[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 1533 Engrossed in Senate (ES)]

  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
107th CONGRESS
  2d Session
                                S. 1533

_______________________________________________________________________

                                 AN ACT


 
 To amend the Public Health Service Act to reauthorize and strengthen 
 the health centers program and the National Health Service Corps, and 
 to establish the Healthy Communities Access Program, which will help 
 coordinate services for the uninsured and underinsured, 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 Amendments of 2002''.
    (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.
                         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.
            Subtitle D--School-Based Health Center Networks

Sec. 231. Networks.
            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.
Sec. 317. Demonstration project.
            TITLE IV--HEALTHY COMMUNITIES ACCESS PROGRAM ACT

Sec. 401. Purpose.
Sec. 402. Creation of Healthy Communities Access Program.
Sec. 403. Expanding availability of dental services.
                     TITLE V--RURAL HEALTH CLINICS

Sec. 501. Exemptions for rural health clinics.
                            TITLE VI--STUDY

Sec. 601. Guarantee study.
                    TITLE VII--CONFORMING AMENDMENTS

Sec. 701. Conforming amendments.

         TITLE I--CONSOLIDATED HEALTH CENTER PROGRAM AMENDMENTS

SEC. 101. HEALTH CENTERS.

    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) in subparagraph (A)--
                            (i) in clause (vi), by striking ``and'';
                            (ii) by redesignating clause (vii) as 
                        clause (x); and
                            (iii) by inserting after clause (vi) the 
                        following:
                            ``(vii) the detection and alleviation of 
                        chemical and pesticide exposures;
                            ``(viii) the promotion of indoor and 
                        outdoor air quality;
                            ``(ix) the detection and remediation of 
                        lead exposures; and'';
                    (B) by redesignating subparagraphs (A) and (B) as 
                subparagraphs (D) and (E), respectively;
                    (C) by inserting before subparagraph (D) (as 
                redesignated by subparagraph (B)) the following:
                    ``(A) behavioral and mental health and substance 
                abuse services;
                    ``(B) recuperative care services;
                    ``(C) public health services;'';
                    (D) 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
                    (E) 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.'';
            (3) 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 ``up 
                        to 90 percent of 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).'';
                            (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 an existing loan (as 
                        of the date of refinancing) to the center or 
                        centers, if the Secretary determines such 
                        refinancing will be beneficial to the health 
                        center and the Federal Government and will 
                        result in more favorable terms.''; and
                            (iii) by adding at the end the following:
                    ``(D) Loan guarantees.--Notwithstanding any other 
                provision of law, the following funds shall be made 
                available until expended for loan guarantees under this 
                subsection:
                            ``(i) Funds appropriated for fiscal year 
                        1997 under the Departments of Labor, Health and 
                        Human Services, and Education, and Related 
                        Agencies Appropriations Act, 1997, which were 
                        made available for loan guarantees for loans to 
                        health centers for the costs of developing and 
                        operating managed care networks or plans, and 
                        which have not been expended.
                            ``(ii) Funds appropriated for fiscal year 
                        1998 under the Departments of Labor, Health and 
                        Human Services, and Education, and Related 
                        Agencies Appropriations Act, 1998, which were 
                        made available for loan guarantees for loans to 
                        health centers under this subsection (as in 
                        effect on the day before the date of enactment 
                        of the Health Care Safety Net Amendments of 
                        2002), and which have not been expended.
                    ``(E) 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.
                    ``(F) Federal credit reform.--The requirements of 
                the Federal Credit Reform Act of 1990 (2 U.S.C. 661 et 
                seq.) shall apply with respect to loans refinanced 
                under subparagraph (B)(iii).''; and
                    (C)(i) by striking paragraphs (6) and (7); and
                    (ii) by redesignating paragraph (8) as paragraph 
                (6);
            (4) in subsection (e)--
                    (A) in paragraph (1)--
                            (i) in subparagraph (B), by striking 
                        ``subsection (j)(3)'' and inserting 
                        ``subsection (l)(3)''; and
                            (ii) by adding at the end the following:
                    ``(C) Operation of networks and plans.--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).'';
                    (B) in paragraph (2) by adding at the end the 
                following: ``The costs for which a grant may be made 
                under paragraph (1)(C) may include the costs of 
                providing such training.'';
                    (C) 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 or to a network or 
                plan shall be determined by the Secretary, but may not 
                exceed 2 percent of the total amount appropriated under 
                this section for such fiscal year.''; and
                    (D) by redesignating paragraphs (4) and (5) as 
                paragraphs (3) and (4), respectively;
