[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2175 Introduced in House (IH)]







104th CONGRESS
  1st Session
                                H. R. 2175

 To amend the Public Health Service Act and the Social Security Act to 
    improve the access of rural residents to quality health care by 
  consolidating various categorical programs into a single program of 
             grants to the States, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             August 2, 1995

 Mr. Williams introduced the following bill; which was referred to the 
  Committee on Commerce, and in addition to the Committee on Ways and 
 Means, for a period to be subsequently determined by the Speaker, in 
   each case for consideration of such provisions as fall within the 
                jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
 To amend the Public Health Service Act and the Social Security Act to 
    improve the access of rural residents to quality health care by 
  consolidating various categorical programs into a single program of 
             grants to the States, 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.

    This Act may be cited as the ``Rural Health Consolidated Grant 
Act''.

     TITLE I--CONSOLIDATION OF PROGRAMS REGARDING HEALTH OF RURAL 
                              POPULATIONS

      Subtitle A--Provisions Relating to Public Health Service Act

SEC. 101. PROVISIONS RELATING TO PUBLIC HEALTH SERVICE ACT.

    The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by 
adding at the end the following title:

               ``TITLE XXVII--HEALTH OF RURAL POPULATIONS

``Subtitle A--Consolidated Grants Regarding Health of Rural Populations

``SEC. 2701. FORMULA GRANTS TO STATES.

    ``(a) In General.--In the case of each State that in accordance 
with section 2707 submits to the Secretary an application for fiscal 
year 1996 or any subsequent fiscal year, the Secretary shall make a 
grant for the year to the State for the purposes specified in section 
2703(1). The grant shall consist of the allotment determined for the 
State under section 2708.
    ``(b) Administrator of Federal Program.--The Secretary shall carry 
out this subtitle acting through the Director of the Office of Rural 
Health Policy.
    ``(c) Administrator of State Programs.--A funding agreement under 
subsection (a) for a State for a fiscal year is that the expenditure of 
the grant to the State under such subsection will be administered 
through--
            ``(1) the State office of rural health (operated pursuant 
        to section 338J, as such section was in effect for fiscal years 
        1991 through 1995); or
            ``(2) a public or nonprofit private entity designated by 
        the State and approved by the Director of the Office of Rural 
        Health Policy.

``SEC. 2702. STATE DISCRETION.

    ``With respect to the expenditure by a State of a grant under 
section 2701 for a fiscal year, the State has discretion to select, 
from among the purposes described in section 2703(1), the purposes for 
which the grant is expended.

``SEC. 2703. EXPENDITURE OF GRANT; EXPANDED SCOPE REGARDING RELEVANT 
              PROGRAMS AND FUNDS.

    ``Funding agreements under section 2701 for a State for a fiscal 
year are as follows:
            ``(1) The grant under such section will be expended 
        exclusively for the following purposes (regarding the health of 
        rural populations in the State):
                    ``(A) To develop integrated health networks.
                    ``(B) To develop systems for providing emergency 
                medical services.
                    ``(C) To develop telemedicine systems (as defined 
                in section 2741).
                    ``(D) To recruit and retain health care providers.
                    ``(E) To carry out any activity that was authorized 
                to be carried out with amounts provided to the States 
                under any of the programs that were repealed (or 
                otherwise terminated) by title II of the Rural Health 
                Consolidated Grant Act.
                    ``(F) To carry out activities that are authorized 
                by the State in collaboration with the Director of the 
                Office.
            ``(2) In the case of the purposes selected under paragraph 
        (1) by the State, the State will give special consideration to 
        the following in expending the grant:
                    ``(A) To carrying out the purposes through one or 
                more consortia, each of which consists of three or more 
                community organizations. Such consortia may include 
                for-profit entities, subject to section 2706(a)(5).
                    ``(B) To utilizing entities that have 
                administrative offices within the rural areas to be 
                served by the entity.
                    ``(C) To expending a substantial majority of the 
                grant within the rural areas that are to be served or 
                at the direction of one or more entities located within 
                those same areas.
                    ``(D) To utilizing entities and facilities that 
                were serving rural areas of the State as of the date of 
                submission of an application for a grant by the State.
                    ``(E) To utilizing entities that will have the 
                financial capacity to continue serving rural areas 
                after assistance under the grant for the entities is 
                terminated.
            ``(3) The State will in expending the grant give special 
        consideration to developing integrated health networks for the 
        provision of primary health care, including preventive health 
        services.

``SEC. 2704. TECHNICAL ASSISTANCE; MATCHING FUNDS.

