[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1343 Engrossed Amendment Senate (EAS)]
In the Senate of the United States,
September 24 (legislative day, September 17), 2008.
Resolved, That the bill from the House of Representatives (H.R.
1343) entitled ``An Act to amend the Public Health Service Act to
provide additional authorizations of appropriations for the health
centers program under section 330 of such Act, and for other
purposes.'', do pass with the following
AMENDMENT:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Health Care Safety Net Act of
2008''.
SEC. 2. COMMUNITY HEALTH CENTERS PROGRAM OF THE PUBLIC HEALTH SERVICE
ACT.
(a) Additional Authorizations of Appropriations for the Health
Centers Program of Public Health Service Act.--Section 330(r) of the
Public Health Service Act (42 U.S.C. 254b(r)) is amended by amending
paragraph (1) to read as follows:
``(1) In general.--For the purpose of carrying out this
section, in addition to the amounts authorized to be
appropriated under subsection (d), there are authorized to be
appropriated--
``(A) $2,065,000,000 for fiscal year 2008;
``(B) $2,313,000,000 for fiscal year 2009;
``(C) $2,602,000,000 for fiscal year 2010;
``(D) $2,940,000,000 for fiscal year 2011; and
``(E) $3,337,000,000 for fiscal year 2012.''.
(b) Studies Relating to Community Health Centers.--
(1) Definitions.--For purposes of this subsection--
(A) the term ``community health center'' means a
health center receiving assistance under section 330 of
the Public Health Service Act (42 U.S.C. 254b); and
(B) the term ``medically underserved population''
has the meaning given that term in such section 330.
(2) School-based health center study.--
(A) In general.--Not later than 2 years after the
date of enactment of this Act, the Comptroller General
of the United States shall issue a study of the
economic costs and benefits of school-based health
centers and the impact on the health of students of
these centers.
(B) Content.--In conducting the study under
subparagraph (A), the Comptroller General of the United
States shall analyze--
(i) the impact that Federal funding could
have on the operation of school-based health
centers;
(ii) any cost savings to other Federal
programs derived from providing health services
in school-based health centers;
(iii) the effect on the Federal Budget and
the health of students of providing Federal
funds to school-based health centers and
clinics, including the result of providing
disease prevention and nutrition information;
(iv) the impact of access to health care
from school-based health centers in rural or
underserved areas; and
(v) other sources of Federal funding for
school-based health centers.
(3) Health care quality study.--
(A) In general.--Not later than 1 year after the
date of enactment of this Act, the Secretary of Health
and Human Services (referred to in this Act as the
``Secretary''), acting through the Administrator of the
Health Resources and Services Administration, and in
collaboration with the Agency for Healthcare Research
and Quality, shall prepare and submit to the Committee
on Health, Education, Labor, and Pensions of the Senate
and the Committee on Energy and Commerce of the House
of Representatives a report that describes agency
efforts to expand and accelerate quality improvement
activities in community health centers.
(B) Content.--The report under subparagraph (A)
shall focus on--
(i) Federal efforts, as of the date of
enactment of this Act, regarding health care
quality in community health centers, including
quality data collection, analysis, and
reporting requirements;
(ii) identification of effective models for
quality improvement in community health
centers, which may include models that--
(I) incorporate care coordination,
disease management, and other services
demonstrated to improve care;
(II) are designed to address
multiple, co-occurring diseases and
conditions;
(III) improve access to providers
through non-traditional means, such as
the use of remote monitoring equipment;
(IV) target various medically
underserved populations, including
uninsured patient populations;
(V) increase access to specialty
care, including referrals and
diagnostic testing; and
(VI) enhance the use of electronic
health records to improve quality;
(iii) efforts to determine how effective
quality improvement models may be adapted for
implementation by community health centers that
vary by size, budget, staffing, services
offered, populations served, and other
characteristics determined appropriate by the
Secretary;
(iv) types of technical assistance and
resources provided to community health centers
that may facilitate the implementation of
quality improvement interventions;
(v) proposed or adopted methodologies for
community health center evaluations of quality
improvement interventions, including any
development of new measures that are tailored
to safety-net, community-based providers;
(vi) successful strategies for sustaining
quality improvement interventions in the long-
term; and
(vii) partnerships with other Federal
agencies and private organizations or networks
as appropriate, to enhance health care quality
in community health centers.
