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<bill bill-stage="Introduced-in-House" bill-type="olc" dms-id="H47B1B99EA36640C5A501E911BCBFFC" public-private="public">
<metadata xmlns:dc="http://purl.org/dc/elements/1.1/">
<dublinCore>
<dc:title>110 HR 2860 IH: Health Care Access and Rural Equity (H–CARE)
</dc:title>
<dc:publisher>U.S. House of Representatives</dc:publisher>
<dc:date>2007-06-26</dc:date>
<dc:format>text/xml</dc:format>
<dc:language>EN</dc:language>
<dc:rights>Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.</dc:rights>
</dublinCore>
</metadata>
	<form>
		<distribution-code display="yes">I</distribution-code>
		<congress>110th CONGRESS</congress>
		<session>1st Session</session>
		<legis-num>H. R. 2860</legis-num>
		<current-chamber>IN THE HOUSE OF REPRESENTATIVES</current-chamber>
		<action>
			<action-date date="20070626">June 26, 2007</action-date>
			<action-desc><sponsor name-id="P000422">Mr. Pomeroy</sponsor> (for
			 himself, <cosponsor name-id="W000791">Mr. Walden of Oregon</cosponsor>,
			 <cosponsor name-id="S001045">Mr. Stupak</cosponsor>,
			 <cosponsor name-id="E000172">Mrs. Emerson</cosponsor>,
			 <cosponsor name-id="T000460">Mr. Thompson of California</cosponsor>,
			 <cosponsor name-id="M000934">Mr. Moran of Kansas</cosponsor>,
			 <cosponsor name-id="K000188">Mr. Kind</cosponsor>, <cosponsor name-id="P000263">Mr. Peterson of Pennsylvania</cosponsor>,
			 <cosponsor name-id="A000357">Mr. Allen</cosponsor>,
			 <cosponsor name-id="B000420">Mr. Berry</cosponsor>,
			 <cosponsor name-id="C000071">Mr. Camp of Michigan</cosponsor>,
			 <cosponsor name-id="H001037">Ms. Herseth Sandlin</cosponsor>,
			 <cosponsor name-id="M000485">Mr. McIntyre</cosponsor>,
			 <cosponsor name-id="T000038">Mr. Tanner</cosponsor>,
			 <cosponsor name-id="B000490">Mr. Bishop of Georgia</cosponsor>,
			 <cosponsor name-id="B000652">Mr. Boswell</cosponsor>,
			 <cosponsor name-id="B000716">Mr. Boyd of Florida</cosponsor>,
			 <cosponsor name-id="B000657">Mr. Boucher</cosponsor>,
			 <cosponsor name-id="B001258">Mrs. Boyda of Kansas</cosponsor>,
			 <cosponsor name-id="B001259">Mr. Braley of Iowa</cosponsor>,
			 <cosponsor name-id="C001065">Mr. Carney</cosponsor>,
			 <cosponsor name-id="D000602">Mr. Davis of Alabama</cosponsor>,
			 <cosponsor name-id="E000063">Mr. Edwards</cosponsor>,
			 <cosponsor name-id="E000226">Mr. Etheridge</cosponsor>,
			 <cosponsor name-id="G000180">Mr. Gilchrest</cosponsor>,
			 <cosponsor name-id="G000546">Mr. Graves</cosponsor>,
			 <cosponsor name-id="H001040">Mr. Hare</cosponsor>, <cosponsor name-id="H000329">Mr. Hastings of Washington</cosponsor>,
			 <cosponsor name-id="H000627">Mr. Hinchey</cosponsor>,
			 <cosponsor name-id="J000032">Ms. Jackson-Lee of Texas</cosponsor>,
			 <cosponsor name-id="J000255">Mr. Jones of North Carolina</cosponsor>,
			 <cosponsor name-id="K000008">Mr. Kanjorski</cosponsor>,
			 <cosponsor name-id="L000552">Mr. LaHood</cosponsor>,
			 <cosponsor name-id="L000491">Mr. Lucas</cosponsor>,
			 <cosponsor name-id="M001142">Mr. Matheson</cosponsor>,
			 <cosponsor name-id="M000472">Mr. McHugh</cosponsor>,
			 <cosponsor name-id="M001159">Mrs. McMorris Rodgers</cosponsor>,
			 <cosponsor name-id="M000590">Mr. McNulty</cosponsor>,
			 <cosponsor name-id="M001161">Mr. Melancon</cosponsor>,
			 <cosponsor name-id="O000006">Mr. Oberstar</cosponsor>,
			 <cosponsor name-id="P000583">Mr. Paul</cosponsor>, <cosponsor name-id="P000323">Mr. Pickering</cosponsor>, <cosponsor name-id="R000011">Mr.
			 Rahall</cosponsor>, <cosponsor name-id="R000571">Mr. Rehberg</cosponsor>,
			 <cosponsor name-id="R000574">Mr. Renzi</cosponsor>,
			 <cosponsor name-id="S001158">Mr. Salazar</cosponsor>,
			 <cosponsor name-id="S001148">Mr. Simpson</cosponsor>,
			 <cosponsor name-id="T000260">Mr. Tiahrt</cosponsor>,
			 <cosponsor name-id="W000800">Mr. Welch of Vermont</cosponsor>,
			 <cosponsor name-id="W000801">Mr. Wilson of Ohio</cosponsor>,
			 <cosponsor name-id="Y000033">Mr. Young of Alaska</cosponsor>,
			 <cosponsor name-id="T000238">Mr. Thornberry</cosponsor>, and
			 <cosponsor name-id="R000573">Mr. Ross</cosponsor>) introduced the following
			 bill; which was referred to the <committee-name committee-id="HIF00">Committee
			 on Energy and Commerce</committee-name>, and in addition to the Committee on
			 <committee-name committee-id="HWM00">Ways and Means</committee-name>, for a
			 period to be subsequently determined by the Speaker, in each case for
			 consideration of such provisions as fall within the jurisdiction of the
			 committee concerned</action-desc>
		</action>
		<legis-type>A BILL</legis-type>
		<official-title>To amend title XVIII of the Social Security Act to
		  protect and preserve access of Medicare beneficiaries in rural areas to health
		  care providers under the Medicare Program, and for other
		  purposes.</official-title>
	</form>
	<legis-body id="H6DDD203928A4461090F0AEE8CA15DF2" style="OLC">
		<section display-inline="no-display-inline" id="H7247CA88F6924C4D9CD4DF96B5CA1F" section-type="section-one"><enum>1.</enum><header>Short title; table of
			 contents</header>
			<subsection id="H9156FD1D5F28447E86340644E76FFA16"><enum>(a)</enum><header>Short
			 title</header><text>This Act may be cited as the <quote><short-title>Health Care Access and Rural Equity (H–CARE) Act of
			 2007</short-title></quote>.</text>
			</subsection><subsection id="H960DBBA1E70C4309B3AAC4ED5EEA53D"><enum>(b)</enum><header>Table of
			 Contents</header><text>The table of contents of this Act is as follows:</text>
				<toc container-level="legis-body-container" lowest-bolded-level="division-lowest-bolded" lowest-level="section" quoted-block="no-quoted-block" regeneration="yes-regeneration">
					<toc-entry idref="H7247CA88F6924C4D9CD4DF96B5CA1F" level="section">Sec. 1. Short title; table of contents.</toc-entry>
					<toc-entry idref="H1717C5D7C64943D4B7CEE4046FD0011" level="title">Title I—Medicare Hospital Services</toc-entry>
					<toc-entry idref="HCE6E1869AB064D5F81E8007B613CBA2F" level="section">Sec. 101. Fairness in the Medicare disproportionate share
				hospital (DSH) adjustment for rural hospitals.</toc-entry>
					<toc-entry idref="HA58DD66B19614C2593BC43A9AEEA73BE" level="section">Sec. 102. Treatment of Medicare hospital
				reclassifications.</toc-entry>
					<toc-entry idref="H527AA8006C4B4A92AE94846600DC2E73" level="section">Sec. 103. Critical access hospital improvements.</toc-entry>
					<toc-entry idref="HA3D52906E6CB41728B6E3B17C7764961" level="section">Sec. 104. Rebasing for sole community hospitals.</toc-entry>
					<toc-entry idref="HED0DC03A925C4CD5A821D56512668DB6" level="section">Sec. 105. Establishment of rural community hospital (RCH)
				program.</toc-entry>
					<toc-entry idref="HAB7EFACD2D9F4124AE4F4B4464BE2954" level="section">Sec. 106. Hold harmless through 2012 for small rural hospitals
				and sole community hospitals under the prospective payment system for hospital
				outpatient department services under the Medicare program.</toc-entry>
					<toc-entry idref="HC97C7DBCE7EC41C200B300E43D2E90A8" level="title">Title II—Medicare Practitioner Services</toc-entry>
					<toc-entry idref="H239C156394FD4E65912BFF00C2E3A271" level="section">Sec. 201. Coverage of marriage and family therapist services
				and mental health counselor services under part
				<enum-in-header>B</enum-in-header> of the Medicare program.</toc-entry>
					<toc-entry idref="H616ACF9F6AF349A59129443C63C9F372" level="section">Sec. 202. Permanent treatment of certain physician pathology
				services under Medicare.</toc-entry>
					<toc-entry idref="HEE58901B7B66453E805FFBCA06C91C6" level="section">Sec. 203. Extension of Medicare incentive payment program for
				physician scarcity areas.</toc-entry>
					<toc-entry idref="H2CE013DE849A4F81A2CA8BBDF6EC3D34" level="section">Sec. 204. Extension of Medicare increase payments for ground
				ambulance services in rural areas.</toc-entry>
					<toc-entry idref="H931F9D0B71C54AC000E1FA2995A7FAEC" level="section">Sec. 205. Extension of floor on Medicare work geographic
				adjustment.</toc-entry>
					<toc-entry idref="HC2C2FA34429D444FBF1E7F631ED9B7E6" level="title">Title III—Other Medicare Provisions</toc-entry>
					<toc-entry idref="HF1B894D8DEEE4605855C49033CCD8C40" level="section">Sec. 301. Ensuring proportional representation of interests of
				rural areas on MedPAC.</toc-entry>
					<toc-entry idref="HF77153A49F044FC3A3B6AE12AE3000DF" level="section">Sec. 302. Rural health clinic improvements.</toc-entry>
					<toc-entry idref="H91825F9C79604FDBAD3D668391831FAC" level="section">Sec. 303. Use of medical conditions for coding ambulance
				services.</toc-entry>
					<toc-entry idref="H9624B5C4EFC5400995BA2F9EB8F93EF3" level="section">Sec. 304. Improvement in payments to retain emergency and other
				capacity for ambulances in rural areas.</toc-entry>
					<toc-entry idref="H13892689A75A4738B64DE724C1152438" level="section">Sec. 305. Medicare remote monitoring pilot
				projects.</toc-entry>
					<toc-entry idref="HEAC224F544194D89A1D71E67F85DFE88" level="section">Sec. 306. Minimum payment rate by Medicare Advantage
				organizations for services furnished by a critical access hospital and a rural
				health clinic.</toc-entry>
					<toc-entry idref="H3B4BCCE5E404478A9BDC553C42C7F3E3" level="section">Sec. 307. Prompt payment by Medicare prescription drug plans
				and MA–PD plans under part D.</toc-entry>
					<toc-entry idref="H927A8996544E496FA1C700CA6DCA5217" level="section">Sec. 308. Extension of Medicare reasonable costs payments for
				certain clinical diagnostic laboratory tests furnished to hospital patients in
				certain rural areas.</toc-entry>
					<toc-entry idref="HFDC3C65E013545CABC6FCC1E5C704B80" level="section">Sec. 309. Extension of temporary Medicare payment increase for
				home health services furnished in a rural area.</toc-entry>
					<toc-entry idref="H9CDD3CB0B123473EA68DF206C3CC6597" level="title">Title IV—Other Provisions</toc-entry>
					<toc-entry idref="H79D6EED8AF6C448E848150FD4EEE6F5D" level="section">Sec. 401. Health information technology grants for rural health
				care providers.</toc-entry>
					<toc-entry idref="H94F32465756246E7AF7DABB23FCF5834" level="section">Sec. 402. Rural health quality advisory commission and
				demonstration projects.</toc-entry>
					<toc-entry idref="H8403C84486DF47BCA8625968EB463F9" level="section">Sec. 403. Rural health care services.</toc-entry>
					<toc-entry idref="H2BC477912F8F4CB6B57131E9AE6E52D0" level="section">Sec. 404. Community health center collaborative access
				expansion.</toc-entry>
					<toc-entry idref="H6BF8C633E42D4DFD9813D856E90019EE" level="section">Sec. 405. Facilitating the provision of telehealth services
				across State lines.</toc-entry>
					<toc-entry idref="H4602E1219E3F4683A03F62877985DD07" level="section">Sec. 406. Expanded application of the 340B program to drugs
				provided in rural hospitals.</toc-entry>
				</toc>
			</subsection></section><title id="H1717C5D7C64943D4B7CEE4046FD0011"><enum>I</enum><header>Medicare Hospital
			 Services</header>
			<section id="HCE6E1869AB064D5F81E8007B613CBA2F"><enum>101.</enum><header>Fairness in the
			 Medicare disproportionate share hospital (DSH) adjustment for rural
			 hospitals</header><text display-inline="no-display-inline">Section
			 1886(d)(5)(F)(xiv)(II) of the <act-name parsable-cite="SSA">Social Security
			 Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(d)(5)(F)(xiv)(II)</external-xref>) is amended—</text>
				<paragraph id="H6C23F45ADF2D4B40BFC4559BDD01B959"><enum>(1)</enum><text>by striking
			 <quote>or, in the case</quote> and all that follows through <quote>subparagraph
			 (G)(iv)</quote>; and</text>
				</paragraph><paragraph id="HD1E51F3F0D694467A52D09E348084BFC"><enum>(2)</enum><text display-inline="yes-display-inline">by inserting at the end the following new
			 sentence: <quote>The preceding sentence shall not apply to any hospital with
			 respect to discharges occurring on or after October 1, 2007.</quote>.</text>
				</paragraph></section><section display-inline="no-display-inline" id="HA58DD66B19614C2593BC43A9AEEA73BE" section-type="subsequent-section"><enum>102.</enum><header>Treatment of
			 Medicare hospital reclassifications</header>
				<subsection id="HFC32910EA8754BA797B709A41FE0729C"><enum>(a)</enum><header>Extending
			 certain Medicare hospital wage index reclassifications through fiscal year
			 2010</header>
					<paragraph id="HC517C6DEA4B94306B83C32298438A12E"><enum>(1)</enum><header>In
			 general</header><text>Section 106(a) of the Medicare Improvements and Extension
			 Act of 2006 (division B of public Law 109–432) is amended by striking
			 <quote>September 30, 2007</quote> and inserting <quote>September 30,
			 2010</quote>.</text>
					</paragraph><paragraph id="H6FDA6E9DC9374D89B025E213B11F3E23"><enum>(2)</enum><header>Special