    ``(a) Requirement of Technical Assistance for Rural Areas.--A 
funding agreement under section 2701 for a State for a fiscal year is 
that, in the case of the entities to which the State provides amounts 
from the grant to carry out activities for rural areas, the State will 
make available to the entities technical assistance in carrying out the 
activities.
    ``(b) Matching Funds.--With respect to the costs of the programs to 
be carried out by a State with a grant under section 2701, a funding 
agreement under such section for the State for a fiscal year is that 
the State will make available (directly or through donations from 
public or private entities) non-Federal contributions toward such costs 
in an amount that is not less than $1 for each $4 of Federal funds 
provided in the grant.

``SEC. 2705. EXERCISE OF STATE DISCRETION; GOALS AND OBJECTIVES; ANNUAL 
              REPORT.

    ``(a) Exercise of State Discretion; Participation of State 
Residents.--With respect to the purposes that a State has selected 
pursuant to section 2703 regarding the expenditure of a grant under 
section 2701 for a fiscal year, conditions for the receipt of the grant 
are as follows:
            ``(1) The application submitted under section 2707 
        specifies the purposes the State has selected.
            ``(2) The application demonstrates that, in preparing the 
        application (including provisions included pursuant to 
        subsection (b)), the State consulted with members of the public 
        throughout rural areas in the State, with a reasonable number 
        and variety of health care providers who provide services in 
        such areas, and with local governments in such areas.
    ``(b) Goals and Objectives Regarding Health of Rural Populations.--
Conditions for the receipt of a grant under section 2701 for a fiscal 
year are that the application submitted by the State under section 2707 
demonstrates that the State has complied with the following:
            ``(1) The State has identified the needs of rural 
        populations in the State regarding the purposes described in 
        section 2703(1), including an identification of any 
        deficiencies in the health status of such populations.
            ``(2) The State has determined goals and objectives 
        regarding such purposes; the means to be utilized to meet such 
        goals and objectives; and the dates by which the State expects 
        to meet the various goals and objectives.
            ``(3) The State has determined a methodology for measuring 
        the progress of the State toward meeting the goals and 
        objectives, and to the extent practicable, the methodology 
        conforms to any applicable guidelines that the Director of the 
        Office has established for uniformity in the collection and 
        reporting of data in order to provide for the comparability of 
        the data.
    ``(c) Implementation of Decisions by State.--Funding agreements 
under section 2701 for a State for a fiscal year are as follows:
            ``(1) The grant under such section will be expended in 
        accordance with the purposes that, pursuant to subsection (a), 
        are specified in the application submitted under section 2707.
            ``(2) If during the fiscal year the State elects to make 
        modifications in the application regarding such purposes, the 
        State will make the modifications in accordance with subsection 
        (a)(2) and will submit to the Director of the Office a 
        description of the modifications (including a description of 
        the effect of the modifications on the provisions included in 
        the application pursuant to subsection (b)).
    ``(d) Annual Report.--A funding agreement under section 2701 for a 
State for a fiscal year is that, after the end of the fiscal year, the 
State will submit to the Director of the Office (not later than the 
date specified by the Director) a report describing, in terms of the 
matters specified in subsection (b), the activities carried out under 
the grant.

``SEC. 2706. LIMITATIONS ON EXPENDITURES OF GRANT.

    ``(a) Limitations.--A funding agreement under section 2701 for a 
State for a fiscal year is that the grant under such section will not 
be expended--
            ``(1) to provide inpatient health services;
            ``(2) to conduct research projects;
            ``(3) to purchase or improve land, or to purchase, 
        construct, or permanently improve (other than minor remodeling) 
        any building or other facility;
            ``(4) to satisfy any requirement under other Federal 
        programs that non-Federal funds be provided as a condition of 
        the receipt of Federal funds; or
            ``(5) to provide financial assistance to any entity other 
        than a public or nonprofit private entity.
    ``(b) Administrative Expenses.--A funding agreement under section 
2701 for a State for a fiscal year is that not more than $75,000 of the 
grant under such section will be expended for administrative expenses 
regarding the grant.
``SEC. 2707. APPLICATION FOR GRANT.

    ``The Director of the Office may make a grant under section 2701 
only if an application for the grant is submitted to the Director by 
the date specified by the Director; the application meets the 
requirements established in this subtitle for the application; and the 
application is in such form, is made in such manner, and contains such 
agreements, assurances, and information as may be necessary for the 
Director to carry out this title.

``SEC. 2708. AMOUNT OF ALLOTMENT.

