[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1343 Engrossed in House (EH)]
110th CONGRESS
2d Session
H. R. 1343
_______________________________________________________________________
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.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Health Centers Renewal Act of
2008''.
SEC. 2. ADDITIONAL AUTHORIZATIONS OF APPROPRIATIONS FOR HEALTH CENTERS
PROGRAM.
Section 330(r)(1) of the Public Health Service Act (42 U.S.C.
254b(r)(1)) is amended 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) for fiscal year 2008, $2,213,020,000;
``(B) for fiscal year 2009, $2,451,394,400;
``(C) for fiscal year 2010, $2,757,818,700;
``(D) for fiscal year 2011, $3,116,335,131; and
``(E) for fiscal year 2012, $3,537,040,374.''.
SEC. 3. RECOGNITION OF HIGH POVERTY AREAS.
(a) 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 areas.--
``(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.''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to grants made on or after January 1, 2009.
SEC. 4. LIABILITY PROTECTIONS FOR HEALTH CENTER VOLUNTEER
PRACTITIONERS.
(a) In General.--Section 224 of the Public Health Service Act (42
U.S.C. 233) is amended--
(1) in subsection (g)(1)(A)--
(A) in the first sentence, by striking ``or
employee'' and inserting ``employee, or (subject to
subsection (k)(4)) volunteer practitioner''; and
(B) in the second sentence, by inserting ``and
subsection (k)(4)'' after ``subject to paragraph (5)'';
and
(2) in each of subsections (g), (i), (j), (k), (l), and
(m)--
(A) by striking the term ``employee, or
contractor'' each place such term appears and inserting
``employee, volunteer practitioner, or contractor'';
(B) by striking the term ``employee, and
contractor'' each place such term appears and inserting
``employee, volunteer practitioner, and contractor'';
(C) by striking the term ``employee, or any
contractor'' each place such term appears and inserting
``employee, volunteer practitioner, or contractor'';
and
(D) by striking the term ``employees, or
contractors'' each place such term appears and
inserting ``employees, volunteer practitioners, or
contractors''.
(b) Applicability; Definition.--Section 224(k) of the Public Health
Service Act (42 U.S.C. 233(k)) is amended by adding at the end the
following paragraph:
``(4)(A) Subsections (g) through (m) apply with respect to
volunteer practitioners beginning with the first fiscal year for which
an appropriations Act provides that amounts in the fund under paragraph
(2) are available with respect to such practitioners.
``(B) For purposes of subsections (g) through (m), the term
`volunteer practitioner' means a practitioner who, with respect to an
entity described in subsection (g)(4), meets the following conditions:
``(i) In the State involved, the practitioner is a licensed
physician, a licensed clinical psychologist, or other licensed
or certified health care practitioner.
``(ii) At the request of such entity, the practitioner
provides services to patients of the entity, at a site at which
the entity operates or at a site designated by the entity. The
weekly number of hours of services provided to the patients by
the practitioner is not a factor with respect to meeting
conditions under this subparagraph.
``(iii) The practitioner does not for the provision of such
services receive any compensation from such patients, from the
entity, or from third-party payors (including reimbursement
under any insurance policy or health plan, or under any Federal
or State health benefits program).''.
SEC. 5. LIABILITY PROTECTIONS FOR HEALTH CENTER PRACTITIONERS PROVIDING
SERVICES IN EMERGENCY AREAS.
Section 224(g) of the Public Health Service Act (42 U.S.C. 233(g))
is amended--
(1) in paragraph (1)(B)(ii), by striking ``subparagraph
(C)'' and inserting ``subparagraph (C) and paragraph (6)''; and
(2) by adding at the end the following paragraph:
``(6)(A) Subject to subparagraph (C), paragraph (1)(B)(ii) applies
to health services provided to individuals who are not patients of the
entity involved if, as determined under criteria issued by the
Secretary, the following conditions are met:
``(i) The services are provided by a contractor, volunteer
practitioner (as defined in subsection (k)(4)(B)), or employee
of the entity who is a physician or other licensed or certified
health care practitioner and who is otherwise deemed to be an
employee for purposes of paragraph (1)(A) when providing
services with respect to the entity.
``(ii) The services are provided in an emergency area (as
defined in subparagraph (D)), with respect to a public health
emergency or major disaster described in subparagraph (D), and
during the period for which such emergency or disaster is
determined or declared, respectively.
``(iii) The services of the contractor, volunteer
practitioner, or employee (referred to in this paragraph as the
`out-of-area practitioner') are provided under an arrangement
with--
``(I) an entity that is deemed to be an employee
for purposes of paragraph (1)(A) and that serves the
emergency area involved (referred to in this paragraph
as an `emergency-area entity'); or
``(II) a Federal agency that has responsibilities
regarding the provision of health services in such area
during the emergency.