			 exception reclassifications</header><text display-inline="yes-display-inline">The Secretary of Health and Human Services
			 shall extend for discharges occurring through September 30, 2013, the special
			 exception reclassification of a sole community hospital located in a State with
			 less than 10 people per square mile, made under the authority of section
			 1886(d)(5)(I)(i) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(d)(5)(I)(i)</external-xref>) and
			 contained in the final rule promulgated by the Secretary in the Federal
			 Register on August 11, 2004 (69 Fed. Reg. 49107).</text>
					</paragraph></subsection><subsection id="H6765D769796D4378B208041000D5E032"><enum>(b)</enum><header>Disregarding
			 section 508 hospital reclassifications for purposes of group
			 reclassifications</header><text display-inline="yes-display-inline">Section 508
			 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003
			 (<external-xref legal-doc="public-law" parsable-cite="pl/108/173">Public Law 108–173</external-xref>, <external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww</external-xref> note) is amended by adding at the end the
			 following new subsection:</text>
					<quoted-block display-inline="no-display-inline" id="H24C9F9F261314D84008B4FDB99B9EDB2" style="OLC">
						<subsection id="H458103DDADC14A02B6273DD89E00FB2"><enum>(g)</enum><header>Disregarding
				hospital reclassifications for purposes of group
				reclassifications</header><text>For purposes of the reclassification of a group
				of hospitals in a geographic area under section 1886(d), a hospital
				reclassified under this section (including any such reclassification which is
				extended under section 106(a) of the Medicare Improvements and Extension Act of
				2006) shall not be taken into account and shall not prevent the other hospitals
				in such area from establishing such a group for such
				purpose.</text>
						</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
				</subsection></section><section id="H527AA8006C4B4A92AE94846600DC2E73"><enum>103.</enum><header>Critical access
			 hospital improvements</header>
				<subsection id="HD12864BCA64F49108B4100D7DF518905"><enum>(a)</enum><header>Clarification of
			 payment for clinical laboratory tests furnished by critical access
			 hospitals</header>
					<paragraph id="H94677A2683364DAD9FECD8CBCE43FF8"><enum>(1)</enum><header>In
			 general</header><text>Section 1834(g)(4) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(g)(4)</external-xref>) is
			 amended—</text>
						<subparagraph id="H4594A318F7614127B697EA6D00C63624"><enum>(A)</enum><text>in the heading, by
			 striking <quote><header-in-text level="paragraph" style="OLC">no beneficiary
			 cost-sharing</header-in-text></quote> and inserting <quote><header-in-text level="paragraph" style="OLC">treatment of</header-in-text></quote>; and</text>
						</subparagraph><subparagraph id="H2117CFC7C2C44F778B15EB7706BD95AC"><enum>(B)</enum><text>by adding at the
			 end the following new sentence: “For purposes of the preceding sentence and
			 section 1861(mm)(3), clinical diagnostic laboratory services furnished by a
			 critical access hospital shall be treated as being furnished as part of
			 outpatient critical access services without regard to whether—</text>
							<quoted-block id="HD93CAE8E7BBD4E08BFC485591BEFC431">
								<subparagraph id="HF34A31450CBE401C81931101BBD80059"><enum>(A)</enum><text>the individual
				with respect to whom such services are furnished is physically present in the
				critical access hospital at the time the specimen is collected;</text>
								</subparagraph><subparagraph id="H7D9611EB9877434C9D772EEFBA6D64AF"><enum>(B)</enum><text>such individual is
				registered as an outpatient on the records of, and receives such services
				directly from, the critical access hospital; or</text>
								</subparagraph><subparagraph id="H1619FDBF34F6460E83F318C343042400"><enum>(C)</enum><text>payment is (or,
				but for this subsection, would be) available for such services under the fee
				schedule established under section
				1833(h).</text>
								</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
						</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HC14161E6A8DF4163A6688D412DF7D1CC"><enum>(2)</enum><header>Effective
			 date</header><text>The amendments made by paragraph (1) shall apply to cost
			 reporting periods beginning on or after October 1, 2003.</text>
					</paragraph></subsection><subsection id="H873A065F51C64B10B3B288CC9EC00B"><enum>(b)</enum><header>Elimination of
			 isolation Test for cost-based ambulance reimbursement</header>
					<paragraph id="H35FC2713757A40D1ADF737087433BFD"><enum>(1)</enum><header>In
			 general</header><text>Section 1834(l)(8) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(l)(8)</external-xref>) is
			 amended—</text>
						<subparagraph id="H198F4DDEC29F4BB79C8D4CE58F5C3643"><enum>(A)</enum><text>in subparagraph
			 (B)—</text>
							<clause id="H61C31926E5344DBCB0277F29749D6BC5"><enum>(i)</enum><text>by
			 striking <quote>owned and</quote>; and</text>
							</clause><clause id="H7B34ADFE8D544642AA37E411419EAD31"><enum>(ii)</enum><text>by
			 inserting <quote>(including when such services are provided by the entity under
			 an arrangement with the hospital)</quote> after <quote>hospital</quote>;
			 and</text>
							</clause></subparagraph><subparagraph id="H34A7B236F3E848C781C58FDC82632094"><enum>(B)</enum><text>by striking the
			 comma at the end of subparagraph (B) and all that follows and inserting a
			 period.</text>
						</subparagraph></paragraph><paragraph id="HFBE682ECE52641EAA1D5C81F3015EEC8"><enum>(2)</enum><header>Effective
			 date</header><text>The amendments made by this subsection shall apply to
			 services furnished on or after January 1, 2008.</text>
					</paragraph></subsection><subsection display-inline="no-display-inline" id="HA5EB37F7C9304C75A5B15FB5ADD29E16"><enum>(c)</enum><header>Provision of a
			 more flexible alternative to the CAH designation 25 inpatient bed limit
			 requirement</header>
					<paragraph id="H1B80661DD40F40D3A68226F6FB785391"><enum>(1)</enum><header>In
			 general</header><text>Section 1820(c)(2) of the Social Security Act (42 U.S.C.
			 1395i–4(c)(2)) is amended—</text>
						<subparagraph id="H315D78CA9B134CABBFFA258C3994FFC5"><enum>(A)</enum><text>in subparagraph
			 (B)(iii), by striking <quote>provides not more than</quote> and inserting
			 <quote>subject to subparagraph (F), provides not more than</quote>; and</text>
						</subparagraph><subparagraph id="H922E5CB3320B4DC999C829259C45EB38"><enum>(B)</enum><text>by adding at the
			 end the following new subparagraph:</text>
							<quoted-block display-inline="no-display-inline" id="H93CF5E7B28934909BF002286EC7580F3" style="OLC">
								<subparagraph id="HD01DB690178B40E19BF6139629DE1F00"><enum>(F)</enum><header>Alternative to
				25 inpatient bed limit requirement</header>
									<clause id="H58AD16730125483B87F56853F7FA6728"><enum>(i)</enum><header>In
				general</header><text display-inline="yes-display-inline">A State may elect to
				treat a facility, with respect to the designation of the facility for a cost
				reporting period, as satisfying the requirement of subparagraph (B)(iii)
				relating to a maximum number of acute care inpatient beds if the facility
				elects, in accordance with a method specified by the Secretary and before the
				beginning of the cost reporting period, to meet the requirement under clause
				(ii).</text>
									</clause><clause id="H4FF7B438F3EC4EF8ABCA13A534D8CD40"><enum>(ii)</enum><header>Alternate
				requirement</header><text>The requirement under this clause, with respect to a
				facility and a cost reporting period, is that the total number of inpatient bed
				days described in subparagraph (B)(iii) during such period will not exceed
				7,300. For purposes of this subparagraph, an individual who is an inpatient in
				a bed in the facility for a single day shall be counted as one inpatient bed
				day.</text>
									</clause><clause id="HAFE63455DF3E4608A994B33C7D00A3C3"><enum>(iii)</enum><header>Withdrawal of
				election</header><text>The option described in clause (i) shall not apply to a
				facility for a cost reporting period if the facility (for any two consecutive
				cost reporting periods during the previous 5 cost reporting periods) was
				treated under such option and had a total number of inpatient bed days for each
				of such two cost reporting periods that exceeded the number specified in such
				clause.</text>
									</clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
						</subparagraph></paragraph><paragraph id="H38B3B10BE3DB4B9D963E15FF8351AA91"><enum>(2)</enum><header>Effective
			 date</header><text>The amendments made by paragraph (1) shall apply to cost
			 reporting periods beginning on or after the date of the enactment of this
			 Act.</text>
					</paragraph></subsection></section><section display-inline="no-display-inline" id="HA3D52906E6CB41728B6E3B17C7764961" section-type="subsequent-section"><enum>104.</enum><header>Rebasing for sole
			 community hospitals</header>
				<subsection id="HEC777B5FD75A4D060000878D78EE262E"><enum>(a)</enum><header>Rebasing
			 permitted</header><text display-inline="yes-display-inline">Section 1886(b)(3)
			 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(b)(3)</external-xref>) is amended by adding at the
			 end the following new subparagraph:</text>
					<quoted-block display-inline="no-display-inline" id="HCB1B772797C74705A34BD366638602FE" other-style="archaic" style="other">
						<subparagraph id="H068B8AD8542C4DE682AC49C14D53F61" indent="up2"><enum>(K)</enum><clause commented="no" display-inline="yes-display-inline" id="HB1E96DA556F741A6B4BF3D1096EDAC4D"><enum>(i)</enum><text display-inline="yes-display-inline">For cost reporting periods beginning on or
				after October 1, 2007, in the case of a sole community hospital there shall be
				substituted for the amount otherwise determined under subsection (d)(5)(D)(i)
				of this section, if such substitution results in a greater amount of payment
				under this section for the hospital—</text>
								<subclause id="H51AD6CD61BFA4746815442870095CB4D" indent="up1"><enum>(I)</enum><text display-inline="yes-display-inline">with respect to discharges occurring in
				fiscal year 2008, 75 percent of the subsection (d)(5)(D)(i) amount (as
				described in subparagraph (I)(i)(I)) and 25 percent of the subparagraph (K)
				rebased target amount (as defined in clause (ii));</text>
								</subclause><subclause id="HF0A4B9876D2A47F481B19500E8B9E07B" indent="up1"><enum>(II)</enum><text display-inline="yes-display-inline">with respect to discharges occurring in
				fiscal year 2009, 50 percent of the subsection (d)(5)(D)(i) amount and 50
				percent of the subparagraph (K) rebased target amount;</text>
								</subclause><subclause id="H5C1020D2DD8C438A9100E800BAD828F" indent="up1"><enum>(III)</enum><text>with respect to discharges occurring
				in fiscal year 2010, 25 percent of the subsection (d)(5)(D)(i) amount and 75
				percent of the subparagraph (K) rebased target amount; and</text>
								</subclause><subclause id="H1978C7E30A2A4586A12C0008BD59657" indent="up1"><enum>(IV)</enum><text display-inline="yes-display-inline">with respect to discharges occurring after
				fiscal year 2010, 100 percent of the subparagraph (K) rebased target
				amount.</text>
								</subclause></clause><clause id="H49EED55C1A854CC182054229DCBFBED9" indent="up1"><enum>(ii)</enum><text display-inline="yes-display-inline">For purposes of this subparagraph, the
				<quote>subparagraph (K) rebased target amount</quote> has the meaning given the
				term <term>target amount</term> in subparagraph (C), except that—</text>
								<subclause id="H1EC9DD8607424F2FBB222CC88D203B99"><enum>(I)</enum><text display-inline="yes-display-inline">there shall be substituted for the base
				cost reporting period the 12-month cost reporting period beginning during
				fiscal year 2002;</text>
								</subclause><subclause id="H2B5C70ACE6AA403DA7A3301884489D8D"><enum>(II)</enum><text display-inline="yes-display-inline">any reference in subparagraph (C)(i) to the
				<quote>first cost reporting period</quote> described in such subparagraph is
				deemed a reference to the first cost reporting period beginning on or after
				October 1, 2007; and</text>
								</subclause><subclause id="HBDD828E781394EBFBF693CE797DA2447"><enum>(III)</enum><text display-inline="yes-display-inline">the applicable percentage increase shall
				only be applied under subparagraph (C)(iv) for discharges occurring in fiscal
				years beginning with fiscal year
				2009.</text>
								</subclause></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
				</subsection><subsection id="H133224BE507A4DCC99EB60408415D2F4"><enum>(b)</enum><header>Conforming
			 amendments</header><text>Section 1886(b)(3) of such Act (42 U.S.C.
