[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