            (5) in subsection (g)--
                    (A) in paragraph (2)--
                            (i) in subparagraph (A), by inserting ``and 
                        seasonal agricultural worker'' after 
                        ``agricultural worker''; and
                            (ii) in subparagraph (B), by striking ``and 
                        members of their families'' and inserting ``and 
                        seasonal agricultural workers, and members of 
                        their families,''; and
                    (B) in paragraph (3)(A), by striking ``on a 
                seasonal basis'';
            (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''; and
                    (C) in subparagraph (H)--
                            (i) in clause (ii), by inserting ``reviews 
                        any internal outreach plans for specific 
                        subpopulations served by the center,'' after 
                        ``such services will be provided,''; and
                            (ii) in the matter following clause (iii), 
                        by striking ``or (p)'' and inserting ``or 
                        (q)'';
            (8)(A) by redesignating subsection (l) as subsection (s) 
        and moving that subsection (s) to the end of the section;
            (B) by redesignating subsections (j), (k), and (m) through 
        (q) as subsections (l), (m), and (n) through (r), respectively; 
        and
            (C) by inserting after subsection (i) the following:
    ``(j) Environmental Concerns.--The Secretary may make grants to 
health centers for the purpose of assisting such centers in identifying 
and detecting environmental factors and conditions, and providing 
services, including environmental health services described in 
subsection (b)(2)(D), to reduce the disease burden related to 
environmental factors and exposure of populations to such factors, and 
alleviate environmental conditions that affect the health of 
individuals and communities served by health centers funded under this 
section.
    ``(k) Linguistic Access Grants.--
            ``(1) In general.--The Secretary may award grants to 
        eligible health centers with a substantial number of clients 
        with limited English speaking proficiency to provide 
        translation, interpretation, and other such services for such 
        clients with limited English speaking proficiency.
            ``(2) Eligible health center.--In this subsection, the term 
        `eligible health center' means an entity that--
                    ``(A) is a health center as defined under 
                subsection (a); and
                    ``(B) provides health care services for clients for 
                whom English is a second language.
            ``(3) Grant amount.--The amount of a grant awarded to a 
        center under this subsection shall be determined by the 
        Administrator. Such determination of such amount shall be based 
        on the number of clients for whom English is a second language 
        that is served by such center, and larger grant amounts shall 
        be awarded to centers serving larger numbers of such clients.
            ``(4) Use of funds.--An eligible health center that 
        receives a grant under this subsection may use funds received 
        through such grant to--
                    ``(A) provide translation, interpretation, and 
                other such services for clients for whom English is a 
                second language, including hiring professional 
                translation and interpretation services; and
                    ``(B) compensate bilingual or multilingual staff 
                for language assistance services provided by the staff 
                for such clients.
            ``(5) Application.--An eligible health center desiring a 
        grant under this subsection shall submit an application to the 
        Secretary at such time, in such manner, and containing such 
        information as the Secretary may reasonably require, 
        including--
                    ``(A) an estimate of the number of clients that the 
                center serves for whom English is a second language;
                    ``(B) the ratio of the number of clients for whom 
                English is a second language to the total number of 
                clients served by the center; and
                    ``(C) a description of any language assistance 
                services that the center proposes to provide to aid 
                clients for whom English is a second language.
            ``(6) Authorization of appropriations.--There are 
        authorized to be appropriated to carry out this subsection, in 
        addition to any funds authorized to be appropriated or 
        appropriated for health centers under any other subsection of 
        this section, $10,000,000 for fiscal year 2002, and such sums 
        as may be necessary for each of fiscal years 2003 through 
        2006.'';
            (9) by striking subsection (m) (as redesignated by 
        paragraph (9)(B)) and inserting the following:
    ``(m) 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 subsection (l)(3) in developing plans for, or 
operating, health centers. Services provided through the program may 
include necessary technical and nonfinancial assistance, including 
fiscal and program management assistance, training in fiscal and 
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.'';
            (10) in subsection (q) (as redesignated by paragraph 
        (9)(B)), by striking ``(j)(3)(G)'' and inserting ``(l)(3)(G)''; 
        and
            (11) in subsection (s) (as redesignated by paragraph 
        (9)(A))--
                    (A) in paragraph (1), by striking ``$802,124,000'' 
                and all that follows through the period and inserting 
                ``$1,369,000,000 for fiscal year 2002 and such sums as 
                may be necessary for each of the fiscal years 2003 
                through 2006.'';
                    (B) in paragraph (2)--
                            (i) in subparagraph (A)--
                                    (I) by striking ``(j)(3))'' and 
                                inserting ``(l)(3))''; and
                                    (II) by striking ``(j)(3)(G)(ii)'' 
                                and inserting ``(l)(3)(H)''; and
                            (ii) 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.''.

