[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[S. 980 Introduced in Senate (IS)]







104th CONGRESS
  1st Session
                                 S. 980

 To amend the Public Health Service Act and the Social Security Act to 
  protect and improve the availability, quality and affordability of 
          health care in rural areas, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                June 28 (legislative day, June 19), 1995

  Mr. Harkin introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 To amend the Public Health Service Act and the Social Security Act to 
  protect and improve the availability, quality and affordability of 
          health care in rural areas, 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 Care Protection and 
Improvement Act of 1995''.

SEC. 2. IMPROVING HEALTH CARE ACCESS AND REDUCING HEALTH CARE COSTS 
              THROUGH TELEMEDICINE.

    (a) In General.--Title XVII of the Public Health Service Act (42 
U.S.C. 300u et seq.) is amended--
            (1) in the title heading by striking out ``AND HEALTH 
        PROMOTION'' and inserting ``, HEALTH PROMOTION AND TELEMEDICINE 
        DEVELOPMENT'';
            (2) by inserting after the title heading the following:

        ``Part A--Health Information and Health Promotion''; and

            (3) by adding at the end thereof the following new part:

                   ``Part B--Telemedicine Development

``SEC. 1711. GRANT PROGRAM FOR PROMOTING THE DEVELOPMENT OF RURAL 
              TELEMEDICINE NETWORKS.

    ``(a) Establishment.--The Secretary shall establish a program to 
award grants to eligible entities in accordance with this subsection to 
promote the development of rural telemedicine networks.
    ``(b) Grants for Development of Rural Telemedicine.--The Secretary 
of Health and Human Services, acting through the Office of Rural Health 
Policy, shall award grants to eligible entities that have applications 
approved under subsection (d) for the purpose of expanding access to 
health care services for individuals in rural areas through the use of 
telemedicine. Grants shall be awarded under this section to--
            ``(1) encourage the initial development of rural 
        telemedicine networks;
            ``(2) expand existing networks;
            ``(3) link existing networks together; or
            ``(4) link such networks to existing fiber optic 
        telecommunications systems.
    ``(c) Eligible Entity Defined.--For the purposes of this section 
the term `eligible entity' means hospitals and other health care 
providers operating in a health care network of community-based 
providers that includes at least three of the following--
            ``(1) community or migrant health centers;
            ``(2) local health departments;
            ``(3) community mental health centers;
            ``(4) nonprofit hospitals;
            ``(5) private practice health professionals, including 
        rural health clinics; or
            ``(6) other publicly funded health or social services 
        agencies.
    ``(d) Application.--To be eligible to receive a grant under this 
section an eligible 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 description of--
            ``(1) the need of the entity for the grant;
            ``(2) the use to which the entity would apply any amounts 
        received under such grant;
            ``(3) the source and amount of non-Federal funds that the 
        entity will pledge for the project funded under the grant; and
            ``(4) the long-term viability of the project and evidence 
        of the providers commitment to the network.
    ``(e) Preference in Awarding Grants.--In awarding grants under this 
section, the Secretary shall give preference to applicants that--
            ``(1) are health care providers operating in rural health 
        care networks or that propose to form such networks with the 
        majority of the providers in such networks being located in a 
        medically undeserved area or health professional shortage area;
            ``(2) can demonstrate broad geographic coverage in the 
        rural areas of the State, or States in which the applicant is 
        located; and
            ``(3) propose to use funds received under the grant to 
        develop plans for, or to establish, telemedicine systems that 
        will link rural hospitals and rural health care providers to 
        other hospitals and health care providers;
            ``(4) will use the amounts provided under the grant for a 
        range of health care applications and to promote greater 
        efficiency in the use of health care resources;
            ``(5) demonstrate the long-term viability of projects 
        through use of local matching funds (in cash or in-kind); and
            ``(6) demonstrate financial, institutional, and community 
        support and the long-range viability of the network.
    ``(f) Use of Amounts.--Amounts received under a grant awarded under 
this section shall be utilized for the development of telemedicine 
networks. Such amounts may be used to cover the costs associated with 
the development of telemedicine networks and the acquisition of 
telemedicine equipment and modifications or improvements of 
telecommunications facilities, including--
            ``(1) the development and acquisition through lease or 
        purchase of computer hardware and software, audio and visual 
        equipment, computer network equipment, modification or 
        improvements to telecommunications transmission facilities, 
        telecommunications terminal equipment, interactive video 
        equipment, data terminal equipment, and other facilities and 
        equipment that would further the purposes of this section;
            ``(2) the provision of technical assistance and instruction 
        for the development and use of such programming equipment or 
        facilities;
            ``(3) the development and acquisition of instructional 
        programming;
            ``(4) the development of projects for teaching or training 
        medical students, residents, and other health professions 
        students in rural training sites about the application of 
        telemedicine;
            ``(5) transmission costs, maintenance of equipment, and 
        compensation of specialists and referring practitioners;
            ``(6) the development of projects to use telemedicine to 
        facilitate collaboration between health care providers; and
            ``(7) such other uses that are consistent with achieving 
        the purposes of this section as approved by the Secretary.
    ``(g) Prohibited Use of Amounts.--Amounts received under a grant 
awarded under this section shall not be used for--
            ``(1) expenditures to purchase or lease equipment to the 
        extent the expenditures would exceed more than 60 percent of 
        the total grant funds; or
            ``(2) expenditures for indirect costs (as determined by the 
        Secretary) to the extent the expenditures would exceed more 
        than 10 percent of the total grant funds.
    ``(h) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out this section.
    ``(i) Definition.--For the purposes of this section, the term 
`rural health care network' means a group of rural hospitals or other 
rural health care providers (including clinics, physicians and non-
physicians primary care providers) that have entered into a 
relationship with each other or with nonrural hospitals and health care 
providers for the purpose of strengthening the delivery of health care 
services in rural areas or specifically to improve their patients' 
access to telemedicine services. At least 75 percent of hospitals and 
other health care providers participating in the network shall be 
located in rural areas.
    ``(j) Regulations on Reimbursement of Telemedicine.--Not later than 
July 1, 1996, the Secretary, in consultation with the Office of Rural 
Health and the Health Care Financing Administration, shall issue 
regulations regarding reimbursement for telemedicine services provided 
under title XVIII of the Social Security Act.''.

