[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3450 Placed on Calendar Senate (PCS)]

                                                       Calendar No. 629
107th CONGRESS
  2d Session
                                H. R. 3450


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            October 2, 2002

            Received; read twice and placed on the calendar

_______________________________________________________________________

                                 AN ACT


 
 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)''.

            Passed the House of Representatives October 1, 2002.

            Attest:

                                                 JEFF TRANDAHL,

                                                                 Clerk.
                                                       Calendar No. 629

107th CONGRESS

  2d Session

                               H. R. 3450

_______________________________________________________________________

                                 AN ACT

 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.

_______________________________________________________________________

                            October 2, 2002

            Received; read twice and placed on the calendar