(C) Dissemination.--The Administrator of the Health
Resources and Services Administration shall establish a
formal mechanism or mechanisms for the ongoing
dissemination of agency initiatives, best practices,
and other information that may assist health care
quality improvement efforts in community health
centers.
(4) GAO study on integrated health systems model for the
delivery of health care services to medically underserved and
uninsured populations.--
(A) Study.--The Comptroller General of the United
States shall conduct a study on integrated health
system models of at least 15 sites for the delivery of
health care services to medically underserved and
uninsured populations. The study shall include an
examination of--
(i) health care delivery models sponsored
by public or private non-profit entities that--
(I) integrate primary, specialty,
and acute care; and
(II) serve medically underserved
and uninsured populations; and
(ii) such models in rural and urban areas.
(B) Report.--Not later than 1 year after the date
of the enactment of this Act, the Comptroller General
of the United States shall submit to Congress a report
on the study conducted under subparagraph (A). The
report shall include--
(i) an evaluation of the models, as
described in subparagraph (A), in--
(I) expanding access to primary,
preventive, and specialty services for
medically underserved and uninsured
populations; and
(II) improving care coordination
and health outcomes;
(III) increasing efficiency in the
delivery of quality health care; and
(IV) conducting some combination of
the following services--
(aa) outreach activities;
(bb) case management and
patient navigation services;
(cc) chronic care
management;
(dd) transportation to
health care facilities;
(ee) development of
provider networks and other
innovative models to engage
local physicians and other
providers to serve the
medically underserved within a
community;
(ff) recruitment, training,
and compensation of necessary
personnel;
(gg) acquisition of
technology for the purpose of
coordinating care;
(hh) improvements to
provider communication,
including implementation of
shared information systems or
shared clinical systems;
(ii) determination of
eligibility for Federal, State,
and local programs that
provide, or financially support
the provision of, medical,
social, housing, educational,
or other related services;
(jj) development of
prevention and disease
management tools and processes;
(kk) translation services;
(ll) development and
implementation of evaluation
measures and processes to
assess patient outcomes;
(mm) integration of primary
care and mental health
services; and
(nn) 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; and
(ii) an assessment of--
(I) challenges, including barriers
to Federal programs, encountered by
such entities in providing care to
medically underserved and uninsured
populations; and
(II) advantages and disadvantages
of such models compared to other models
of care delivery for medically
underserved and uninsured populations,
including--
(aa) quality measurement
and quality outcomes;
(bb) administrative
efficiencies; and
(cc) geographic
distribution of federally-
supported clinics compared to
geographic distribution of
integrated health systems.
(5) GAO study on volunteer enhancement.--
(A) In general.--Not later than 6 months after the
date of enactment of this Act, the Comptroller General
of the United States shall conduct a study, and submit
a report to Congress, concerning the implications of
extending Federal Tort Claims Act (chapter 171 of title
28, United States Code) coverage to health care
professionals who volunteer to furnish care to patients
of health centers.
(B) Content.--In conducting the study under
subparagraph (A), the Comptroller General of the United
States shall analyze--
(i) the potential financial implications
for the Federal Government of such an
extension, including any increased funding
needed for current health center Federal Tort
Claims Act coverage;
(ii) an estimate of the increase in the
number of health care professionals at health
centers, and what types of such professionals
would most likely volunteer given the extension
of Federal Tort Claims Act coverage;
(iii) the increase in services provided by
health centers as a result of such an increase
in health care professionals, and in particular
the effect of such action on the ability of
health centers to secure specialty and
diagnostic services needed by their uninsured
and other patients;
(iv) the volume of patient workload at
health centers and how volunteer health care
professionals may help address the patient
volume;
(v) the most appropriate manner of
extending such coverage to volunteer health
care professionals at health centers, including
any potential difference from the mechanism
currently used for health care professional
volunteers at free clinics;
(vi) State laws that have been shown to
encourage physicians and other health care
providers to provide charity care as an agent
of the State; and
(vii) other policies, including legislative
or regulatory changes, that have the potential
to increase the number of volunteer health care
staff at health centers and the financial
implications of such policies, including the
cost savings associated with the ability to
provide more services in health centers rather
than more expensive sites of care.