                         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 rural nonprofit 
                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;
                    ``(E) a description of how the project will be 
                evaluated; and
                    ``(F) other such information as the Secretary 
                determines to be appropriate.
    ``(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 rural nonprofit 
                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;
                    ``(F) a description of how the project will be 
                evaluated; and
                    ``(G) other such information as the Secretary 
                determines to be appropriate.
    ``(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 or another 
        appropriate State entity, such as 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;
                    ``(F) a description of how the project will be 
                evaluated; and
                    ``(G) other such information as the Secretary 
                determines to be appropriate.
            ``(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 2002''.

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' 
        shall have the meaning given the term in regulations issued 
        under subsection (r).
            ``(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;
            ``(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; and
            ``(8) other such information as the Secretary determines to 
        be appropriate.
    ``(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 Amendments of 2002).
    ``(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), except on the premises of an entity 
        participating in the telehealth network;
            ``(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 20 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) Regulations.--The Secretary shall issue regulations 
specifying, for purposes of this section, a definition of the term 
`frontier area'. The definition shall be based on factors that include 
population density, travel distance in miles to the nearest medical 
facility, travel time in minutes to the nearest medical facility, and 
such other factors as the Secretary determines to be appropriate. The 
Secretary shall develop the definition in consultation with the 
Director of the Bureau of the Census and the Administrator of the 
Economic Research Service of the Department of Agriculture.
    ``(s) 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.

``SEC. 330J. TELEHOMECARE DEMONSTRATION PROJECT.

    ``(a) Definitions.--In this section:
            ``(1) Distant site.--The term `distant site' means a site 
        at which a certified home care provider is located at the time 
        at which a health care service (including a health care item) 
        is provided through a telecommunications system.
            ``(2) Telehomecare.--The term `telehomecare' means the 
        provision of health care services through technology relating 
        to the use of electronic information, or through telemedicine 
        or telecommunication technology, to support and promote, at a 
        distant site, the monitoring and management of home health care 
        services for a resident of a rural area.
    ``(b) Establishment.--Not later than 9 months after the date of 
enactment of the Health Care Safety Net Amendments of 2002, the 
Secretary shall establish and carry out a telehomecare demonstration 
project.
    ``(c) Grants.--In carrying out the demonstration project referred 
to in subsection (b), the Secretary shall make not more than 5 grants 
to eligible certified home care providers, individually or as part of a 
network of home health agencies, for the provision of telehomecare to 
improve patient care, prevent health care complications, improve 
patient outcomes, and achieve efficiencies in the delivery of care to 
patients who reside in rural areas.
    ``(d) Periods.--The Secretary shall make the grants for periods of 
not more than 3 years.
    ``(e) Applications.--To be eligible to receive a grant under this 
section, a certified home care provider shall submit an application to 
the Secretary at such time, in such manner, and containing such 
information as the Secretary may require.
    ``(f) Use of Funds.--A provider that receives a grant under this 
section shall use the funds made available through the grant to carry 
out objectives that include--
            ``(1) improving access to care for home care patients 
        served by home health care agencies, improving the quality of 
        that care, increasing patient satisfaction with that care, and 
        reducing the cost of that care through direct 
        telecommunications links that connect the provider with 
        information networks;
            ``(2) developing effective care management practices and 
        educational curricula to train home care registered nurses and 
        increase their general level of competency through that 
        training; and
            ``(3) developing curricula to train health care 
        professionals, particularly registered nurses, serving home 
        care agencies in the use of telecommunications.
    ``(g) Coverage.--Nothing in this section shall be construed to 
supersede or modify the provisions relating to exclusion of coverage 
under section 1862(a) of the Social Security Act (42 U.S.C 1395y(a)), 
or the provisions relating to the amount payable to a home health 
agency under section 1895 of that Act (42 U.S.C. 1395fff).
    ``(h) Report.--
            ``(1) Interim report.--The Secretary shall submit to 
        Congress an interim report describing the results of the 
        demonstration project.
            ``(2) Final report.--Not later than 6 months after the end 
        of the last grant period for a grant made under this section, 
        the Secretary shall submit to Congress a final report--
                    ``(A) describing the results of the demonstration 
                project; and
                    ``(B) including an evaluation of the impact of the 
                use of telehomecare, including telemedicine and 
                telecommunications, on--
                            ``(i) access to care for home care 
                        patients; and
                            ``(ii) the quality of, patient satisfaction 
                        with, and the cost of, that care.
    ``(i) Authorization of Appropriations.--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.''.

