[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1343 Referred in Senate (RFS)]

  2d Session
                                H. R. 1343


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              June 5, 2008

     Received; read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 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:

                                            LORRAINE C. MILLER,

                                                                 Clerk.