			 1395ww(b)(3)) is amended—</text>
					<paragraph id="H9E85DAC5789E4F9B87611296A3000400"><enum>(1)</enum><text>in subparagraph
			 (C), by inserting <quote>and subparagraph (K)</quote> after <quote>subject to
			 subparagraph (I)</quote> in the matter preceding clause (i); and</text>
					</paragraph><paragraph id="H81CECEE782354F69BCE00BD171BE4BD"><enum>(2)</enum><text>in
			 subparagraph (I)(i)—</text>
						<subparagraph id="HADC1986C49E44C26B049062DD73CE8DB"><enum>(A)</enum><text>by striking
			 <quote>For</quote> in the matter preceding subclause (I) and inserting
			 <quote>Subject to subparagraph (K), for</quote>; and</text>
						</subparagraph><subparagraph id="HD1106E45369D41A9B7B27EBB94E3F3DD"><enum>(B)</enum><text>in subclause (I),
			 by inserting <quote>and subparagraph (K)</quote> after <quote>referred to in
			 this clause</quote>.</text>
						</subparagraph></paragraph></subsection></section><section display-inline="no-display-inline" id="HED0DC03A925C4CD5A821D56512668DB6" section-type="subsequent-section"><enum>105.</enum><header>Establishment of
			 rural community hospital (RCH) program</header>
				<subsection id="H5BFCB99272FA4693B9F8E1B33DA6823C"><enum>(a)</enum><header>In
			 general</header><text>Section 1861 of the Social Security Act (42 U.S.C.
			 1395x), as amended by section 201, is amended by adding at the end of the
			 following new subsection:</text>
					<quoted-block act-name="" display-inline="no-display-inline" id="H07943D1EDEEB411E8CD3CBC687B04317" other-style="archaic" style="other">
						<subsection id="H78FF97B1154F4167B10053CAAFF49B8"><enum>(ddd)</enum><header>Rural community Hospital; Rural Community Hospital
		  Services</header><paragraph commented="no" display-inline="yes-display-inline" id="H326A3D00AB7047EAA1D5C1A8E00C6FD"><enum>(1)</enum><text>The term <term>rural
				community hospital</term> means a hospital (as defined in subsection (e))
				that—</text>
								<subparagraph id="H6B522EFD2B7644EE95D80200C96FE22D" indent="up1"><enum>(A)</enum><text>is located in a rural area (as defined
				in section 1886(d)(2)(D)) or treated as being so located pursuant to section
				1886(d)(8)(E);</text>
								</subparagraph><subparagraph id="HA38DD63BF3A04C4FB5866F92699BA241" indent="up1"><enum>(B)</enum><text>subject to paragraph (2), has less
				than 51 acute care inpatient beds, as reported in its most recent cost
				report;</text>
								</subparagraph><subparagraph id="HCADA9607503841A4A213188FFCE389E1" indent="up1"><enum>(C)</enum><text>makes available 24-hour emergency care
				services;</text>
								</subparagraph><subparagraph id="H5AD5BB6A280D4C648198F8D5BA1E26D5" indent="up1"><enum>(D)</enum><text>subject to paragraph (3), has a
				provider agreement in effect with the Secretary and is open to the public as of
				January 1, 2008; and</text>
								</subparagraph><subparagraph id="H2201EB384E774DC98D2F50E64F39992B" indent="up1"><enum>(E)</enum><text>applies to the Secretary for such
				designation.</text>
								</subparagraph></paragraph><paragraph id="H9C561754748F43129DAEEC9E13F62EE" indent="up1"><enum>(2)</enum><text>For purposes of paragraph (1)(B),
				beds in a psychiatric or rehabilitation unit of the hospital which is a
				distinct part of the hospital shall not be counted.</text>
							</paragraph><paragraph id="HF6B006D316164C049B81411328E5FE70" indent="up1"><enum>(3)</enum><text>Subparagraph (1)(D) shall not be
				construed to prohibit any of the following from qualifying as a rural community
				hospital:</text>
								<subparagraph id="HA4BA27F8DE1747D487D6E8954DD718A4"><enum>(A)</enum><text>A replacement facility (as defined by
				the Secretary in regulations in effect on January 1, 2008) with the same
				service area (as defined by the Secretary in regulations in effect on such
				date).</text>
								</subparagraph><subparagraph id="HCC3EB3A9BBB44B79BF43A7BA204217D6"><enum>(B)</enum><text>A facility obtaining a new provider
				number pursuant to a change of ownership.</text>
								</subparagraph><subparagraph id="H4B94280EC3C94ED2805C512300AFC678"><enum>(C)</enum><text>A facility which has a binding written
				agreement with an outside, unrelated party for the construction,
				reconstruction, lease, rental, or financing of a building as of January 1,
				2008.</text>
								</subparagraph></paragraph><paragraph id="H83FB1CA5972F48088256C35D93B096D0" indent="up1"><enum>(4)</enum><text>Nothing in this subsection shall be
				construed as prohibiting a critical access hospital from qualifying as a rural
				community hospital if the critical access hospital meets the conditions
				otherwise applicable to hospitals under subsection (e) and section 1866.</text>
							</paragraph><paragraph id="H8056AF6E4E6840E992E23ECD2C5C2C" indent="up1"><enum>(5)</enum><text>Nothing in this subsection shall be
				construed as prohibiting a rural community hospital participating in the
				demonstration program under Section 410A of the Medicare Prescription Drug,
				Improvement, and Modernization Act of 2003 (<external-xref legal-doc="public-law" parsable-cite="pl/108/173">Public Law 108–173</external-xref>; 117 Stat. 2313)
				from qualifying as a rural community hospital if the rural community hospital
				meets the conditions otherwise applicable to hospitals under subsection (e) and
				section
				1866.</text>
							</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
				</subsection><subsection id="H5AD2C6FCD3C64ED6B2ABDB8B5DB16370"><enum>(b)</enum><header>Payment</header>
					<paragraph id="H0BEC4B0488264BECA8D3C7EF605DEAFF"><enum>(1)</enum><header>Inpatient
			 hospital services</header><text>Section 1814 of the Social Security Act (42
			 U.S.C. 1395f) is amended by adding at the end the following new
			 subsection:</text>
						<quoted-block act-name="" display-inline="no-display-inline" id="H40E163EFF3054D4EA84EDEAADB5D283" other-style="archaic" style="other">
							<subsection id="H0B434DC64AFF4E2A9171F4C2AA4B392"><enum>(m)</enum><header>Payment for Inpatient Services Furnished in Rural Community
		  Hospitals</header><text>The amount of
				payment under this part for inpatient hospital services furnished in a rural
				community hospital, other than such services furnished in a psychiatric or
				rehabilitation unit of the hospital which is a distinct part, is, at the
				election of the hospital in the application referred to in section
				1861(ddd)(1)(E)—</text>
								<paragraph id="HFE41800384A54AFEAD68E6FD12C50290"><enum>(1)</enum><text>101 percent of the
				reasonable costs of providing such services, without regard to the amount of
				the customary or other charge, or</text>
								</paragraph><paragraph id="H73923BC91946499396386B864F81E797"><enum>(2)</enum><text>the amount of
				payment provided for under the prospective payment system for inpatient
				hospital services under section
				1886(d).</text>
								</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
					</paragraph><paragraph id="H62E7F016FA664FA78DC5C6BDE3E0E393"><enum>(2)</enum><header>Outpatient
			 services</header><text>Section 1834 of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m</external-xref>) is amended by
			 adding at the end the following new subsection:</text>
						<quoted-block display-inline="no-display-inline" id="HFCE6BAD8DC574581B2E61C8BA3E7B56" style="OLC">
							<subsection id="H43014169F650418B8762A7B2E9D95B8E"><enum>(n)</enum><header>Payment for
				outpatient services furnished in rural community hospitals</header><text>The
				amount of payment under this part for outpatient services furnished in a rural
				community hospital is, at the election of the hospital in the application
				referred to in section 1861(ddd)(1)(E)—</text>
								<paragraph id="H47F827AEB2B04E19AC67C3BCB37F72B"><enum>(1)</enum><text>101 percent of the
				reasonable costs of providing such services, without regard to the amount of
				the customary or other charge and any limitation under section 1861(v)(1)(U),
				or</text>
								</paragraph><paragraph id="HEC189048573F42D991BCAD2F4BD0080"><enum>(2)</enum><text>the amount of
				payment provided for under the prospective payment system for covered OPD
				services under section
				1833(t).</text>
								</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
					</paragraph><paragraph id="HBF8C18E12514412EB4F7006BB956DEF3"><enum>(3)</enum><header>Exemption from
			 30-percent reduction in reimbursement for bad debt</header><text>Section
			 1861(v)(1)(T) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(v)(1)(T)</external-xref>) is amended by inserting
			 <quote>(other than for a rural community hospital)</quote> after <quote>In
			 determining such reasonable costs for hospitals</quote>.</text>
					</paragraph></subsection><subsection id="H692FA9BB118C474BA403BB7575AE9098"><enum>(c)</enum><header>Beneficiary
			 cost-sharing for outpatient services</header><text>Section 1834(n) of such Act
			 (as added by subsection (b)(2)) is amended—</text>
					<paragraph id="H21F1E572F4C34F6E9391009761A7182C"><enum>(1)</enum><text>by redesignating
			 paragraphs (1) and (2) as subparagraphs (A) and (B), respectively;</text>
					</paragraph><paragraph id="HAC68E90DE9B04F03BB3E84421100CA9C"><enum>(2)</enum><text>by inserting
			 <quote>(1)</quote> after <quote>(n)</quote>; and</text>
					</paragraph><paragraph id="H62643A99F51C4CE1B2002145003EC894"><enum>(3)</enum><text>by adding at the
			 end the following:</text>
						<quoted-block display-inline="no-display-inline" id="H03903D1141CB4951AFB32D00AE002425" style="OLC">
							<paragraph id="HEBB1D0FC23AA43048FE9D971FB7D0400" indent="up1"><enum>(2)</enum><text>The amounts of beneficiary
				cost-sharing for outpatient services furnished in a rural community hospital
				under this part shall be as follows:</text>
								<subparagraph id="HA8108DC9885C42849D9BA6DC15B27598"><enum>(A)</enum><text>For items and services that would have
				been paid under section 1833(t) if provided by a hospital, the amount of
				cost-sharing determined under paragraph (8) of such section.</text>
								</subparagraph><subparagraph id="H514B086D4A1F4FFA8BD06532F136369B"><enum>(B)</enum><text>For items and services that would have
				been paid under section 1833(h) if furnished by a provider or supplier, no
				cost-sharing shall apply.</text>
								</subparagraph><subparagraph id="HD92E1DAF1D78420580A26B5555DEBC8D"><enum>(C)</enum><text>For all other items and services, the
				amount of cost-sharing that would apply to the item or service under the
				methodology that would be used to determine payment for such item or service if
				provided by a physician, provider, or supplier, as the case may
				be.</text>
								</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
					</paragraph></subsection><subsection id="H6003DFC4EF53402FB2C409B1A3316663"><enum>(d)</enum><header>Conforming
			 amendments</header>
					<paragraph id="H2F81776CF966416FA2EFE200F802BD8D"><enum>(1)</enum><header>Part a
			 payment</header><text>Section 1814(b) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395f">42 U.S.C. 1395f(b)</external-xref>) is
			 amended in the matter preceding paragraph (1) by inserting <quote>other than
			 inpatient hospital services furnished by a rural community hospital,</quote>
			 after <quote>critical access hospital services,</quote>.</text>
					</paragraph><paragraph id="HB3DA29B008744B70AF5BB9B23E9BC54"><enum>(2)</enum><header>Part B
			 payment</header><text>Section 1833(a) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(a)</external-xref>) is
			 amended—</text>
						<subparagraph id="HAEF06FC41D43410B866994FA75A5D100"><enum>(A)</enum><text>in paragraph (2),
			 in the matter before subparagraph (A), by striking <quote>and (I)</quote> and
			 inserting <quote>(I), and (K)</quote>;</text>
						</subparagraph><subparagraph id="H43118C276603483BA88CDCC6E855F79"><enum>(B)</enum><text>by striking
			 <quote>and</quote> at the end of paragraph (8);</text>
						</subparagraph><subparagraph id="H53EA7DF41D544AFF80EDCD27E8D90373"><enum>(C)</enum><text>by striking the
			 period at the end of paragraph (9) and inserting <quote>; and</quote>;
			 and</text>
						</subparagraph><subparagraph id="H46B7C86113AD4E62BEEE5A4E312FB00"><enum>(D)</enum><text>by adding at the
			 end the following:</text>
							<quoted-block display-inline="no-display-inline" id="H0BCAC4C4FE5D4A3C001C7899A249A99D" style="OLC">
								<paragraph id="HD8268F7BBCF6431DA9011784B83B4953"><enum>(10)</enum><text>in the case of
				outpatient services furnished by a rural community hospital, the amounts
				described in section
				1834(n).</text>
								</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
						</subparagraph></paragraph><paragraph id="H71090459B2394390B730F4AAB457E735"><enum>(3)</enum><header>Technical
			 amendments</header>
						<subparagraph id="H11EEC5B04FF343979E6BC767A9E3ADCE"><enum>(A)</enum><header>Consultation
			 with state agencies</header><text>Section 1863 of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395z">42 U.S.C. 1395z</external-xref>) is
			 amended by striking <quote>and (dd)(2)</quote> and inserting <quote>(dd)(2),
			 (mm)(1), and (ddd)(1)</quote>.</text>
						</subparagraph><subparagraph id="H0BA47F163F6D4F0080C558A42BA6CBC3"><enum>(B)</enum><header>Provider
			 agreements</header><text>Section 1866(a)(2)(A) of such Act (42 U.S.C.
