findings and
conclusions of the study, together with its recommendations for such
legislation and administrative actions as the Secretary considers
appropriate.
SEC. 404. ELIGIBILITY OF CERTAIN ENTITIES FOR GRANTS.
If under a program established in this Act (other than section
401), or if pursuant to an amendment made by this Act, a private entity
that is not a nonprofit entity is eligible for an award of a grant,
contract, or cooperative agreement, such an award may not be made to
such private entity unless the entity is the only available provider of
quality health services in the geographic area involved.
SEC. 405. CONFORMING AMENDMENTS.
(a) Homeless Programs.--Subsections (g)(1)(G)(ii), (k)(2), and
(n)(1)(C) of section 224, and sections 317A(a)(2), 317E(c), 318A(e),
332(a)(2)(C), 340D(c)(5), 799B(6)(B), 1313, and 2652(2) of the Public
Health Service Act (42 U.S.C. 233, 247b-1(a)(2), 247b-6(c), 247c-1(e),
254e(a)(2)(C), 256d(c)(5), 295p(6)(B), 300e-12, and 300ff-52(2)) are
amended by striking ``340'' and inserting ``330(h)''.
(b) Homeless Individual.--Section 534(2) of the Public Health
Service Act (42 U.S.C. 290cc-34(2)) is amended by striking ``340(r)''
and inserting ``330(h)(5)''.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
Referred to the Subcommittee on Health.
Mr. Bilirakis moved to suspend the rules and pass the bill.
Considered under suspension of the rules. (consideration: CR H6793-6808)
DEBATE - The House proceeded with forty minutes of debate on H.R. 3450.
Passed/agreed to in House: On motion to suspend the rules and pass the bill Agreed to by voice vote.(text: CR H6793-6804)
On motion to suspend the rules and pass the bill Agreed to by voice vote. (text: CR H6793-6804)
Motion to reconsider laid on the table Agreed to without objection.
Received in the Senate. Read twice. Placed on Senate Legislative Calendar under General Orders. Calendar No. 629.
Llama 3.2 · runs locally in your browser
Ask anything about this bill. The AI reads the full text to answer.
Enter to send · Shift+Enter for new line