    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. 330K. 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. 330L. 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 education professionals.--The 
        term `qualified mental health education professionals' refers 
        to teachers, community mental health professionals, nurses, and 
        other entities as determined by the Secretary who have 
        additional training in the delivery of information on mental 
        illness to children and adolescents or who have additional 
        training in the delivery of information on mental illness to 
        the elderly.
            ``(3) 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.
            ``(4) Special populations.--The term `special populations' 
        refers to the following 2 distinct groups:
                    ``(A) Children and adolescents located in public 
                elementary and public secondary schools 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.
            ``(5) 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) Amount.--Each entity that receives a grant under subsection 
(b) shall receive not less than $1,200,000 under the grant, and shall 
use not more than 40 percent of the grant funds for equipment.
    ``(d) 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)(4)(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;
                            ``(ii) to provide education regarding 
                        mental illness (including suicide and violence) 
                        in public elementary and public secondary 
                        schools as delivered remotely by qualified 
                        mental health professionals and qualified 
                        mental health education professionals using 
                        telehealth, including education regarding early 
                        recognition of the signs and symptoms of mental 
                        illness, and instruction on coping and dealing 
                        with stressful experiences of childhood and 
                        adolescence (such as violence, social 
                        isolation, and depression); and
                            ``(iii) to collaborate with local public 
                        health entities to provide the mental health 
                        services; and
                    ``(B) for the populations described in subsection 
                (a)(4)(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;
                            ``(ii) to provide education regarding 
                        mental illness to primary staff (including 
                        physicians, nurses, and nursing aides) as 
                        delivered remotely by qualified mental health 
                        professionals and qualified mental health 
                        education professionals using telehealth, 
                        including education regarding early recognition 
                        of the signs and symptoms of mental illness, 
                        and instruction on coping and dealing with 
                        stressful experiences of old age (such as loss 
                        of physical and cognitive capabilities, death 
                        of loved ones and friends, social isolation, 
                        and depression); and
                            ``(iii) 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) acquire telehealth equipment to use in public 
                elementary and public secondary schools and long-term 
                care facilities for the objectives of this section;
                    ``(B) develop curricula to support activities 
                described in subparagraphs (A)(ii) and (B)(ii) of 
                paragraph (1);
                    ``(C) pay telecommunications costs; and
                    ``(D) pay qualified mental health professionals and 
                qualified mental health education professionals on a 
                reasonable cost 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 (except 
                for minor renovations related to the installation of 
                reimbursable equipment).
    ``(e) 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.
    ``(f) 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.
    ``(g) Report.--Not later than 4 years after the date of enactment 
of the Health Care Safety Net Amendments of 2002, the Secretary shall 
prepare and submit to the appropriate committees of Congress a report 
that shall evaluate activities funded with grants under this section.
    ``(h) 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.''.

            Subtitle D--School-Based Health Center Networks

SEC. 231. NETWORKS.

    Subpart I of part D of title III of the Public Health Service Act 
(42 U.S.C. 254b et seq.), as amended in section 221, is further amended 
by adding at the end the following:

``SEC. 330M. SCHOOL-BASED HEALTH CENTER NETWORKS.

    ``(a) Eligible Entity.--In this section, the term `eligible entity' 
means a nonprofit organization, such as a State school-based health 
center association, academic institution, or primary care association, 
that has experience working with low-income communities, schools, 
families, and school-based health centers.
    ``(b) Program Authorized.--The Secretary shall award grants to 
eligible entities to establish statewide technical assistance centers 
and carry out activities described in subsection (c) through the 
centers.
    ``(c) Use of Funds.--An eligible entity that receives a grant under 
this section may use funds received through such grant to--
            ``(1) establish a statewide technical assistance center 
        that shall coordinate local, State, and Federal health care 
        services, including primary, dental, and behavioral and mental 
        health services, that contribute to the delivery of school-
        based health care for medically underserved individuals;
            ``(2) conduct operational and administrative support 
        activities for statewide school-based health center networks to 
        maximize operational effectiveness and efficiency;
            ``(3) provide technical support training, including 
        training on topics regarding--
                    ``(A) identifying parent and community interests 
                and priorities;
                    ``(B) assessing community health needs and 
                resources;
                    ``(C) implementing accountability and management 
                information systems;
                    ``(D) integrating school-based health centers with 
                care provided by any other school-linked provider, and 
                with community-based primary and specialty health care 
                systems;
                    ``(E) securing third party payments through 
                effective billing and collection systems;
                    ``(F) developing shared services and joint 
                purchasing arrangements across provider networks;
                    ``(G) linking services with health care services 
                provided by other programs, especially services 
                provided under the medicaid program under title XIX of 
                the Social Security Act (42 U.S.C. 1396 et seq.) and 
                the State Children's Health Insurance Program under 
                title XXI of the Social Security Act (42 U.S.C. 1397aa 
                et seq.);
                    ``(H) contracting with managed care organizations; 
                and
                    ``(I) assuring and improving clinical quality and 
                improvement; and
            ``(4) provide to interested communities technical 
        assistance for the planning and implementation of school-based 
        health centers.
    ``(d) Application.--An eligible entity 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, including--
            ``(1) a description of the region that will receive service 
        and the potential partners in such region;
            ``(2) a description of the policy and program environment 
        and the needs of the community that will receive service;
            ``(3) a 1- to 3-year work plan that describes the goals and 
        objectives of the entity, and any activities that the entity 
        proposes to carry out; and
            ``(4) a description of the organizational capacity of the 
        entity and its experience in serving the region's school-based 
        health center community.
    ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $5,000,000 for fiscal year 
2002, and such sums as may be necessary for subsequent fiscal years.''.