			 1395cc(a)(2)(A)) is amended by inserting <quote>section 1834(n)(2),</quote>
			 after <quote>section 1833(b),</quote>.</text>
						</subparagraph></paragraph></subsection><subsection id="H9788CC94533A42FA804FD29671D1F59"><enum>(e)</enum><header>Effective
			 date</header><text>The amendments made by this section shall apply to items and
			 services furnished on or after October 1, 2007.</text>
				</subsection></section><section display-inline="no-display-inline" id="HAB7EFACD2D9F4124AE4F4B4464BE2954" section-type="subsequent-section"><enum>106.</enum><header>Hold harmless
			 through 2012 for small rural hospitals and sole community hospitals under the
			 prospective payment system for hospital outpatient department services under
			 the Medicare program</header><text display-inline="no-display-inline">Section
			 1833(t)(7)(D)(i) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(t)(7)(D)</external-xref>) is
			 amended—</text>
				<paragraph id="H1A8DBC7D16E64478A33392FE425ECB4"><enum>(1)</enum><text>in
			 subclause (II)—</text>
					<subparagraph id="HBF8AE201B64247C299DCDA735BFB5796"><enum>(A)</enum><text>by striking
			 <quote>January 1, 2009</quote> and inserting <quote>January 1,
			 2008</quote>;</text>
					</subparagraph><subparagraph id="H874A1DF6928341699FD54E4249EF3CDE"><enum>(B)</enum><text>by striking
			 <quote>2006, 2007, or 2008</quote> and inserting <quote>2006 or 2007</quote>;
			 and</text>
					</subparagraph><subparagraph id="H29B4F13E65B346609868F771F300D76F"><enum>(C)</enum><text>by striking
			 <quote>95 percent, 90 percent, and 85 percent</quote> and inserting <quote>95
			 percent and 90 percent</quote>; and</text>
					</subparagraph></paragraph><paragraph id="HF0F747EA83A34D13B3255FF3870018AB"><enum>(2)</enum><text>by adding at the
			 end the following new subclause:</text>
					<quoted-block display-inline="no-display-inline" id="H4346EB858A6046A988A54CE330CFC119" style="OLC">
						<clause id="H7549E307DB674DDE9CD14C4B58408BDA"><enum>(III)</enum><text display-inline="yes-display-inline">In the case of a hospital located in a
				rural area and that has not more than 100 beds or a sole community hospital (as
				defined in section 1886(d)(5)(D)(iii)), for covered OPD services furnished
				after December 31, 2007, and before January 1, 2013, for which the PPS amount
				is less than the pre-BBA amount, the amount of payment under this subsection
				shall be increased by the amount of such
				difference.</text>
						</clause><after-quoted-block>.</after-quoted-block></quoted-block>
				</paragraph></section></title><title id="HC97C7DBCE7EC41C200B300E43D2E90A8"><enum>II</enum><header>Medicare
			 Practitioner Services</header>
			<section id="H239C156394FD4E65912BFF00C2E3A271"><enum>201.</enum><header>Coverage of
			 marriage and family therapist services and mental health counselor services
			 under part <enum-in-header>B</enum-in-header> of the Medicare program</header>
				<subsection id="HD09C157980894B9F86D440290A9AC26"><enum>(a)</enum><header>Coverage of
			 Services</header>
					<paragraph id="H06F37398C02A46889CCE66BC54C1B100"><enum>(1)</enum><header>In
			 general</header><text>Section 1861(s)(2) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(s)(2)</external-xref>) is
			 amended—</text>
						<subparagraph id="H63667102FBBB4B4FB5C2CAD3003C6822"><enum>(A)</enum><text>in subparagraph
			 (Z), by striking <quote>and</quote> at the end;</text>
						</subparagraph><subparagraph id="H644214FBD9744D44005EE7D56ED40009"><enum>(B)</enum><text>in subparagraph
			 (AA), by inserting <quote>and</quote> at the end; and</text>
						</subparagraph><subparagraph id="H0C779F8BEDE943D3BB3F583B156E885E"><enum>(C)</enum><text>by adding at the
			 end the following new subparagraph:</text>
							<quoted-block id="H87C12BA2A948470B9F638D26D712C509" style="OLC">
								<subitem id="H8EBFA2232677442FA69900CAC7CC426C" indent="up5"><enum>(BB)</enum><text>marriage and family therapist
				services (as defined in subsection (ccc)(1)) and mental health counselor
				services (as defined in subsection
				(ccc)(3));</text>
								</subitem><after-quoted-block>.</after-quoted-block></quoted-block>
						</subparagraph></paragraph><paragraph id="H3537C4DA954B4D829DCF988EFF2DA12C"><enum>(2)</enum><header>Definitions</header><text>Section
			 1861 of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x</external-xref>) is amended by adding at the end the
			 following new subsection:</text>
						<quoted-block act-name="Social" id="H4C976295E17545FEAA1360006418117B" other-style="archaic" style="other"><subsection id="H730219F142E94C9FBF123DD9C88775E9"><enum>(ccc)</enum><header>Marriage and Family
		  Therapist Services; Marriage and Family Therapist; Mental Health Counselor
		  Services; Mental Health Counselor</header><paragraph commented="no" display-inline="yes-display-inline" id="H06D18C570A644548A5E78C00063FA5F"><enum>(1)</enum><text>The term <term>marriage
				and family therapist services</term> means services performed by a marriage and
				family therapist (as defined in paragraph (2)) for the diagnosis and treatment
				of mental illnesses, which the marriage and family therapist is legally
				authorized to perform under State law (or the State regulatory mechanism
				provided by State law) of the State in which such services are performed, as
				would otherwise be covered if furnished by a physician or as an incident to a
				physician’s professional service, but only if no facility or other provider
				charges or is paid any amounts with respect to the furnishing of such
				services.</text>
								</paragraph><paragraph id="H8C345CF750F0489F8F1773736958EDA" indent="up1"><enum>(2)</enum><text>The term <term>marriage and family
				therapist</term> means an individual who—</text>
									<subparagraph id="H8284E673042247B09D34BEC2D8E07B6D"><enum>(A)</enum><text>possesses a master’s or doctoral
				degree which qualifies for licensure or certification as a marriage and family
				therapist pursuant to State law;</text>
									</subparagraph><subparagraph id="HF3091C5AF78D48DC987301EA6CF19B06"><enum>(B)</enum><text>after obtaining such degree has
				performed at least 2 years of clinical supervised experience in marriage and
				family therapy; and</text>
									</subparagraph><subparagraph id="HB10D2D4E6EB0470DA4F669427F381D34"><enum>(C)</enum><text>in the case of an individual
				performing services in a State that provides for licensure or certification of
				marriage and family therapists, is licensed or certified as a marriage and
				family therapist in such State.</text>
									</subparagraph></paragraph><paragraph id="H6368D446E966427C9EA11597EBCACC48" indent="up1"><enum>(3)</enum><text>The term <term>mental health
				counselor services</term> means services performed by a mental health counselor
				(as defined in paragraph (4)) for the diagnosis and treatment of mental
				illnesses which the mental health counselor is legally authorized to perform
				under State law (or the State regulatory mechanism provided by the State law)
				of the State in which such services are performed, as would otherwise be
				covered if furnished by a physician or as incident to a physician’s
				professional service, but only if no facility or other provider charges or is
				paid any amounts with respect to the furnishing of such services.</text>
								</paragraph><paragraph id="H764E3F71358B43D78CA555CA3957AE23" indent="up1"><enum>(4)</enum><text>The term <term>mental health
				counselor</term> means an individual who—</text>
									<subparagraph id="HEF42CB9A3E1E41A3ABFBEDDDA320C7D3"><enum>(A)</enum><text>possesses a master’s or doctor’s
				degree in mental health counseling or a related field;</text>
									</subparagraph><subparagraph id="H4A5A771B878C468398F42EE359BB3D2"><enum>(B)</enum><text>after obtaining such a degree has
				performed at least 2 years of supervised mental health counselor practice;
				and</text>
									</subparagraph><subparagraph id="H38194A94D7B84D21838854F5544F69BC"><enum>(C)</enum><text>in the case of an individual
				performing services in a State that provides for licensure or certification of
				mental health counselors or professional counselors, is licensed or certified
				as a mental health counselor or professional counselor in such
				State.</text>
									</subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
					</paragraph><paragraph id="HAC7A88FC32F74B77BB8CAEA6C9CA6896"><enum>(3)</enum><header>Provision for
			 payment under part B</header><text>Section 1832(a)(2)(B) of such Act (42 U.S.C.
			 1395k(a)(2)(B)) is amended by adding at the end the following new
			 clause:</text>
						<quoted-block act-name="Social" id="HB3ADF853033D4034A2F5495001B7C56" style="OLC">
							<clause id="HD0ECBE15FFED43F2A66C4CD84551F8B5"><enum>(v)</enum><text>marriage and
				family therapist services and mental health counselor
				services;</text>
							</clause><after-quoted-block>.</after-quoted-block></quoted-block>
					</paragraph><paragraph id="HEAAEECB383404C43A185CC2C9BAE742"><enum>(4)</enum><header>Amount of
			 payment</header><text>Section 1833(a)(1) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(a)(1)</external-xref>) is
			 amended—</text>
						<subparagraph id="H3B29B06DE34447CE81EB40A12E471C8F"><enum>(A)</enum><text>by striking
			 <quote>and (V)</quote> and inserting <quote>(V)</quote>; and</text>
						</subparagraph><subparagraph id="H1558965A001247EF998704BA6E00805B"><enum>(B)</enum><text>by inserting
			 before the semicolon at the end the following: <quote>, and (W) with respect to
			 marriage and family therapist services and mental health counselor services
			 under section 1861(s)(2)(BB), the amounts paid shall be 80 percent of the
			 lesser of the actual charge for the services or 75 percent of the amount
			 determined for payment of a psychologist under subparagraph (L)</quote>.</text>
						</subparagraph></paragraph><paragraph id="HAAF93D31176D40128E7E8776D1ABCCB9"><enum>(5)</enum><header>Exclusion of
			 marriage and family therapist services and mental health counselor services
			 from skilled nursing facility prospective payment system</header><text>Section
			 1888(e)(2)(A)(ii) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395yy">42 U.S.C. 1395yy(e)(2)(A)(ii)</external-xref>) is amended by
			 inserting <quote>marriage and family therapist services (as defined in section
			 1861(ccc)(1)), mental health counselor services (as defined in section
			 1861(ccc)(3)),</quote> after <quote>qualified psychologist
			 services,</quote>.</text>
					</paragraph><paragraph id="H754254E23E2543E5A884B86F32E14DBE"><enum>(6)</enum><header>Inclusion of
			 marriage and family therapists and mental health counselors as practitioners
			 for assignment of claims</header><text>Section 1842(b)(18)(C) of such Act (42
			 U.S.C. 1395u(b)(18)(C)) is amended by adding at the end the following new
			 clauses:</text>
						<quoted-block act-name="Social" id="H2B4A423AD1BD4EDEA9EB7FB7D24C489" style="OLC">
							<clause id="H1C1D74FC8FA94E208EA342E2383D0877" indent="up2"><enum>(vii)</enum><text>A marriage and family therapist (as
				defined in section 1861(ccc)(2)).</text>
							</clause><clause id="HEE33EB05DB7444CBBA1F77548C6D5FCE" indent="up2"><enum>(viii)</enum><text>A mental health counselor (as
				defined in section
				1861(ccc)(4)).</text>
							</clause><after-quoted-block>.</after-quoted-block></quoted-block>
					</paragraph></subsection><subsection id="HB9BB90C2DA684EA6A979F8EE726D56BC"><enum>(b)</enum><header>Coverage of
			 Certain Mental Health Services Provided in Certain Settings</header>
					<paragraph id="H5A1924C892A744FE8600731C286500DD"><enum>(1)</enum><header>Rural health
			 clinics and federally qualified health centers</header><text>Section
			 1861(aa)(1)(B) of the <act-name parsable-cite="SSA">Social Security
			 Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(aa)(1)(B)</external-xref>) is amended by striking <quote>or by
			 a clinical social worker (as defined in subsection (hh)(1)),</quote> and
			 inserting <quote>, by a clinical social worker (as defined in subsection
			 (hh)(1)), by a marriage and family therapist (as defined in subsection
			 (ccc)(2)), or by a mental health counselor (as defined in subsection
			 (ccc)(4)),</quote>.</text>
					</paragraph><paragraph id="H0288BC6077C7434E885C6B0051EFAD8D"><enum>(2)</enum><header>Hospice
			 programs</header><text>Section 1861(dd)(2)(B)(i)(III) of such Act (42 U.S.C.