``(iv) The purposes of the arrangement are--
``(I) to coordinate, to the extent practicable, the
provision of health services in the emergency area by
the out-of-area practitioner with the provision of
services by the emergency-area entity, or by the
Federal agency, as the case may be;
``(II) to identify a location in the emergency area
to which such practitioner should report for purposes
of providing health services, and to identify an
individual or individuals in the area to whom the
practitioner should report for such purposes; and
``(III) to verify the identity of the practitioner
and that the practitioner is licensed or certified by
one or more of the States.
``(v) With respect to the licensure or certification of
health care practitioners, the provision of services by the
out-of-area practitioner in the emergency area is not a
violation of the law of the State in which the area is located.
``(B) In issuing criteria under subparagraph (A), the Secretary
shall take into account the need to rapidly enter into arrangements
under such subparagraph in order to provide health services in
emergency areas promptly after the emergency begins.
``(C) Subparagraph (A) applies with respect to an act or omission
of an out-of-area practitioner only to the extent that the practitioner
is not immune from liability for such act or omission under the
Volunteer Protection Act of 1997.
``(D) For purposes of this paragraph, the term `emergency area'
means a geographic area for which--
``(i) the Secretary has made a determination under section
319 that a public health emergency exists; or
``(ii) a presidential declaration of major disaster has
been issued under section 401 of the Robert T. Stafford
Disaster Relief and Emergency Assistance Act.''.
SEC. 6. DEMONSTRATION PROJECT FOR INTEGRATED HEALTH SYSTEMS TO EXPAND
ACCESS TO PRIMARY AND PREVENTIVE SERVICES FOR THE
MEDICALLY UNDERSERVED.
Part D of title III of the Public Health Service Act (42 U.S.C.
259b et seq.) is amended by adding at the end the following new
subpart:
``Subpart XI--Demonstration Project for Integrated Health Systems to
Expand Access to Primary and Preventive Services for the Medically
Underserved
``SEC. 340H. DEMONSTRATION PROJECT FOR INTEGRATED HEALTH SYSTEMS TO
EXPAND ACCESS TO PRIMARY AND PREVENTIVE CARE FOR THE
MEDICALLY UNDERSERVED.
``(a) Establishment of Demonstration.--
``(1) In general.--Not later than January 1, 2009, the
Secretary shall establish a demonstration project (hereafter in
this section referred to as the `demonstration') under which up
to 30 qualifying integrated health systems receive grants for
the costs of their operations to expand access to primary and
preventive services for the medically underserved.
``(2) Rule of construction.--Nothing in this section shall
be construed as authorizing grants to be made or used for the
costs of specialty care or hospital care furnished by an
integrated health system.
``(b) Application.--Any integrated health system desiring to
participate in the demonstration shall submit an application in such
manner, at such time, and containing such information as the Secretary
may require.
``(c) Criteria for Selection.--In selecting integrated health
systems to participate in the demonstration (hereafter in this section
referred to as `participating integrated health systems'), the
Secretary shall ensure representation of integrated health systems that
are located in a variety of States (including the District of Columbia
and the territories and possessions of the United States) and locations
within States, including rural areas, inner-city areas, and frontier
areas.
``(d) Duration.--Subject to the availability of appropriations, the
demonstration shall be conducted (and operating grants be made to each
participating integrated health system) for a period of 3 years.
``(e) Reports.--
``(1) In general.--The Secretary shall submit to the
appropriate committees of the Congress interim and final
reports with respect to the demonstration, with an interim
report being submitted not later than 3 months after the
demonstration has been in operation for 24 months and a final
report being submitted not later than 3 months after the close
of the demonstration.
``(2) Content.--Such reports shall evaluate the
effectiveness of the demonstration in providing greater access
to primary and preventive care for medically underserved
populations, and how the coordinated approach offered by
integrated health systems contributes to improved patient
outcomes.
``(f) Authorization of Appropriations.--
``(1) In general.--There is authorized to be appropriated
$25,000,000 for each of the fiscal years 2009, 2010, and 2011
to carry out this section.
``(2) Construction.--Nothing in this section shall be
construed as requiring or authorizing a reduction in the
amounts appropriated for grants to health centers under section
330 for the fiscal years referred to in paragraph (1).
``(g) Definitions.--For purposes of this section:
``(1) Frontier area.--The term `frontier area' has the
meaning given to such term in regulations promulgated pursuant
to section 330I(r).
``(2) Integrated health system.--The term `integrated
health system' means a health system that--
``(A) has a demonstrated capacity and commitment to
provide a full range of primary care, specialty care,
and hospital care in both inpatient and outpatient
settings; and
``(B) is organized to provide such care in a
coordinated fashion.
``(3) Qualifying integrated health system.--
``(A) In general.--The term `qualifying integrated
health system' means a public or private nonprofit
entity that is an integrated health system that meets
the requirements of subparagraph (B) and serves a
medically underserved population (either through the
staff and supporting resources of the integrated health
system or through contracts or cooperative
arrangements) by providing--
``(i) required primary and preventive
health and related services (as defined in
paragraph (4)); and
``(ii) as may be appropriate for a
population served by a particular integrated
health system, integrative health services (as
defined in paragraph (5)) that are necessary
for the adequate support of the required
primary and preventive health and related
services and that improve care coordination.