            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 `behavioral 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 behavioral 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, the individual's family, and the family's possessions 
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.
    ``(3) In evaluating a demonstration project described in paragraph 
(1), the Secretary shall examine the effect of multidisciplinary 
teams.''.

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, on the date of 
                enactment of the Health Care Safety Net Amendments of 
                2002, as having such a shortage. Not later than 5 years 
                after such date of enactment, and every 5 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 the American Dental 
Association, the American Dental Education Association, the American 
Dental Hygienists Association, the American Academy of Pediatric 
Dentistry, the Association of State and Territorial Dental Directors, 
and the National Association of Community Health Centers, 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 the Association of 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).''.

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 first sentence, by striking 
                        ``may'' and inserting ``shall'';
                            (ii) 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
                            (iii) 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.'';
                    (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 for New Participants.--Of the amounts 
appropriated under subsection (a) for a fiscal year, the Secretary 
shall obligate not less than 30 percent for the purpose of providing 
contracts for scholarships under this subpart to individuals who have 
not previously received such scholarships.
    ``(c) 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.

SEC. 317. DEMONSTRATION PROJECT.

    Subpart III of part D of title III of the Public Health Service Act 
(42 U.S.C. 254l et seq.) is amended by adding at the end the following:

``SEC. 338L. DEMONSTRATION PROJECT.

    ``(a) Program Authorized.--The Secretary shall establish a 
demonstration project to provide for the participation of individuals 
who are chiropractic doctors or pharmacists in the Loan Repayment 
Program described in section 338B.
    ``(b) Procedure.--An individual that receives assistance under this 
section with regard to the program described in section 338B shall 
comply with all rules and requirements described in such section (other 
than subparagraphs (A) and (B) of section 338B(b)(1)) in order to 
receive assistance under this section.
    ``(c) Limitations.--The demonstration project described in this 
section shall provide for the participation of individuals who shall 
provide services in rural and urban areas, and shall also provide for 
the participation of enough individuals to allow the Secretary to 
properly analyze the effectiveness of such project.
    ``(d) Designations.--The demonstration project described in this 
section, and any providers who are selected to participate in such 
project, shall not be considered by the Secretary in the designation of 
a health professional shortage area under section 332 during fiscal 
years 2002 through 2004.
    ``(e) Rule of Construction.--This section shall not be construed to 
require any State to participate in the project described in this 
section.
    ``(f) Report.--
            ``(1) In general.--The Secretary shall prepare and submit a 
        report describing the information described in paragraph (2) 
        to--
                    ``(A) the Committee on Health, Education, Labor, 
                and Pensions of the Senate;
                    ``(B) the Subcommittee on Labor, Health and Human 
                Services, and Education of the Committee on 
                Appropriations of the Senate;
                    ``(C) the Committee on Energy and Commerce of the 
                House of Representatives; and
                    ``(D) the Subcommittee on Labor, Health and Human 
                Services, and Education of the Committee on 
                Appropriations of the House of Representatives.
            ``(2) Content.--The report described in paragraph (1) shall 
        detail--
                    ``(A) the manner in which the demonstration project 
                described in this section has affected access to 
                primary care services, patient satisfaction, quality of 
                care, and health care services provided for 
                traditionally underserved populations;
                    ``(B) how the participation of chiropractic doctors 
                and pharmacists in the Loan Repayment Program might 
                affect the designation of health professional shortage 
                areas; and
                    ``(C) the feasibility of adding chiropractic 
                doctors and pharmacists as permanent members of the 
                National Health Service Corps.
    ``(g) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for fiscal years 2002 through 2004.''.

            TITLE IV--HEALTHY COMMUNITIES ACCESS PROGRAM ACT

SEC. 401. PURPOSE.