			 1395x(dd)(2)(B)(i)(III)) is amended by inserting <quote>or one marriage and
			 family therapist (as defined in subsection (ccc)(2))</quote> after
			 <quote>social worker</quote>.</text>
					</paragraph></subsection><subsection id="H67FEC598BFD446EFA445825D9695D562"><enum>(c)</enum><header>Authorization of
			 Marriage and Family Therapists To Develop Discharge Plans for Post-Hospital
			 Services</header><text>Section 1861(ee)(2)(G) of the
			 <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
			 1395x(ee)(2)(G)) is amended by inserting <quote>marriage and family therapist
			 (as defined in subsection (ccc)(2)),</quote> after <quote>social
			 worker,</quote>.</text>
				</subsection><subsection id="H8B4C315A6BFA41DBA2ADE5B4C7057FC"><enum>(d)</enum><header>Effective
			 Date</header><text>The amendments made by this section shall apply with respect
			 to services furnished on or after January 1, 2008.</text>
				</subsection></section><section display-inline="no-display-inline" id="H616ACF9F6AF349A59129443C63C9F372" section-type="subsequent-section"><enum>202.</enum><header>Permanent treatment
			 of certain physician pathology services under Medicare</header><text display-inline="no-display-inline">Section 1848(i) of the Social Security Act
			 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(i)</external-xref>) is amended by adding at the end the following new
			 paragraph:</text>
				<quoted-block id="H212EC36879654C40AA7C16BC00DBCC4" style="OLC">
					<paragraph id="HDD8C0A6E41AA40628B1EB004F84F559C"><enum>(4)</enum><header>Treatment of
				certain physician pathology services</header>
						<subparagraph id="H21E1969BAFF646098FD936F0F1476BB4"><enum>(A)</enum><header>In
				general</header><text>With respect to services furnished on or after January 1,
				2008, if an independent laboratory furnishes the technical component of a
				physician pathology service to a fee-for-service Medicare beneficiary who is an
				inpatient or outpatient of a covered hospital, the Secretary shall treat such
				component as a service for which payment shall be made to the laboratory under
				this section and not as an inpatient hospital service for which payment is made
				to the hospital under section 1886(d) or as a hospital outpatient service for
				which payment is made to the hospital under section 1833(t).</text>
						</subparagraph><subparagraph id="HB73238853A264961BBCFF0C43E5CEDCB"><enum>(B)</enum><header>Definitions</header><text>In
				this paragraph:</text>
							<clause id="H9B7E2739160B44DAB5C95B9ECD1F27BB"><enum>(i)</enum><header>Covered
				hospital</header>
								<subclause id="HCF00C4B39E4E4F3189E7241D74B895D8"><enum>(I)</enum><header>In
				general</header><text>The term <term>covered hospital</term> means, with
				respect to an inpatient or outpatient, a hospital that had an arrangement with
				an independent laboratory that was in effect as of July 22, 1999, under which a
				laboratory furnished the technical component of physician pathology services to
				fee-for-service Medicare beneficiaries who were hospital inpatients or
				outpatients, respectively, and submitted claims for payment for such component
				to a carrier with a contract under section 1842 and not to the hospital.</text>
								</subclause><subclause id="H494A1DF25BAA48F8A6A2C5BD491DC7D"><enum>(II)</enum><header>Change in
				ownership does not affect determination</header><text>A change in ownership
				with respect to a hospital on or after the date referred to in subclause (I)
				shall not affect the determination of whether such hospital is a covered
				hospital for purposes of such subclause.</text>
								</subclause></clause><clause id="H0ABC1D289D204130B3AC64CB6DE7B707"><enum>(ii)</enum><header>Fee-for-service
				Medicare beneficiary</header><text>The term <term>fee-for-service Medicare
				beneficiary</term> means an individual who is entitled to (or enrolled for)
				benefits under part A, or enrolled under this part, or both, but who is not
				enrolled in any of the following:</text>
								<subclause id="H3A25E4DA34C44D878733698418EA6DB0"><enum>(I)</enum><text>A Medicare
				Advantage plan under part C.</text>
								</subclause><subclause id="HBD110481AEBD4816AC5D70DE2E286000"><enum>(II)</enum><text>A plan offered by
				an eligible organization under section 1876.</text>
								</subclause><subclause id="HD11F7F24F9034D5A8CFFE02FB21072EB"><enum>(III)</enum><text>A program of
				all-inclusive care for the elderly (PACE) under section 1894.</text>
								</subclause><subclause id="H818EF7D5980748FD93A27430A7B53CB"><enum>(IV)</enum><text>A social health
				maintenance organization (SHMO) demonstration project established under section
				4018(b) of the Omnibus Budget Reconciliation Act of 1987 (Public Law
				100–203).</text>
								</subclause></clause></subparagraph><subparagraph id="H55FB010B30624349A10630005710C190"><enum>(C)</enum><header>Reference</header><text>For
				the provision related to the treatment of certain services furnished prior to
				January 1, 2008, see section 542 of the Medicare, Medicaid, and SCHIP Benefits
				Improvement and Protection Act of 2000, as amended by section 732 of the
				Medicare Prescription Drug, Improvement, and Modernization Act of 2003 and
				section 104 of the Medicare Improvements and Extension Act of 2006 (division B
				of Public Law
				109–432).</text>
						</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
			</section><section id="HEE58901B7B66453E805FFBCA06C91C6" section-type="subsequent-section"><enum>203.</enum><header>Extension of
			 Medicare incentive payment program for physician scarcity areas</header><text display-inline="no-display-inline">Section 1833(u)(1) of the Social Security
			 Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(u)(1)</external-xref>) is amended by striking <quote>2008</quote> and
			 inserting <quote>2013</quote>.</text>
			</section><section id="H2CE013DE849A4F81A2CA8BBDF6EC3D34" section-type="subsequent-section"><enum>204.</enum><header>Extension of
			 Medicare increase payments for ground ambulance services in rural
			 areas</header><text display-inline="no-display-inline">Section 1834(l)(13) of
			 the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(l)(13)</external-xref>) is amended—</text>
				<paragraph id="H492C144724FF47DCA68CB8678938BD4C"><enum>(1)</enum><text>in subparagraph
			 (A)—</text>
					<subparagraph id="HBA88D916F1134447A6689BC712F1F34D"><enum>(A)</enum><text>in the matter
			 before clause (i), by striking <quote>furnished on or after July 1, 2004, and
			 before January 1, 2007,</quote>;</text>
					</subparagraph><subparagraph id="HC133D281EAE54EB5B4CBC482B2B0594E"><enum>(B)</enum><text>in clause (i), by
			 inserting <quote>for services furnished on or after July 1, 2004, and before
			 January 1, 2012,</quote> after <quote>in such paragraph,</quote>; and</text>
					</subparagraph><subparagraph id="H947282BF955641268209086ED0729CEB"><enum>(C)</enum><text>in clause (ii), by
			 inserting <quote>for services furnished on or after July 1, 2004, and before
			 January 1, 2007,</quote> after <quote>in clause (i),</quote>; and</text>
					</subparagraph></paragraph><paragraph id="H882A59C318A74E39BC189B6DA0CE31B"><enum>(2)</enum><text>in
			 subparagraph (B)—</text>
					<subparagraph id="H5D46D4189B184DA58DC32D98D25848B5"><enum>(A)</enum><text>in the heading, by
			 striking <quote><header-in-text level="subparagraph" style="OLC">after
			 2006</header-in-text></quote> and inserting <quote><header-in-text level="subparagraph" style="OLC">for subsequent
			 periods</header-in-text></quote>;</text>
					</subparagraph><subparagraph id="H380F17AB6EF148358FA8007FA95B26F9"><enum>(B)</enum><text>by inserting
			 <quote>clauses (i) and (ii) of</quote> before <quote>subparagraph (A)</quote>;
			 and</text>
					</subparagraph><subparagraph id="HD8ACB18334DE4D458DDEF250BD2C1F44"><enum>(C)</enum><text>by striking
			 <quote>in such subparagraph</quote> and inserting <quote>in the respective
			 clause</quote>.</text>
					</subparagraph></paragraph></section><section id="H931F9D0B71C54AC000E1FA2995A7FAEC"><enum>205.</enum><header>Extension of
			 floor on Medicare work geographic adjustment</header><text display-inline="no-display-inline">Section 1848(e)(1)(E) of the Social Security
			 Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(e)(1)(E)</external-xref>) is amended by striking <quote>2008</quote> and
			 inserting <quote>2012</quote>.</text>
			</section></title><title id="HC2C2FA34429D444FBF1E7F631ED9B7E6"><enum>III</enum><header>Other Medicare
			 Provisions</header>
			<section display-inline="no-display-inline" id="HF1B894D8DEEE4605855C49033CCD8C40" section-type="subsequent-section"><enum>301.</enum><header>Ensuring
			 proportional representation of interests of rural areas on MedPAC</header>
				<subsection id="H92904D5AE99E460A00802D9B5123E2E5"><enum>(a)</enum><header>In
			 general</header><text>Section 1805(c)(2) of the Social Security Act (42 U.S.C.