(c) Recognition of High Poverty.--
(1) In general.--Section 330(c) of the Public Health
Service Act (42 U.S.C. 254b(c)) is amended by adding at the end
the following new paragraph:
``(3) Recognition of high poverty.--
``(A) In general.--In making grants under this
subsection, the Secretary may recognize the unique
needs of high poverty areas.
``(B) High poverty area defined.--For purposes of
subparagraph (A), the term `high poverty area' means a
catchment area which is established in a manner that is
consistent with the factors in subsection (k)(3)(J),
and the poverty rate of which is greater than the
national average poverty rate as determined by the
Bureau of the Census.''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply to grants made on or after January 1, 2009.
SEC. 3. NATIONAL HEALTH SERVICE CORPS.
(a) Funding.--
(1) Reauthorization of national health service corps
program.--Section 338(a) of the Public Health Service Act (42
U.S.C. 254k(a)) is amended by striking ``2002 through 2006''
and inserting ``2008 through 2012''.
(2) Scholarship and loan repayment programs.--Subsection
(a) of section 338H of such Act (42 U.S.C. 254q) is amended by
striking ``appropriated $146,250,000'' and all that follows
through the period and inserting the following:
``appropriated--
``(1) for fiscal year 2008, $131,500,000;
``(2) for fiscal year 2009, $143,335,000;
``(3) for fiscal year 2010, $156,235,150;
``(4) for fiscal year 2011, $170,296,310; and
``(5) for fiscal year 2012, $185,622,980.''.
(b) Elimination of 6-Year Demonstration Requirement.--Section
332(a)(1) of the Public Health Service Act (42 U.S.C. 254e(a)(1)) is
amended by striking ``Not earlier than 6 years'' and all that follows
through ``purposes of this section.''.
(c) Assignment to Shortage Area.--Section 333(a)(1)(D)(ii) of the
Public Health Service Act (42 U.S.C. 254f(a)(1)(D)(ii)) is amended--
(1) in subclause (IV), by striking ``and'';
(2) in subclause (V), by striking the period at the end and
inserting ``; and''; and
(3) by adding at the end the following:
``(VI) the entity demonstrates
willingness to support or facilitate
mentorship, professional development,
and training opportunities for Corps
members.''.
(d) Professional Development and Training.--Subsection (d) of
section 336 of the Public Health Service Act (42 U.S.C. 254h-1) is
amended to read as follows:
``(d) Professional Development and Training.--
``(1) In general.--The Secretary shall assist Corps members
in establishing and maintaining professional relationships and
development opportunities, including by--
``(A) establishing appropriate professional
relationships between the Corps member involved and the
health professions community of the geographic area
with respect to which the member is assigned;
``(B) establishing professional development,
training, and mentorship linkages between the Corps
member involved and the larger health professions
community, including through distance learning, direct
mentorship, and development and implementation of
training modules designed to meet the educational needs
of offsite Corps members;
``(C) establishing professional networks among
Corps members; or
``(D) engaging in other professional development,
mentorship, and training activities for Corps members,
at the discretion of the Secretary.
``(2) Assistance in establishing professional
relationships.--In providing such assistance under paragraph
(1), the Secretary shall focus on establishing relationships
with hospitals, with academic medical centers and health
professions schools, with area health education centers under
section 751, with health education and training centers under
section 752, and with border health education and training
centers under such section 752. Such assistance shall include
assistance in obtaining faculty appointments at health
professions schools.