    The purpose of this title is to provide assistance to communities 
and consortia of health care providers and others, to develop or 
strengthen integrated community health care delivery systems that 
coordinate health care services for individuals who are uninsured or 
underinsured and to develop or strengthen activities related to 
providing coordinated care for individuals with chronic conditions who 
are uninsured or underinsured, through the--
            (1) coordination of services to allow individuals to 
        receive efficient and higher quality care and to gain entry 
        into and receive services from a comprehensive system of care;
            (2) development of the infrastructure for a health care 
        delivery system characterized by effective collaboration, 
        information sharing, and clinical and financial coordination 
        among all providers of care in the community; and
            (3) provision of new Federal resources that do not supplant 
        funding for existing Federal categorical programs that support 
        entities providing services to low-income populations.

SEC. 402. CREATION OF HEALTHY COMMUNITIES ACCESS 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--Healthy Communities Access Program

``SEC. 340. GRANTS TO STRENGTHEN THE EFFECTIVENESS, EFFICIENCY, AND 
              COORDINATION OF SERVICES FOR THE UNINSURED AND 
              UNDERINSURED.

    ``(a) In General.--The Secretary may award grants to eligible 
entities to assist in the development of integrated health care 
delivery systems to serve communities of individuals who are uninsured 
and individuals who are underinsured--
            ``(1) to improve the efficiency of, and coordination among, 
        the providers providing services through such systems;
            ``(2) to assist communities in developing programs targeted 
        toward preventing and managing chronic diseases; and
            ``(3) to expand and enhance the services provided through 
        such systems.
    ``(b) Eligible Entities.--To be eligible to receive a grant under 
this section, an entity shall be a public or nonprofit entity that--
            ``(1) represents a consortium--
                    ``(A) whose principal purpose is to provide a broad 
                range of coordinated health care services for a 
                community defined in the entity's grant application as 
                described in paragraph (2); and
                    ``(B) that includes a provider (unless such 
                provider does not exist within the community, declines 
                or refuses to participate, or places unreasonable 
                conditions on their participation) that--
                            ``(i) serves the community; and
                            ``(ii)(I) is a Federally qualified health 
                        center (as defined in section 1861(aa) of the 
                        Social Security Act (42 U.S.C. 1395x(aa)));
                            ``(II) is a hospital with a low-income 
                        utilization rate (as defined in section 
                        1923(b)(3) of the Social Security Act (42 
                        U.S.C. 1396r-4(b)(3)), that is greater than 25 
                        percent;
                            ``(III) is a public health department; and
                            ``(IV) is an interested public or private 
                        sector health care provider or an organization 
                        that has traditionally served the medically 
                        uninsured and underserved;
            ``(2) submits to the Secretary an application, in such form 
        and manner as the Secretary shall prescribe, that--
                    ``(A) defines a community of uninsured and 
                underinsured individuals that consists of all such 
                individuals--
                            ``(i) in a specified geographical area, 
                        such as a rural area; or
                            ``(ii) in a specified population within 
                        such an area, such as American Indians, Native 
                        Alaskans, Native Hawaiians, Hispanics, homeless 
                        individuals, migrant and seasonal farmworkers, 
                        individuals with disabilities, and public 
                        housing residents;
                    ``(B) identifies the providers who will participate 
                in the consortium's program under the grant, and 
                specifies each provider's contribution to the care of 
                uninsured and underinsured individuals in the 
                community, including the volume of care the provider 
                provides to beneficiaries under the medicare, medicaid, 
                and State child health insurance programs carried out 
                under titles XVIII, XIX, and XXI of the Social Security 
                Act (42 U.S.C. 1395 et seq., 1396 et seq., and 1397aa 
                et seq.) and to patients who pay privately for 
                services;
                    ``(C) describes the activities that the applicant 
                and the consortium propose to perform under the grant 
                to further the objectives of this section;
                    ``(D) demonstrates the consortium's ability to 
                build on the current system (as of the date of 
                submission of the application) for serving a community 
                of uninsured and underinsured individuals by involving 
                providers who have traditionally provided a significant 
                volume of care for that community;
                    ``(E) demonstrates 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 that assures 
                continuity of care in the community;
                    ``(F) demonstrates the consortium's ability to 
                create comprehensive programs to address the prevention 
                and management of chronic diseases of high importance 
                within the community, where applicable;
                    ``(G) provides evidence of community involvement in 
                the development, implementation, and direction of the 
                program that the entity proposes to operate;
                    ``(H) demonstrates the consortium's ability to 
                ensure that individuals participating in the program 
                are enrolled in public insurance programs for which the 
                individuals are eligible;
                    ``(I) presents 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 of the program;
                    ``(J) describes a plan for evaluation of the 
                activities carried out under the grant, including 
                measurement of progress toward the goals and objectives 
                of the program and the use of evaluation findings to 
                improve program performance;
                    ``(K) demonstrates fiscal responsibility through 
                the use of appropriate accounting procedures and 
                appropriate management systems;
                    ``(L) demonstrates the consortium's commitment to 
                serve the community without regard to the ability of an 
                individual or family to pay by arranging for or 
                providing free or reduced charge care for the poor; and
                    ``(M) includes such other information as the 
                Secretary may prescribe;
            ``(3) agrees along with each of the participating providers 
        identified under paragraph (2)(B) that each will commit to use 
        grant funds awarded under this section to supplement, not 
        supplant, any other sources of funding (including the value of 
        any in-kind contributions) available to cover the expenditures 
        of the consortium and of the participating providers in 
        carrying out the activities for which the grant would be 
        awarded; and
            ``(4) has established or will establish before the receipt 
        of any grant under this section, a decision-making body that 
        has full and complete authority to determine and oversee all 
        the activities undertaken by the consortium with funds made 
        available through such grant and that includes representation 
        from each of the following providers listed in (b)(1)(B) if 
        they participate in the consortium.
    ``(c) Priorities.--In awarding grants under this section, the 
Secretary--
            ``(1) shall accord priority to applicants that demonstrate 
        the extent of unmet need in the community involved for a more 
        coordinated system of care; and
            ``(2) may accord priority to applicants that best promote 
        the objectives of this section, taking into consideration the 
        extent to which the application involved--
                    ``(A) identifies a community whose geographical 
                area has a high or increasing percentage of individuals 
                who are uninsured;
                    ``(B) demonstrates that the applicant has included 
                in its consortium providers, support systems, and 
