[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1343 Enrolled Bill (ENR)]

        H.R.1343

                       One Hundred Tenth Congress

                                 of the

                        United States of America


                          AT THE SECOND SESSION

          Begun and held at the City of Washington on Thursday,
            the third day of January, two thousand and eight


                                 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 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.

                               Speaker of the House of Representatives.

                            Vice President of the United States and    
                                               President of the Senate.