``(3) Supplement not supplant.--Such efforts under this
subsection shall supplement, not supplant, non-government
efforts by professional health provider societies to establish
and maintain professional relationships and development
opportunities.''.
(e) Eligibility of the District of Columbia and Territories for the
State Loan Repayment Program.--
(1) In general.--Section 338I(h) of the Public Health
Service Act (42 U.S.C. 254q-1(h)) is amended by striking
``several States'' and inserting ``50 States, the District of
Columbia, the Commonwealth of Puerto Rico, the United States
Virgin Islands, Guam, American Samoa, Palau, the Marshall
Islands, and the Commonwealth of the Northern Mariana
Islands''.
(2) Authorization of appropriations.--Section 338I(i)(1) of
such Act (42 U.S.C. 254q-1(i)(1)) is amended by striking
``2002'' and all that follows through the period and inserting
``2008, and such sums as may be necessary for each of fiscal
years 2009 through 2012.''.
SEC. 4. REAUTHORIZATION OF RURAL HEALTH CARE PROGRAMS.
Section 330A(j) of the Public Health Service Act (42 U.S.C.
254c(j)) is amended by striking ``$40,000,000'' and all that follows
through the period and inserting ``$45,000,000 for each of fiscal years
2008 through 2012.''.
SEC. 5. REAUTHORIZATION OF PRIMARY DENTAL HEALTH WORKFORCE PROGRAMS.
Section 340G(f) of the Public Health Service Act (42 U.S.C.
256g(f)) is amended--
(1) by striking ``$50,000,000'' and inserting
``$25,000,000''; and
(2) by striking ``2002'' and inserting ``2008''.
SEC. 6. EMERGENCY RESPONSE COORDINATION OF PRIMARY CARE PROVIDERS.
(a) In General.--Subtitle B of title XXVIII of the Public Health
Service Act (42 U.S.C. 300hh-10 et seq.) is amended by adding at the
end the following:
``SEC. 2815. EMERGENCY RESPONSE COORDINATION OF PRIMARY CARE PROVIDERS.
``The Secretary, acting through Administrator of the Health
Resources and Services Administration, and in coordination with the
Assistant Secretary for Preparedness and Response, shall
``(1) provide guidance and technical assistance to health
centers funded under section 330 and to State and local health
departments and emergency managers to integrate health centers
into State and local emergency response plans and to better
meet the primary care needs of populations served by health
centers during public health emergencies; and
``(2) encourage employees at health centers funded under
section 330 to participate in emergency medical response
programs including the National Disaster Medical System
authorized in section 2812, the Volunteer Medical Reserve Corps
authorized in section 2813, and the Emergency System for
Advance Registration of Health Professions Volunteers
authorized in section 319I.''.
(b) Sense of the Congress.--It is the Sense of Congress that the
Secretary of Health and Human Services, to the extent permitted by law,
utilize the existing authority provided under the Federal Tort Claims
Act for health centers funded under section 330 of the Public Health
Service Act (42 U.S.C. 254b) in order to establish expedited procedures
under which such health centers and their health care professionals
that have been deemed eligible for Federal Tort Claims Act coverage are
able to respond promptly in a coordinated manner and on a temporary
basis to public health emergencies outside their traditional service
area and sites, and across State lines, as necessary and appropriate.
SEC. 7. REVISION OF THE TIMEFRAME FOR THE RECOGNITION OF CERTAIN
DESIGNATIONS IN CERTIFYING RURAL HEALTH CLINICS UNDER THE
MEDICARE PROGRAM.
(a) In General.--The second sentence of section 1861(aa)(2) of the
Social Security Act (42 U.S.C. 1395x(aa)(2)) is amended by striking
``3-year period'' and inserting ``4-year period'' in the matter in
clause (i) preceding subclause (I).
(b) Effective Date.--The amendment made by subsection (a) shall
take effect on the date of the enactment of this Act.
Attest:
Secretary.
110th CONGRESS
2d Session
H.R. 1343
_______________________________________________________________________
AMENDMENT