                programs that have a tradition of serving uninsured 
                individuals and underinsured individuals in the 
                community;
                    ``(C) shows evidence that the program would expand 
                utilization of preventive and primary care services for 
                uninsured and underinsured individuals and families in 
                the community, including behavioral and mental health 
                services, oral health services, or substance abuse 
                services;
                    ``(D) proposes a program that 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;
                    ``(E) demonstrates collaboration with State and 
                local governments;
                    ``(F) demonstrates that the applicant makes use of 
                non-Federal contributions to the greatest extent 
                possible; or
                    ``(G) demonstrates a likelihood that the proposed 
                program will continue after support under this section 
                ceases.
    ``(d) 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 
                        planning and developing the greater integration 
                        of a health care delivery system, and operating 
                        the resulting system, so that the system either 
                        directly provides or ensures the provision of a 
                        broad range of culturally competent 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 under 
                this section, when such use meets the conditions stated 
                in subparagraph (A):
                            ``(i) Increases in outreach activities.
                            ``(ii) Improvements to case management.
                            ``(iii) Improvements to coordination of 
                        transportation to health care facilities.
                            ``(iv) Development of provider networks and 
                        other innovative models to engage physicians in 
                        voluntary efforts to serve the medically 
                        underserved within a community.
                            ``(v) Recruitment, training, and 
                        compensation of necessary personnel.
                            ``(vi) Acquisition of technology, such as 
                        telehealth technologies to increase access to 
                        tertiary care.
                            ``(vii) Identifying and closing gaps in 
                        health care services being provided.
                            ``(viii) Improvements to provider 
                        communication, including implementation of 
                        shared information systems or shared clinical 
                        systems.
                            ``(ix) Development of common processes for 
                        determining eligibility for the programs 
                        provided through the system, including creating 
                        common identification cards and single sliding 
                        scale discounts.
                            ``(x) Creation of a triage system to 
                        coordinate referrals and to screen and route 
                        individuals to appropriate locations of 
                        primary, specialty, and inpatient care.
                            ``(xi) Development of specific prevention 
                        and disease management tools and processes, 
                        including--
                                    ``(I) carrying out a protocol or 
                                plan for each individual patient 
                                concerning what needs to be done, at 
                                what intervals, and by whom, for the 
                                patient;
                                    ``(II) redesigning practices to 
                                incorporate regular patient contact, 
                                collection of critical data on health 
                                and disease status, and use of 
                                strategies to meet the educational and 
                                psychosocial needs of patients who may 
                                need to make lifestyle and other 
                                changes to manage their diseases;
                                    ``(III) the promotion of the 
                                availability of specialized expertise 
                                through the use of--
                                            ``(aa) teams of providers 
                                        with specialized knowledge;
                                            ``(bb) collaborative care 
                                        arrangements;
                                            ``(cc) computer decision 
                                        support services; or
                                            ``(dd) telehealth 
                                        technologies.
                                    ``(IV) providing patient 
                                educational and support tools that are 
                                culturally competent and meet 
                                appropriate health literacy and 
                                literacy requirements; and
                                    ``(V) the collection of data 
                                related to patient care and outcomes.
                            ``(xii) Translation services.
                            ``(xiii) Carrying out other activities that 
                        may be appropriate to a community and that 
                        would increase access by the uninsured to 
                        health care, such as access initiatives for 
                        which private entities provide non-Federal 
                        contributions to supplement the Federal funds 
                        provided through the grants for the 
                        initiatives.
            ``(2) Direct patient care limitation.--Not more than 15 
        percent of the funds provided under a grant awarded under this 
        section may be used for providing direct patient care and 
        services.
            ``(3) 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 providing technical 
        assistance to grantees, obtaining assistance of experts and 
        consultants, holding meetings, development of tools, 
        dissemination of information, evaluation, and carrying out 
        activities that will extend the benefits of a program funded 
        under this section to communities other than the community 
        served by the program funded.
    ``(e) Grantee Requirements.--
            ``(1) In general.--A grantee under this section shall--
                    ``(A) report to the Secretary annually regarding--
                            ``(i) progress in meeting the goals and 
                        measurable objectives set forth in the grant 
                        application submitted by the grantee under 
                        subsection (b); and
                            ``(ii) such additional information as the 
                        Secretary may require; and
                    ``(B) provide for an independent annual financial 
                audit of all records that relate to the disposition of 
                funds received through the grant.
            ``(2) Progress.--The Secretary may not renew an annual 
        grant under this section for an entity for a fiscal year unless 
        the Secretary is satisfied that the consortium represented by 
        the entity has made reasonable and demonstrable progress in 
        meeting the goals and measurable objectives set forth in the 
        entity's grant application for the preceding fiscal year.
    ``(f) Technical Assistance.--The Secretary may, either directly or 
by grant or contract, provide any entity that receives a grant under 
this section with technical and other nonfinancial assistance necessary 
to meet the requirements of this section.
    ``(g) 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 this section.
    ``(h) Demonstration Authority.--The Secretary may make 
demonstration awards under this section to historically black medical 
schools for the purposes of--
            ``(1) developing patient-based research infrastructure at 
        historically black medical schools, which have an affiliation, 
        or affiliations, with any of the providers identified in 
        section (b)(1)(B);
            ``(2) establishment of joint and collaborative programs of 
        medical research and data collection between historically black 
        medical schools and such providers, whose goal is to improve 
        the health status of medically underserved populations; or
            ``(3) supporting the research-related costs of patient 
        care, data collection, and academic training resulting from 
        such affiliations.
    ``(i) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $125,000,000 for fiscal year 
2002 and such sums as may be necessary for each of fiscal years 2003 
through 2006.''.