``(B) Other requirements.--The requirements of this
subparagraph are that the integrated health system--
``(i) will make the required primary and
preventive health and related services of the
integrated health system available and
accessible in the service area of the
integrated health system promptly, as
appropriate, and in a manner which assures
continuity;
``(ii) will demonstrate financial
responsibility by the use of such accounting
procedures and other requirements as may be
prescribed by the Secretary;
``(iii) provides or will provide services
to individuals who are eligible for medical
assistance under title XIX of the Social
Security Act or for assistance under title XXI
of such Act;
``(iv) has prepared a schedule of fees or
payments for the provision of its services
consistent with locally prevailing rates or
charges and designed to cover its reasonable
costs of operation and has prepared a
corresponding schedule of discounts to be
applied to the payment of such fees or
payments, which discounts are adjusted on the
basis of the patient's ability to pay;
``(v) will assure that no patient will be
denied health care services due to an
individual's inability to pay for such
services;
``(vi) will assure that any fees or
payments required by the system for such
services will be reduced or waived to enable
the system to fulfill the assurance described
in clause (v);
``(vii) provides assurances that any grant
funds will be expended to supplement, and not
supplant, the expenditures of the integrated
health system for primary and preventive health
services for the medically underserved; and
``(viii) submits to the Secretary such
reports as the Secretary may require to
determine compliance with this subparagraph.
``(C) Treatment of certain entities.--The term
`qualifying integrated health system' may include a
nurse-managed health clinic if such clinic meets the
requirements of subparagraphs (A) and (B) (except those
requirements that have been waived under paragraph
(4)(B)).
``(4) Required primary and preventive health and related
services.--
``(A) In general.--Except as provided in
subparagraph (B), the term `required primary and
preventive health and related services' means basic
health services consisting of--
``(i) health services related to family
medicine, internal medicine, pediatrics,
obstetrics, or gynecology that are furnished by
physicians where appropriate, physician
assistants, nurse practitioners, and nurse
midwives;
``(ii) diagnostic laboratory services and
radiologic services;
``(iii) preventive health services,
including prenatal and perinatal care;
appropriate cancer screening; well-child
services; immunizations against vaccine-
preventable diseases; screenings for elevated
blood lead levels, communicable diseases, and
cholesterol; pediatric eye, ear, and dental
screenings to determine the need for vision and
hearing correction and dental care; and
voluntary family planning services;
``(iv) emergency medical services; and
``(v) pharmaceutical services, behavioral,
mental health, and substance abuse services,
preventive dental services, and recuperative
care, as may be appropriate.
``(B) Exception.--In the case of an integrated
health system serving a targeted population, the
Secretary shall, upon a showing of good cause, waive
the requirement that the integrated health system
provide each required primary and preventive health and
related service under this paragraph if the Secretary
determines one or more such services are inappropriate
or unnecessary for such population.
``(5) Integrative health services.--The term `integrative
health services' means services that are not included as
required primary and preventive health and related services and
are associated with achieving the greater integration of a
health care delivery system to improve patient care
coordination so that the system either directly provides or
ensures the provision of a broad range of culturally competent
services. Integrative health services include but are not
limited to the following:
``(A) Outreach activities.
``(B) Case management and patient navigation
services.
``(C) Chronic care management.
``(D) Transportation to health care facilities.
``(E) Development of provider networks and other
innovative models to engage local physicians and other
providers to serve the medically underserved within a
community.
``(F) Recruitment, training, and compensation of
necessary personnel.
``(G) Acquisition of technology for the purpose of
coordinating care.
``(H) Improvements to provider communication,
including implementation of shared information systems
or shared clinical systems.
``(I) 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.
``(J) Development of prevention and disease
management tools and processes.
``(K) Translation services.
``(L) Development and implementation of evaluation
measures and processes to assess patient outcomes.
``(M) Integration of primary care and mental health
services.
``(N) 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.
``(6) Specialty care.--The term `specialty care' means care
that is provided through a referral and by a physician or
nonphysician practitioner, such as surgical consultative
services, radiology services requiring the immediate presence
of a physician, audiology, optometric services, cardiology
services, magnetic resonance imagery (MRI) services,
computerized axial tomography (CAT) scans, nuclear medicine
studies, and ambulatory surgical services.
``(7) Nurse-managed health clinic.--The term `nurse-managed
health clinic' means a nurse-practice arrangement, managed by
advanced practice nurses, that provides care for underserved
and vulnerable populations and is associated with a school,
college, or department of nursing or an independent nonprofit
health or social services agency.''.
Passed the House of Representatives June 4, 2008.
Attest:
Clerk.
110th CONGRESS
2d Session
H. R. 1343
_______________________________________________________________________
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.