    ``(a) In General.--For purposes of section 2701(a), the allotment 
determined under this section for a State for a fiscal year is an 
amount determined by the Director of the Office through a formula 
established by the Director on the basis of the following four factors:
            ``(1) The number of individuals living in rural areas in 
        the State.
            ``(2) The extent of poverty in rural areas in the State.
            ``(3) The extent to which primary health care is available 
        in rural areas in the State.
            ``(4) The extent to which individuals living in rural areas 
        in the State are a significant distance from sites at which 
        health services are available.
    ``(b) Submission to Congress of Formula.--In establishing a formula 
under subsection (a), the Director of the Office shall submit to the 
Congress a report that specifies the formula the Director intends to 
apply under such subsection and that provides a description of the 
effect of the formula on the States. The formula may not take effect 
any earlier than 60 days after the date on which the report is 
submitted to the Congress.
    ``(c) Disposition of Certain Funds.--
            ``(1) In general.--Of the amounts available for a fiscal 
        year for grants under section 2701, amounts described in 
        paragraph (2), if any, shall be allotted by the Director of the 
        Office as grants to States that submit applications in 
        accordance with section 2707 for the fiscal year. The amount of 
        such a grant for a State shall be determined in a manner 
        equivalent to the manner in which the amount of a grant was 
        otherwise determined under this section for the State for the 
        fiscal year, and the grant shall be subject to the same 
        conditions as grants under section 2701.
            ``(2) Specification of amounts.--The amounts referred to in 
        paragraph (1) for a fiscal year are any amounts that are not 
        paid under section 2701 to the States for the fiscal year as a 
        result of--
                    ``(A) the failure of one or more States to submit 
                an application in accordance with section 2707 for the 
                fiscal year; or
                    ``(B) one or more States informing the Director of 
                the Office that the State does not intend to expend the 
                full amount of the grant made to the State under 
                section 2701 for the fiscal year.

          ``Subtitle B--Administrator of Program; Other Duties

``SEC. 2731. ADMINISTRATOR.

    ``(a) In General.--There is established within the Office of the 
Secretary an office to be known as the Office of Rural Health Policy, 
which shall be headed by a Director. The provisions of this section are 
subject to subsection (c).
    ``(b) Duties.--With respect to the health of rural populations, the 
Director of the Office shall provide advice to the Secretary regarding 
the effects of Federal policies; coordinate activities within the 
Department of Health and Human Services; provide information to the 
Secretary on the activities of other Federal agencies; provide for the 
collection and dissemination of information; provide for research 
centers; provide for activities regarding the recruitment and retention 
of health care providers; and provide technical assistance. An advisory 
committee may be established in order to advise the Secretary and the 
Director of the Office regarding the health of residents of rural areas 
and the provision and financing of health care services in those same 
areas. The Director of the Office may periodically submit to the 
Congress reports regarding the health of such residents.
    ``(c) Relationship to Medicare and Medicaid Programs.--The duties 
established in this section for the Director of the Office do not apply 
with respect to the programs established in titles XVIII and XIX of the 
Social Security Act.

                    ``Subtitle C--General Provisions

``SEC. 2741. DEFINITIONS.

    ``For purposes of this title:
            ``(1) The term `funding agreement', with respect to a grant 
        under section 2701 to a State, means an agreement that is 
        required as a condition of receiving the grant. The Director of 
        the Office may make such a grant only if the State involved 
        makes each funding agreement described in subtitle A.
            ``(2) The term `Office' means the Office of Rural Health 
        Policy, unless the context of usage indicates otherwise.
            ``(3) The term `rural area' means areas that are outside 
        any standard metropolitan statistical area.
            ``(4) The term `telemedicine system' means a system that 
        uses telecommunications to transmit images for medical 
        diagnosis and patient care between two sites that are distant 
        from each other. Such systems include patient counseling and 
        clinical training of residents and health professions students 
        when such training enables the provision of health care.

``SEC. 2742. FUNDING.

    ``(a) Authorization of Appropriations.--For the purpose of carrying 
out this title, there are authorized to be appropriated $85,000,000 for 
fiscal year 1996, and such sums as may be necessary for each of the 
fiscal years 1997 through 2000.
    ``(b) Limitation Regarding Office of Rural Health Policy.--Of the 
amounts appropriated under subsection (a) for a fiscal year, the 
Director of the Office may reserve not more than $10,000,000 for 
carrying out section 2731.''.

         Subtitle B--Provisions Relating to Social Security Act

SEC. 111. CONFORMING AMENDMENT REGARDING RELATIONSHIP TO MEDICARE AND 
              MEDICAID PROGRAMS.