			 1395b–6(c)(2)) is amended—</text>
					<paragraph id="H760B559B1F8B493281799E83D9116409"><enum>(1)</enum><text>in subparagraph
			 (A), by inserting <quote>consistent with subparagraph (E)</quote> after
			 <quote>rural representatives</quote>; and</text>
					</paragraph><paragraph id="HECD9DC76D9A24322A9F8B27B818E4D9C"><enum>(2)</enum><text>by adding at the
			 end the following new subparagraph:</text>
						<quoted-block display-inline="no-display-inline" id="HE28614618316419F82FAC917040069DD" style="OLC">
							<subparagraph id="H61A478016823480F81A4822F5BAEAD03"><enum>(E)</enum><header>Proportional
				representation of interests of rural areas</header><text display-inline="yes-display-inline">In order to provide a balance between urban
				and rural representatives under subparagraph (A), the proportion of members who
				represent the interests of health care providers and Medicare beneficiaries
				located in rural areas shall be no less than the proportion, of the total
				number of Medicare beneficiaries, who reside in rural
				areas.</text>
							</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
					</paragraph></subsection><subsection id="HDC6F9B3144D7433BB9406CB974597C40"><enum>(b)</enum><header>Effective
			 date</header><text>The amendments made by subsection (a) shall apply with
			 respect to appointments made to the Medicare Payment Advisory Commission after
			 the date of the enactment of this Act.</text>
				</subsection></section><section id="HF77153A49F044FC3A3B6AE12AE3000DF"><enum>302.</enum><header>Rural health
			 clinic improvements</header><text display-inline="no-display-inline">Section
			 1833(f) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (42
			 U.S.C. 1395l(f)) is amended—</text>
				<paragraph id="HD1A50D2BB3E84C84AA35259D9301F6C9"><enum>(1)</enum><text>in paragraph (1),
			 by striking <quote>, and</quote> at the end and inserting a semicolon;</text>
				</paragraph><paragraph id="H2FE4079E79B94CA7B2BDE7DF006BBAE0"><enum>(2)</enum><text>in paragraph
			 (2)—</text>
					<subparagraph id="HCCE730F2D58941E9853302008B001390"><enum>(A)</enum><text>by inserting
			 <quote>(before 2008)</quote> after <quote>in a subsequent year</quote>;
			 and</text>
					</subparagraph><subparagraph id="H36F5E918AA3348CE988B53772DB567FD"><enum>(B)</enum><text>by striking the
			 period at the end and inserting a semicolon; and</text>
					</subparagraph></paragraph><paragraph id="H7E0AD37270704014AFED656DDB252F5B"><enum>(3)</enum><text>by adding at the
			 end the following new paragraphs:</text>
					<quoted-block display-inline="no-display-inline" id="HAE5FD9BD1B4C419BB2C008DD2A8641" style="OLC">
						<paragraph id="H407A3BF2E5164A40AC510025872F52EA"><enum>(3)</enum><text>in 2008, at $92
				per visit; and</text>
						</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H0EB2D71FAB2B4CD8AB664438A68304E6"><enum>(4)</enum><text>in a subsequent
				year, at the limit established under this subsection for the previous year
				increased by the percentage increase in the MEI (as so defined) applicable to
				primary care services (as so defined) furnished as of the first day of that
				year.</text>
						</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
				</paragraph></section><section id="H91825F9C79604FDBAD3D668391831FAC"><enum>303.</enum><header>Use of medical
			 conditions for coding ambulance services</header><text display-inline="no-display-inline">Section 1834(l)(7) of the
			 <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
			 1395m(l)(7)) is amended to read as follows:</text>
				<quoted-block act-name="Social Security Act" id="HC67592164B45476BA98BAC9DB5F88FBA" style="OLC">
					<paragraph id="H2F7EE6CA0CDC4C02ACA14B424D920398"><enum>(7)</enum><header>Coding
				system</header>
						<subparagraph id="HD8800CAE3333480992E86D568EC2AFC1"><enum>(A)</enum><header>In
				general</header><text>The Secretary shall, in accordance with section
				1173(c)(1)(B) and not later than January 1, 2008, establish a mandatory system
				or systems for the coding of claims for ambulance services for which payment is
				made under this subsection, including a code set specifying the medical
				condition of the individual who is transported and the level of service that is
				appropriate for the transportation of an individual with that medical
				condition.</text>
						</subparagraph><subparagraph id="H9A9BE551ED634975AEFB3835ADB99278"><enum>(B)</enum><header>Medical
				conditions</header><text>The code set established under subparagraph (A) shall
				take into account the list of medical conditions developed in the course of the
				negotiated rulemaking process conducted under paragraph
				(1).</text>
						</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
			</section><section id="H9624B5C4EFC5400995BA2F9EB8F93EF3"><enum>304.</enum><header>Improvement in
			 payments to retain emergency and other capacity for ambulances in rural
			 areas</header>
				<subsection id="H20BCB0AB176B4B3D9B57DB71885994E7"><enum>(a)</enum><header>In
			 General</header><text>Section 1834(l) of the <act-name parsable-cite="SSA">Social Security Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(l)</external-xref>) is
			 amended by adding at the end the following new paragraph:</text>
					<quoted-block act-name="Social Security Act" id="H1C48352B21934AB0A523CCB4154385DF" style="OLC">
						<paragraph id="H71F33DA84D894FD8827D30F9E8EABA46"><enum>(15)</enum><header>Additional
				payments for providers furnishing ambulance services in rural areas</header>
							<subparagraph id="H02DBAA04D02A4F17B485C856EBEA2FEE"><enum>(A)</enum><header>In
				general</header><text>In the case of ground ambulance services furnished on or
				after January 1, 2008, for which the transportation originates in a rural area
				(as determined under subparagraph (B)), the Secretary shall provide for a
				percent increase in the base rate of the fee schedule for a trip identified
				under this subsection.</text>
							</subparagraph><subparagraph id="H8D218ED49EA647E383CC29E66C07B795"><enum>(B)</enum><header>Identification
				of rural areas</header><text>The Secretary, in consultation with the Office of
				Rural Health Policy, shall use the Rural-Urban Commuting Areas (RUCA) coding
				system, adopted by that Office, to designate rural areas for the purposes of
				this paragraph. A rural area is any area in RUCA levels 2 through 10 and any
				unclassified area.</text>
							</subparagraph><subparagraph id="HC1452C50FABA41A8B11DD4A4354E3D99"><enum>(C)</enum><header>Tiering of rural
				areas</header><text>The Secretary shall designate 4 tiers of rural areas, using
				a ZIP Code population-based methodology generated by the RUCA coding system, as
				follows:</text>
								<clause id="H6B0454C5E2824139BADC3528D5B67CDB"><enum>(i)</enum><header>Tier
				1</header><text>A rural area that is a high metropolitan commuting area, in
				which 30 percent or more of the commuting flow is to an urban area, as
				designated by the Bureau of the Census (RUCA level 2).</text>
								</clause><clause id="H70E1080BAC8D47C581AC2F74CFA7AD57"><enum>(ii)</enum><header>Tier
				2</header><text>A rural area that is a low metropolitan commuting area, in
				which less than 30 percent of the commuting flow is to an urban area or to a
				large town, as designated by the Bureau of the Census (RUCA levels 3–6).</text>
								</clause><clause id="H8C2DFC8E18814B5EB6FE3FEADE87161D"><enum>(iii)</enum><header>Tier
				3</header><text>A rural area that is a small town core, as designated by the
				Bureau of the Census, in which no significant portion of the commuting flow is
				to an area of population greater than 10,000 people (RUCA levels 7–9).</text>
								</clause><clause id="H71BE0ACBB6ED4714912779DDF5BCE78F"><enum>(iv)</enum><header>Tier
				4</header><text>A rural area in which there is no dominant commuting flow (RUCA
				level 10) and any unclassified area.</text>
								</clause><continuation-text continuation-text-level="subparagraph">The
				Secretary shall consult with the Office of Rural Health Policy not less often
				than every 2 years to update the designation of rural areas in accordance with
				any changes that are made to the RUCA system.</continuation-text></subparagraph><subparagraph id="H022FC6DB5B3646A784CFC86D1D8747F9"><enum>(D)</enum><header>Payment
				adjustments for trips in rural areas</header><text>The Secretary shall adjust
				the payment rate under this section for ambulance trips that originate in each
				of the tiers established in subparagraph (C) according to the national average
				cost of full-cost providers for providing ambulance services in each such
				tier.</text>
							</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
				</subsection><subsection id="H252A6772C11B4FF79390361061D0A389"><enum>(b)</enum><header>Review of
			 Payments for Rural Ambulance Services and Report to Congress</header>
					<paragraph id="HE4E7C9EEC20A4ED60098F7D65CE5C11"><enum>(1)</enum><header>Review</header><text>Not
			 later than July 1, 2009, the Secretary of Health and Human Services shall
			 review the system for adjusting payments for rural ambulance services under
			 section 1834(l)(15) of the <act-name parsable-cite="SSA">Social Security
			 Act</act-name>, as added by subsection (a), to determine the adequacy and
			 appropriateness of such adjustments. In conducting such review, the Secretary
			 shall consult with providers and suppliers affected by such adjustments and
			 with representatives of the ambulance industry generally to determine—</text>
						<subparagraph id="HC1AEF7D7ED9A4B2CB333C49831CF3F5"><enum>(A)</enum><text>whether such
			 adjustments adequately cover the additional costs incurred in serving areas of
			 low population density; and</text>
						</subparagraph><subparagraph id="HB1A1DCD9DEBA42F184EF085593DE8596"><enum>(B)</enum><text>whether the tiered
			 structure for making such adjustments appropriately reflects the difference in
			 costs of providing services in different types of rural areas.</text>
						</subparagraph></paragraph><paragraph id="HC28A3C6B71F14AA887A300F5D2EDDD9"><enum>(2)</enum><header>Report</header><text>Not
			 later than January 1, 2011, the Secretary shall submit to Congress a report on
			 the review conducted under paragraph (1) together with any recommendations for
			 revision to the systems for adjusting payments for ambulance services in rural
			 areas that the Secretary of Health and Human Services determines
			 appropriate.</text>
					</paragraph></subsection><subsection id="H4E7676C7FA5A4A92A883E474CB294BAD"><enum>(c)</enum><header>Conforming
			 Amendments</header><paragraph commented="no" display-inline="yes-display-inline" id="HADE1A4B4DC1B434F959E6289005D2F59"><enum>(1)</enum><text>Section 1834(l) of the
			 <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
			 1395m(l)), as amended by subsection (a), is amended by adding at the end the
			 following new paragraph:</text>
						<quoted-block act-name="Social Security Act" id="HDD5D272D78344ADEBDCD3FB010A5A111" style="OLC">
							<paragraph id="H8B9DD36D3A7944308DD74FD4E246E6FC"><enum>(16)</enum><header>Designation of
				rural areas for mileage payment purposes</header><text>In establishing any
				differential in the amount of payment for mileage between rural and urban areas
				in the fee schedule established under paragraph (1), the Secretary shall, in
				the case of ambulance services furnished on or after January 1, 2008, identify
				rural areas in the same manner as provided in paragraph
				(15)(B).</text>
							</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
					</paragraph><paragraph id="H9DBCDDD13954485B85B452EABFC05884" indent="up1"><enum>(2)</enum><text>Section 1834(l)(12)(A) of such Act
			 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(l)(12)(A)</external-xref>) is amended by striking <quote>January 1,
			 2010</quote> and inserting <quote>January 1, 2008</quote>.</text>
					</paragraph><paragraph id="HA8AA6EC827BC4E51BB343EAA8E78B127" indent="up1"><enum>(3)</enum><text>Section 1834(l)(13)(A)(i) of such Act
			 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(l)(13)(A)(i)</external-xref>) is amended—</text>
						<subparagraph id="H6E968EA6E6AD47768E1131A52F234F34"><enum>(A)</enum><text>by inserting <quote>(or in the case of
			 such services furnished in 2008, in a rural area identified by the Secretary
			 under paragraph (15)(B))</quote> after <quote>such paragraph</quote>;
			 and</text>
						</subparagraph><subparagraph id="H147025F4200D4BEE981D66CBE40578E2"><enum>(B)</enum><text>by striking <quote>paragraphs (11) and
			 (12)</quote> and inserting <quote>paragraphs (11), (12), and
			 (15)</quote>.</text>
						</subparagraph></paragraph></subsection></section><section id="H13892689A75A4738B64DE724C1152438"><enum>305.</enum><header>Medicare remote
			 monitoring pilot projects</header>
				<subsection id="HA0646A5CC8F74A4F848C18CE5C068B87"><enum>(a)</enum><header>Pilot
			 projects</header>
					<paragraph id="H8E4A1C355D4649B089340244E483FB78"><enum>(1)</enum><header>In
			 general</header><text display-inline="yes-display-inline">Not later than 9
			 months after the date of enactment of this Act, the Secretary of Health and
			 Human Services (in this section referred to as the <quote>Secretary</quote>)
			 shall conduct pilot projects under title XVIII of the Social Security Act for
			 the purpose of providing incentives to home health agencies to utilize home
			 monitoring and communications technologies that—</text>
						<subparagraph id="HBB270AB726804181BEE6C0B206D674F2"><enum>(A)</enum><text>enhance health
			 outcomes for Medicare beneficiaries; and</text>
						</subparagraph><subparagraph id="H13E0F6799EF64B6497A6A03100191C56"><enum>(B)</enum><text>reduce
			 expenditures under such title.</text>
						</subparagraph></paragraph><paragraph id="H9013C7D048F14F769F9D82C5B99E683D"><enum>(2)</enum><header>Site
			 requirements</header>
						<subparagraph id="HAA1EC2014C6D49C78BB0CDAB4955AE58"><enum>(A)</enum><header>Urban and
			 Rural</header><text>The Secretary shall conduct the pilot projects under this
			 section in both urban and rural areas.</text>
						</subparagraph><subparagraph id="H1AC5BC92E9BE4CC7A02BF69956DB9977"><enum>(B)</enum><header>Site in a small
			 state</header><text>The Secretary shall conduct at least 3 of the pilot
			 projects in a State with a population of less than 1,000,000.</text>
						</subparagraph></paragraph><paragraph id="H08BBFE830CC440F6AFB04702324986F5"><enum>(3)</enum><header>Definition of
			 home health agency</header><text>In this section, the term <term>home health
			 agency</term> has the meaning given that term in section 1861(o) of the Social
			 Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(o)</external-xref>).</text>
					</paragraph></subsection><subsection id="HC652494D399E403F934F3856A713ED55"><enum>(b)</enum><header>Medicare
			 beneficiaries within the scope of projects</header><text>The Secretary shall
			 specify the criteria for identifying those Medicare beneficiaries who shall be
			 considered within the scope of the pilot projects under this section for
			 purposes of the application of subsection (c) and for the assessment of the
			 effectiveness of the home health agency in achieving the objectives of this
			 section. Such criteria may provide for the inclusion in the projects of
			 Medicare beneficiaries who begin receiving home health services under title
			 XVIII of the Social Security Act after the date of the implementation of the
			 projects.</text>
				</subsection><subsection id="HF8B370A487FE45A7964DE8A4E98321AD"><enum>(c)</enum><header>Incentives</header>
					<paragraph id="HC1F37A2B70DC4ACEBEA8C22719CF16ED"><enum>(1)</enum><header>Performance
			 targets</header><text>The Secretary shall establish for each home health agency
			 participating in a pilot project under this section a performance target using
			 one of the following methodologies, as determined appropriate by the
			 Secretary:</text>
						<subparagraph id="H1F62C2AAF0AB43D7BDDD625036E4445D"><enum>(A)</enum><header>Adjusted
			 historical performance target</header><text>The Secretary shall establish for
			 the agency—</text>
							<clause id="HCE55804C4E614AEB8E03F2EBA346522B"><enum>(i)</enum><text>a
			 base expenditure amount equal to the average total payments made to the agency
			 under parts A and B of title XVIII of the Social Security Act for Medicare
			 beneficiaries determined to be within the scope of the pilot project in a base
			 period determined by the Secretary; and</text>
							</clause><clause id="HF521012D0E8B4FEABA768FC2316EF82F"><enum>(ii)</enum><text>an
			 annual per capita expenditure target for such beneficiaries, reflecting the
			 base expenditure amount adjusted for risk and adjusted growth rates.</text>
							</clause></subparagraph><subparagraph id="H7397CF3D5EEA4B1D8E174FA9F785A450"><enum>(B)</enum><header>Comparative
			 performance target</header><text>The Secretary shall establish for the agency a
			 comparative performance target equal to the average total payments under such
			 parts A and B during the pilot project for comparable individuals in the same
			 geographic area that are not determined to be within the scope of the pilot
			 project.</text>
						</subparagraph></paragraph><paragraph id="H741FDD1618BE499B976B2FA4DD00F014"><enum>(2)</enum><header>Incentive</header><text>Subject
			 to paragraph (3), the Secretary shall pay to each participating home care
			 agency an incentive payment for each year under the pilot project equal to a
			 portion of the Medicare savings realized for such year relative to the
			 performance target under paragraph (1).</text>
					</paragraph><paragraph id="HB84A17D87D7144A0B63783FB034D7384"><enum>(3)</enum><header>Limitation on
			 expenditures</header><text>The Secretary shall limit incentive payments under
			 this section in order to ensure that the aggregate expenditures under title
			 XVIII of the Social Security Act (including incentive payments under this
			 subsection) do not exceed the amount that the Secretary estimates would have
			 been expended if the pilot projects under this section had not been
			 implemented.</text>
					</paragraph></subsection><subsection id="HEC59B0B6168F4E5487E09F043CCCA034"><enum>(d)</enum><header>Waiver
			 authority</header><text>The Secretary may waive such provisions of titles XI
			 and XVIII of the Social Security Act as the Secretary determines to be
			 appropriate for the conduct of the pilot projects under this section.</text>
				</subsection><subsection id="HF04FDF839826490799243ED218D8D207"><enum>(e)</enum><header>Report to
			 Congress</header><text>Not later than 5 years after the date that the first
			 pilot project under this section is implemented, the Secretary shall submit to
			 Congress a report on the pilot projects. Such report shall contain a detailed
			 description of issues related to the expansion of the projects under subsection
			 (f) and recommendations for such legislation and administrative actions as the
			 Secretary considers appropriate.</text>
				</subsection><subsection id="H76C035E18385453283314D6FE9FAC947"><enum>(f)</enum><header>Expansion</header><text>If
			 the Secretary determines that any of the pilot projects under this section
			 enhance health outcomes for Medicare beneficiaries and reduce expenditures
			 under title XVIII of the Social Security Act, the Secretary may initiate
			 comparable projects in additional areas.</text>
				</subsection><subsection id="HCB9017315213465BAF6D8CCF33AA24FB"><enum>(g)</enum><header>Incentive
			 payments have no effect on other Medicare payments to agencies</header><text>An
			 incentive payment under this section—</text>
					<paragraph id="H9FA8B60C5CC74BA6B0FEDB4FD32FE84C"><enum>(1)</enum><text>shall be in
			 addition to the payments that a home health agency would otherwise receive
			 under title XVIII of the Social Security Act for the provision of home health
			 services; and</text>
					</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HC87BAEF5AFAF4B429738240028E33630"><enum>(2)</enum><text>shall have no
			 effect on the amount of such payments.</text>
					</paragraph></subsection></section><section id="HEAC224F544194D89A1D71E67F85DFE88"><enum>306.</enum><header>Minimum payment
			 rate by Medicare Advantage organizations for services furnished by a critical
			 access hospital and a rural health clinic</header>
				<subsection id="HCB2B681D49CB4DABB9D890BF637BABCC"><enum>(a)</enum><header>In
			 general</header><text>Section 1857(e) of the Social Security Act (42 U.S.C.