SEC. 403. 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 Amendments of 2002, 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.''.

                     TITLE V--RURAL HEALTH CLINICS

SEC. 501. EXEMPTIONS FOR RURAL HEALTH CLINICS.

    (a) Exemptions From Coinsurance Requirements.--Section 
1128B(b)(3)(D) of the Social Security Act (42 U.S.C. 1320a-7b(b)(3)(D)) 
is amended by striking ``a Federally qualified health care center'' and 
inserting ``a rural health clinic (as defined in section 1861(aa)) to 
which members of the National Health Service Corps are assigned under 
section 333 of the Public Health Service Act, or a Federally qualified 
health center (as defined in section 1861(aa))''.
    (b) Exemptions From Deductible Requirements.--Section 1833(b)(4) of 
the Social Security Act (42 U.S.C. 1395l(b)(4)) is amended by striking 
``such deductible shall not apply to Federally qualified health center 
services.'' and inserting ``such deductible shall not apply to rural 
health clinic services made available through a rural health clinic to 
which members of the National Health Service Corps are assigned under 
section 333 of the Public Health Service Act, provided to an individual 
who qualifies for subsidized services under the Public Health Service 
Act or Federally qualified health center services,''.

                            TITLE VI--STUDY

SEC. 601. GUARANTEE STUDY.

    The Secretary of Health and Human Services shall conduct a study 
regarding the ability of the Department of Health and Human Services to 
provide for solvency for managed care networks involving health centers 
receiving funding under section 330 of the Public Health Service Act. 
The Secretary shall prepare and submit a report to the appropriate 
Committees of Congress regarding such ability not later than 2 years 
after the date of enactment of the Health Care Safety Net Amendments of 
2002.

                    TITLE VII--CONFORMING AMENDMENTS

SEC. 701. 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 Senate April 16, 2002.

            Attest:

                                                             Secretary.
107th CONGRESS

  2d Session

                                S. 1533

_______________________________________________________________________

                                 AN ACT

 To amend the Public Health Service Act to reauthorize and strengthen 
 the health centers program and the National Health Service Corps, and 
 to establish the Healthy Communities Access Program, which will help 
 coordinate services for the uninsured and underinsured, and for other 
                               purposes.