    Section 711 of the Social Security Act (42 U.S.C. 912) is amended 
to read as follows:

                         ``rural health policy

    ``Sec. 711. (a) With respect to the programs established under 
titles XVIII and XIX, the Director of the Office of Rural Health Policy 
(in this section referred to as the `Office') shall provide advice to 
the Secretary regarding the effects that such programs have on the 
health of rural populations. Such advice shall include advice on the 
effects of current policies and proposed statutory, regulatory, 
administrative, and budgetary changes in such programs on the financial 
viability of small rural hospitals, the ability of rural areas (and 
rural hospitals in particular) to attract and retain physicians and 
other health professionals, and access to (and the quality of) health 
care in rural areas.
    ``(b) The Director of the Office shall oversee compliance with the 
requirements of section 1102(b) of this Act and section 4403 of the 
Omnibus Budget Reconciliation Act of 1987 (as such section pertains to 
rural health issues).
    ``(c) With respect to the effects that the programs established 
under titles XVIII and XIX have on the health of rural populations, the 
Director of the Office shall--
            ``(1) provide for the collection and dissemination of 
        information;
            ``(2) coordinate activities within the Department of Health 
        and Human Services; and
            ``(3) provide information to the Secretary and others in 
        such Department with respect to the activities of other Federal 
        departments and agencies.
    ``(d) For the purpose of carrying out this section, there are 
authorized to be appropriated such sums as may be necessary for each of 
the fiscal years 1996 through 2000.''.

  TITLE II--REPEAL OF CATEGORICAL PROGRAMS REGARDING HEALTH OF RURAL 
                              POPULATIONS

       Subtitle A--Programs Relating to Public Health Service Act

SEC. 201. PUBLIC HEALTH SERVICE ACT; REPEAL OF CATEGORICAL PROGRAMS.

    (a) Statutory Provisions.--
            (1) Demonstrations regarding delivery systems.--With 
        respect to activities under section 902(b)(1) of the Public 
        Health Service Act, the Administrator for Health Care Policy 
        and Research shall, effective October 1, 1995, terminate all 
        demonstration projects that were in operation as of the day 
        before such date. On or after January 1, 1996, such 
        Administrator may establish additional demonstration projects 
        under such section, subject to the extent of amounts made 
        available in appropriations Acts.
            (2) Trauma care.--Effective October 1, 1995, title XII of 
        the Public Health Service Act (42 U.S.C. 300d et seq.) is 
        amended by striking parts A through C.
            (3) Special projects regarding health professions 
        training.--Effective October 1, 1995, section 778 of the Public 
        Health Service Act (42 U.S.C. 294p) is repealed.
            (4) State offices of rural health.--Effective October 1, 
        1995, section 338J of the Public Health Service Act (42 U.S.C. 
        254r) is repealed.
    (b) Administrative Initiatives.--
            (1) Outreach grants.--
                    (A) Effective October 1, 1995, the program 
                specified in subparagraph (B) is terminated.
                    (B) The program referred to in subparagraph (A)--
                            (i) is referred to as the program for rural 
                        outreach grants;
                            (ii) is carried out by the Administrator of 
                        the Health Resources and Services 
                        Administration; and
                            (iii) is carried out for fiscal year 1995 
                        with amounts that, under Public Law 103-333, 
                        are made available for rural outreach grants.
            (2) Telecommunications grants.--
                    (A) Effective October 1, 1995, the program 
                specified in subparagraph (B) is terminated.
                    (B) The program referred to in subparagraph (A)--
                            (i) is referred to as the 
                        telecommunications grant program;
                            (ii) is carried out by the Administrator of 
                        the Health Resources and Services 
                        Administration; and
                            (iii) is carried out for fiscal year 1995 
                        with amounts that, under Public Law 103-333, 
                        are made available for rural health research.

          Subtitle B--Programs Relating to Social Security Act

SEC. 211. SOCIAL SECURITY ACT AND RELATED PROVISIONS; REPEAL OF 
              CATEGORICAL PROGRAMS.

    (a) Statutory Provision; Grant Program for Rural Health Care 
Transition.--Effective October 1, 1995, section 4005 of the Omnibus 
Budget Reconciliation Act of 1987 (101 Stat. 1330-47; Public Law 100-
203) is amended by striking subsection (e) (42 U.S.C. 1395ww note).
    (b) Administrative Initiative; Rural Health System Delivery 
Models.--
            (1) In general.--Effective October 1, 1995, the program 
        specified in paragraph (2) is terminated.
            (2) Specification of program.--The program referred to in 
        paragraph (1)--
                    (A) is referred to as the program to assist States 
                in developing innovative rural health system delivery 
                models;
                    (B) is carried out by the Administrator of the 
                Health Care Financing Administration; and
                    (C) is carried out for fiscal year 1995 with 
                amounts that, under Public Law 103-333, are made 
                available for new rural health grants.
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HR 2175 IH----2