			 1395w–27(e)) is amended by adding at the end the following:</text>
					<quoted-block id="H866B513EE9334C8FB8FDFF31BD068334" style="OLC">
						<paragraph id="HDDBD1DE0AA0A4CDB00A7025127B8DB85"><enum>(4)</enum><header>Minimum payment
				rate for services furnished by a critical access hospital and a rural health
				clinic</header><text>A contract under this section between an MA organization
				and the Secretary for the offering of an MA plan shall require the organization
				to provide for a payment rate under the plan for inpatient and outpatient
				critical access hospital services and rural health clinic services furnished to
				enrollees of the plan and for extended care services furnished by a critical
				access hospital under an agreement entered into under section 1883 to such
				enrollees (whether or not the services are furnished pursuant to an agreement
				between such organization and a critical access hospital or a rural health
				clinic) that is not less than—</text>
							<subparagraph id="HD3779EAD18B14FF0A3033935A70430C9"><enum>(A)</enum><text>the applicable
				payment rate established under part A or part B (which includes the payment of
				an interim rate and a subsequent cost reconciliation) with respect to the
				critical access hospital for such inpatient, outpatient, and extended care
				services or the rural health clinic for such rural health clinic services;
				or</text>
							</subparagraph><subparagraph id="H6A735A52E0A5428198A232FAD497AA63"><enum>(B)</enum><text>if the critical
				access hospital or the rural health clinic determines appropriate, 103 percent
				of the applicable interim payment rate established under part A or part B with
				respect to the critical access hospital for such inpatient, outpatient, and
				extended care services or the rural health clinic for such rural health clinic
				services.</text>
							</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
				</subsection><subsection id="H4548A5F21CA8441F81016715BE73B4D6"><enum>(b)</enum><header>Effective
			 date</header><text display-inline="yes-display-inline">The amendments made by
			 this section shall apply to Medicare Advantage contract years beginning on or
			 after January 1, 2008.</text>
				</subsection></section><section display-inline="no-display-inline" id="H3B4BCCE5E404478A9BDC553C42C7F3E3" section-type="subsequent-section"><enum>307.</enum><header>Prompt payment by
			 Medicare prescription drug plans and MA–PD plans under part D</header>
				<subsection id="HA223FA8FD59C417EAEFA70195F999BFC"><enum>(a)</enum><header>Application to
			 prescription drug plans</header><text>Section 1860D–12(b) of the Social
			 Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-112">42 U.S.C. 1395w–112(b)</external-xref>) is amended by adding at the end the
			 following new paragraph:</text>
					<quoted-block id="H228F4C49CDC74A29AD7CA9CA0324C38" style="OLC">
						<paragraph id="H7E973E5E557C43DEA2A4F664CF00AA28"><enum>(4)</enum><header>Prompt payment
				of clean claims</header>
							<subparagraph id="H295A73EDECB84282BFC6801F5054A8E3"><enum>(A)</enum><header>Prompt
				payment</header><text>Each contract entered into with a PDP sponsor under this
				subsection with respect to a prescription drug plan offered by such sponsor
				shall provide that payment shall be issued, mailed, or otherwise transmitted
				with respect to all clean claims submitted under this part within the
				applicable number of calendar days after the date on which the claim is
				received.</text>
							</subparagraph><subparagraph id="H3C39F22E94D84639A749BB44DEC3C852"><enum>(B)</enum><header>Definitions</header><text>In
				this paragraph:</text>
								<clause id="H07520D56BE7249AE9FB73941F6C2E47"><enum>(i)</enum><header>Clean
				claim</header><text>The term <term>clean claim</term> means a claim, with
				respect to a covered part D drug, that has no apparent defect or impropriety
				(including any lack of any required substantiating documentation) or particular
				circumstance requiring special treatment that prevents timely payment from
				being made on the claim under this part.</text>
								</clause><clause id="HF309EA40617A40D9AF762B00B9CE93BF"><enum>(ii)</enum><header>Applicable
				number of calendar days</header><text>The term <term>applicable number of
				calendar days</term> means—</text>
									<subclause id="HACA0C48FE4BC4D27A48239FF2315FEF2"><enum>(I)</enum><text>with respect to
				claims submitted electronically, 14 calendar days; and</text>
									</subclause><subclause id="HBBD191F7A0434430ADCF9D55DFE7D349"><enum>(II)</enum><text>with respect to
				claims submitted otherwise, 30 calendar days.</text>
									</subclause></clause></subparagraph><subparagraph id="H4BE797C168144EA19797DB6FDCA9009D"><enum>(C)</enum><header>Interest
				payment</header><text>If payment is not issued, mailed, or otherwise
				transmitted within the applicable number of calendar days (as defined in
				subparagraph (B)) after a clean claim is received, interest shall be paid at a
				rate used for purposes of <external-xref legal-doc="usc" parsable-cite="usc/31/3902">section 3902(a)</external-xref> of title 31, United States Code
				(relating to interest penalties for failure to make prompt payments), for the
				period beginning on the day after the required payment date and ending on the
				date on which payment is made.</text>
							</subparagraph><subparagraph id="H7C06565602EF48349FCCCBBC6BBFF29F"><enum>(D)</enum><header>Procedures
				involving claims</header>
								<clause id="H91228CAA02D1407480B51BD3C9AB825C"><enum>(i)</enum><header>Claims deemed to
				be clean claims</header>
									<subclause id="H44CACE37B90D4C9A9415491DD77CD241"><enum>(I)</enum><header>In
				general</header><text>A claim for a covered part D drug shall be deemed to be a
				clean claim for purposes of this paragraph if the PDP sponsor involved does not
				provide a notification of deficiency to the claimant by the 10th day that
				begins after the date on which the claim is submitted.</text>
									</subclause><subclause commented="no" id="H27A79839C2D14720B7978677C3799BC"><enum>(II)</enum><header>Notification of
				deficiency</header><text>For purposes of subclause (II), the term
				<term>notification of deficiency</term> means a notification that specifies all
				defects or improprieties in the claim involved and that lists all additional
				information or documents necessary for the proper processing and payment of the
				claim.</text>
									</subclause></clause><clause id="HA2D3EC468D7047D0AB7C8DBCE1D9B7A9"><enum>(ii)</enum><header>Payment of
				clean portions of claims</header><text>A PDP sponsor shall, as appropriate, pay
				any portion of a claim for a covered part D drug that would be a clean claim
				but for a defect or impropriety in a separate portion of the claim in
				accordance with subparagraph (A).</text>
								</clause><clause id="H24372EED16A44DD2B399E9B8BA8FF65F"><enum>(iii)</enum><header>Obligation to
				pay</header><text>A claim for a covered part D drug submitted to a PDP sponsor
				that is not paid or contested by the provider within the applicable number of
				calendar days (as defined in subparagraph (B)) shall be deemed to be a clean
				claim and shall be paid by the PDP sponsor in accordance with subparagraph
				(A).</text>
								</clause><clause id="H1FAC5D78454B42F5B4CD62EB6038D566"><enum>(iv)</enum><header>Date of payment
				of claim</header><text>Payment of a clean claim under subparagraph (A) is
				considered to have been made on the date on which full payment is received by
				the provider.</text>
								</clause></subparagraph><subparagraph id="HB224ABC7BA984A7DB701E4ED3E221075"><enum>(E)</enum><header>Electronic
				transfer of funds</header><text>A PDP sponsor shall pay all clean claims
				submitted electronically by an electronic funds transfer
				mechanism.</text>
							</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
				</subsection><subsection id="H3DDFD35924D1472EB995B1A7F8FF2B6C"><enum>(b)</enum><header>Application to
			 MA–PD plans</header><text>Section 1857(f) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-27">42 U.S.C. 1395w–27</external-xref>) is
			 amended by adding at the end the following new paragraph:</text>
					<quoted-block id="H4FE3AA19437E4BB784C62494D5B9EBC2" style="OLC">
						<paragraph id="H9BD7400363804D848BD6E639584E0089"><enum>(3)</enum><header>Incorporation of
				certain prescription drug plan contract requirements</header><text>The
				provisions of section 1860D–12(b)(4) shall apply to contracts with a Medicare
				Advantage organization in the same manner as they apply to contracts with a PDP
				sponsor offering a prescription drug plan under part
				D.</text>
						</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
				</subsection><subsection id="H91A80F45EEBA443286EA001E43477784"><enum>(c)</enum><header>Effective
			 date</header><text>The amendments made by this section shall apply to contracts
			 entered into or renewed on or after the date of the enactment of this
			 Act.</text>
				</subsection></section><section display-inline="no-display-inline" id="H927A8996544E496FA1C700CA6DCA5217" section-type="subsequent-section"><enum>308.</enum><header>Extension of
			 Medicare reasonable costs payments for certain clinical diagnostic laboratory
			 tests furnished to hospital patients in certain rural areas</header><text display-inline="no-display-inline">Section 416(b) of the Medicare Prescription
			 Drug, Improvement, and Modernization Act of 2003 (<external-xref legal-doc="public-law" parsable-cite="pl/108/173">Public Law 108–173</external-xref>; 117 Stat.