SEC. 3. ESTABLISHMENT OF RURAL HEALTH OUTREACH GRANT PROGRAM.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) 
is amended by adding at the end thereof the following new part:

                 ``Part O--Rural Health Outreach Grants

``SEC. 399O. RURAL HEALTH OUTREACH GRANT PROGRAM.

    ``(a) In General.--The Secretary may make grants to demonstrate the 
effectiveness of outreach to populations in rural areas that do not 
normally seek or do not have access to health or mental health 
services. Grants shall be awarded to enhance linkages, integration, and 
cooperation in order to provide health or mental health services, to 
enhance services, or increase access to or utilization of health or 
mental health services.
    ``(b) Mission of the Outreach Projects.--Projects funded under 
subsection (a) should be designed to facilitate the integration and 
coordination of services in or among rural communities in order to 
address the needs of populations living in rural or frontier 
communities.
    ``(c) Composition of Program.--
            ``(1) Consortium arrangement.--To be eligible to 
        participate in the grant program established under subsection 
        (a), an applicant entity shall be a consortium of three or more 
        separate and distinct entities formed to carry out an outreach 
        project under subsection (b).
            ``(2) Certain requirements.--A consortium under paragraph 
        (1) shall be composed of three or more public or private 
        nonprofit health care or social service providers. Consortium 
        members may include local health departments, community or 
        migrant health centers, community mental health centers, 
        hospitals or private practices, or other publicly funded health 
        or social service agencies.
    ``(d) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated $30,000,000 
for fiscal year 1996, and such sums as may be necessary for each of the 
fiscal years 1997 through 2000.''.

SEC. 4. EXTENSION OF CERTAIN PAYMENT PROVISIONS FOR MEDICARE DEPENDENT 
              SMALL RURAL HOSPITALS.

    (a) In General.--Section 1886(d)(5)(G)(i) of the Social Security 
Act (42 U.S.C. 1395ww(d)(5)(G)(i)) is amended by striking ``October 1, 
1994'' and inserting ``October 1, 1999''.
    (b) Payment.--Section 1886(b)(3)(D) of such Act (42 U.S.C. 
1395ww(b)(3)(D)) is amended by striking ``September 30, 1994'' and 
inserting ``September 30, 1999''.
    (C) Effective Date.--The amendments made by this section shall take 
effect as if enacted on October 1, 1994.
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