[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.