			 2282; <external-xref legal-doc="usc" parsable-cite="usc/42/1395l-4">42 U.S.C. 1395l–4(b)</external-xref>) is amended by striking <quote>2-year</quote> and
			 inserting <quote>8-year</quote>.</text>
			</section><section id="HFDC3C65E013545CABC6FCC1E5C704B80"><enum>309.</enum><header>Extension of
			 temporary Medicare payment increase for home health services furnished in a
			 rural area</header>
				<subsection id="HD0FE1216FDB14F9AADDF1B2B05675B35"><enum>(a)</enum><header>In
			 general</header><text display-inline="yes-display-inline">Section 421 of the
			 Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public
			 Law 108–173; 117 Stat. 2283; <external-xref legal-doc="usc" parsable-cite="usc/42/1395fff">42 U.S.C. 1395fff</external-xref> note), as amended by section
			 5201(b) of the Deficit Reduction Act of 2005, is amended—</text>
					<paragraph id="HAE808AD59D464B3AAB00A811507740F0"><enum>(1)</enum><text display-inline="yes-display-inline">in the heading, by striking
			 <quote><header-in-text level="section" style="OLC">One-year</header-in-text></quote> and inserting
			 <quote><header-in-text level="section" style="OLC">Temporary</header-in-text></quote>; and</text>
					</paragraph><paragraph id="HE3949D6E5966497300A35D47A1342745"><enum>(2)</enum><text display-inline="yes-display-inline">in subsection (a) by striking <quote>before
			 April 1, 2005, and episodes and visits beginning on or after January 1, 2006,
			 and before January 1, 2007</quote> and inserting <quote>before December 31,
			 2012</quote>.</text>
					</paragraph></subsection><subsection commented="no" id="H3C10F53DC6114B958E0771555D0582F2"><enum>(b)</enum><header>Application to
			 certain home health services furnished prior to date of
			 enactment</header><text>For episodes and visits for home health services
			 furnished on or after January 1, 2007, and before the date of the enactment of
			 this Act, the Secretary of Health and Human Services shall provide for a lump
			 sum payment, not later than 60 days after such enactment, of amounts due under
			 the amendment made by subsection (a)(2).</text>
				</subsection><subsection id="HAC63ABBDE4424B718BEDE2AD92DE80E7"><enum>(c)</enum><header>Effective
			 date</header><text>The amendments made by subsection (a) shall apply to
			 episodes and visits on or after April 1, 2005.</text>
				</subsection></section></title><title id="H9CDD3CB0B123473EA68DF206C3CC6597"><enum>IV</enum><header>Other
			 Provisions</header>
			<section display-inline="no-display-inline" id="H79D6EED8AF6C448E848150FD4EEE6F5D" section-type="subsequent-section"><enum>401.</enum><header>Health information
			 technology grants for rural health care providers</header><text display-inline="no-display-inline">Title II of the Public Health Service Act is
			 amended by adding at the end the following new part:</text>
				<quoted-block display-inline="no-display-inline" id="H21DC43B313404F39A35BFCD1A6817BA3" style="OLC">
					<part id="H08D6F46D54B64FF783428FFDFCE4D71C"><enum>D</enum><header>Health Information
				Technology Grants</header>
						<section id="H69914E4573C447D484DAB911E0E3201C"><enum>271.</enum><header>Grants to
				facilitate the widespread adoption of interoperable health information
				technology in rural areas</header>
							<subsection id="H991AF58725364773A091EC983700C4C4"><enum>(a)</enum><header>Competitive
				grants to eligible entities in rural areas</header>
								<paragraph id="H2C1780D97F6A4D80AFA2C4CE342DF1B"><enum>(1)</enum><header>In
				general</header><text>The Secretary may award competitive grants to eligible
				entities in rural areas to facilitate the purchase and enhance the utilization
				of qualified health information technology systems to improve the quality and
				efficiency of health care.</text>
								</paragraph><paragraph id="H94F074D629CF4E5587D2B5296418B5A8"><enum>(2)</enum><header>Eligibility</header><text>To
				be eligible to receive a grant under paragraph (1) an entity shall—</text>
									<subparagraph id="H30B7D4A4FC9B4AB3A207A1BB3C608D85"><enum>(A)</enum><text>submit to the
				Secretary an application at such time, in such manner, and containing such
				information as the Secretary may require;</text>
									</subparagraph><subparagraph id="H2EEF6F8366004C738E87C1CE960013BB"><enum>(B)</enum><text>submit to the
				Secretary a strategic plan for the implementation of data sharing and
				interoperability measures;</text>
									</subparagraph><subparagraph id="HD6494004373448069BB0FBCE1C21C159"><enum>(C)</enum><text>be a rural health
				care provider;</text>
									</subparagraph><subparagraph id="H74A0315CDEBC4CCEBA11193FB68B7B9"><enum>(D)</enum><text display-inline="yes-display-inline">adopt any applicable core interoperability
				guidelines (endorsed under other provisions of law);</text>
									</subparagraph><subparagraph id="HA7737A0594EF4AD6ACB1F7879D135992"><enum>(E)</enum><text>agree to notify
				patients if their individually identifiable health information is wrongfully
				disclosed;</text>
									</subparagraph><subparagraph id="HDFC6525A91D248BFB385C077F6862B29"><enum>(F)</enum><text>demonstrate
				significant financial need; and</text>
									</subparagraph><subparagraph id="H4509209D6AB84A81BC310200E91CA456"><enum>(G)</enum><text>provide matching
				funds in accordance with paragraph (4).</text>
									</subparagraph></paragraph><paragraph id="HFEF3BA2F62BB41EB915DAD5D2E3B30D0"><enum>(3)</enum><header>Use of
				funds</header><text>Amounts received under a grant under this subsection shall
				be used to facilitate the purchase and enhance the utilization of qualified
				health information technology systems and training personnel in the use of such
				technology.</text>
								</paragraph><paragraph id="H6521CD44B11A4B0DB209B9A2F9AFF185"><enum>(4)</enum><header>Matching
				requirement</header><text>To be eligible for a grant under this subsection an
				entity shall contribute non-Federal contributions to the costs of carrying out
				the activities for which the grant is awarded in an amount equal to $1 for each
				$3 of Federal funds provided under the grant.</text>
								</paragraph><paragraph id="H94AFC7827F864699B6D8FEFD6985BB9B"><enum>(5)</enum><header>Limit on grant
				amount</header><text display-inline="yes-display-inline">In no case shall the
				payment amount under this subsection with respect to the purchase or enhanced
				utilization of qualified health information technology for a rural health care
				provider, in addition to the amount of any loan made to the provider from a
				grant to a State under subsection (b) for such purpose, exceed 100 percent of
				the provider’s costs for such purchase or enhanced utilization (taking into
				account costs for training, implementation, and maintenance).</text>
								</paragraph><paragraph id="H8D73203989234290B795D80047A24E30"><enum>(6)</enum><header>Preference in
				awarding grants</header><text>In awarding grants to eligible entities under
				this subsection, the Secretary shall give preference to each of the following
				types of applicants:</text>
									<subparagraph id="HF47A7D41BA6D419F81811D7E5D32EF06"><enum>(A)</enum><text>An entity that is
				located in a frontier or other rural underserved area as determined by the
				Secretary.</text>
									</subparagraph><subparagraph id="H36B42A7BDFBD4B9B8767EC42B052BD89"><enum>(B)</enum><text>An entity that
				will link, to the extent practicable, the qualified health information system
				to a local or regional health information plan or plans.</text>
									</subparagraph><subparagraph id="HFA543286D3004B8BBAC2B5A1BED157BA"><enum>(C)</enum><text display-inline="yes-display-inline">A rural health care provider that is a
				nonprofit hospital or a Federally qualified health center.</text>
									</subparagraph><subparagraph id="HB22E1D80BDA8430A89CB80E5473C33C"><enum>(D)</enum><text display-inline="yes-display-inline">A rural health care provider that is an
				individual practice or group practice.</text>
									</subparagraph></paragraph></subsection><subsection display-inline="no-display-inline" id="H2A75A5A434014CE0BE7C6E452EF0F4E2"><enum>(b)</enum><header>Authorization of
				appropriations</header>
								<paragraph id="H4CECCFA3C1D74846BC272B2B32DA2E6B"><enum>(1)</enum><header>In
				general</header><text display-inline="yes-display-inline">For the purpose of
				carrying out this section, there is authorized to be appropriated $20,000,000
				for fiscal year 2008, $30,000,000 for fiscal year 2009, and such sums as may be
				necessary, but not to exceed $30,000,000 for each of fiscal years 2010 through
				2012.</text>
								</paragraph><paragraph id="HBC549F3628B4487A8BDCE0898DCF38D"><enum>(2)</enum><header>Availability</header><text display-inline="yes-display-inline">Amounts appropriated under paragraph (1)
				shall remain available through fiscal year 2011.</text>
								</paragraph></subsection><subsection id="HFA255DE42D5240AA9700015584789B46"><enum>(c)</enum><header>Definitions</header><text>In
				this section:</text>
								<paragraph id="H35CF131192E642AAB7605F3821AE0016"><enum>(1)</enum><header>Federally
				qualified health center</header><text display-inline="yes-display-inline">The
				term <term>Federally qualified health center</term> has the meaning given that
				term in section 1861(aa)(4) of the Social Security Act (42 U.S.C.
				1395x(aa)(4)).</text>
								</paragraph><paragraph id="HEE194CCB1ECE495F908103FF2DEDC605"><enum>(2)</enum><header>Group
				practice</header><text>The term <term>group practice</term> has the meaning
				given that term in section 1877(h)(4) of the Social Security Act (42 U.S.C.
				1395nn(h)(4)).</text>
								</paragraph><paragraph id="HDDDC7E8AB6FC4CF08D6724B3D2C74749"><enum>(3)</enum><header>Health care
				provider</header><text display-inline="yes-display-inline">The term
				<term>health care provider</term> means a hospital, skilled nursing facility,
				home health agency (as defined in subsection (o) of section 1861 of the Social
				Security Act, <external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x</external-xref>), health care clinic, rural health clinic,
				Federally qualified health center, group practice, a pharmacist, a pharmacy, a
				laboratory, a physician (as defined in subsection (r) of such section), a
				practitioner (as defined in section 1842(b)(18)(CC) of such Act, 42 U.S.C.
				1395u(b)(18)(CC)), a health facility operated by or pursuant to a contract with
				the Indian Health Service, and any other category of facility or clinician
				determined appropriate by the Secretary.</text>
								</paragraph><paragraph id="H8C9ABA575E2B4DB08C98E9C665F200C8"><enum>(4)</enum><header>Health
				information; individually identifiable health information</header><text>The
				terms <term>health information</term> and <term>individually identifiable
				health information</term> have the meanings given those terms in paragraphs (4)
				and (6), respectively, of section 1171 of the Social Security Act (42 U.S.C.
				1320d).</text>
								</paragraph><paragraph id="H1FD623FA487648A6AB262ED06995569C"><enum>(5)</enum><header>Laboratory</header><text>The
				term <term>laboratory</term> has the meaning given that term in section
				353.</text>
								</paragraph><paragraph id="H2A17526B8005441AAAFA31029B496F79"><enum>(6)</enum><header>Pharmacist</header><text display-inline="yes-display-inline">The term <term>pharmacist</term> has the
				meaning given that term in section 804(a)(2) of the Federal Food, Drug, and
				Cosmetic Act (<external-xref legal-doc="usc" parsable-cite="usc/21/384">21 U.S.C. 384(a)(2)</external-xref>).</text>
								</paragraph><paragraph id="H6FCBCEE1298641EB957618D99C19B4C"><enum>(7)</enum><header>Qualified health
				information technology</header><text display-inline="yes-display-inline">The
				term <term>qualified health information technology</term> means a system or
				components of health information technology that meet any applicable core
				interoperability guidelines (endorsed under applicable provisions of law) when
				in use or that use interface software that allows for interoperability in
				accordance with such guidelines.</text>
								</paragraph><paragraph id="H2C7097E7FE0B4FC7A485E466A67416A7"><enum>(8)</enum><header>Rural
				area</header><text display-inline="yes-display-inline">The term <term>rural
				area</term> has the meaning given such term for purposes of section
				1886(d)(2)(D) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(d)(2)(D)</external-xref>).</text>
								</paragraph><paragraph id="HF418340CA69149BE9BB806A9BB576277"><enum>(9)</enum><header>Rural health
				care provider</header><text>The term <term>rural health care provider</term>
				means a health care provider that is located in a rural area.</text>
								</paragraph><paragraph id="HB56D6B71AA1C4E30A88F54323FDD1B50"><enum>(10)</enum><header>State</header><text>The
				term <term>State</term> means each of the several States, the District of
				Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the
				Northern Mariana
				Islands.</text>
								</paragraph></subsection></section></part><after-quoted-block>.</after-quoted-block></quoted-block>
			</section><section id="H94F32465756246E7AF7DABB23FCF5834" section-type="subsequent-section"><enum>402.</enum><header>Rural health quality
			 advisory commission and demonstration projects</header>
				<subsection id="HAA2A6129BB1C452791EC4252CBC4A3D0"><enum>(a)</enum><header>Rural Health
			 Quality Advisory Commission</header>
					<paragraph id="H5984678E43D9489F94237EBA9868A39E"><enum>(1)</enum><header>Establishment</header><text>Not
			 later than 6 months after the date of the enactment of this section, the
			 Secretary of Health and Human Services (in this section referred to as the
			 <quote>Secretary</quote>) shall establish a commission to be known as the Rural
			 Health Quality Advisory Commission (in this section referred to as the
			 <quote>Commission</quote>).</text>
					</paragraph><paragraph id="HBF5C6D5E68FE41300073753494A7A4D8"><enum>(2)</enum><header>Duties of
			 commission</header>
						<subparagraph id="H0A6301672BBE412EB5665CDC9E206354"><enum>(A)</enum><header>National
			 plan</header><text>The Commission shall develop, coordinate, and facilitate
			 implementation of a national plan for rural health quality improvement. The
			 national plan shall—</text>
							<clause id="H20754346D4804B4EA5CFA228A66FE90"><enum>(i)</enum><text>identify objectives
			 for rural health quality improvement;</text>
							</clause><clause id="H837BF3B900C347FABD09A2C8A9A4E844"><enum>(ii)</enum><text>identify
			 strategies to eliminate known gaps in rural health system capacity and improve
			 rural health quality; and</text>
							</clause><clause id="H52F2553F5E7244E5A6F528072D19A68D"><enum>(iii)</enum><text>provide for
			 Federal programs to identify opportunities for strengthening and aligning
			 policies and programs to improve rural health quality.</text>
							</clause></subparagraph><subparagraph id="H7D1EEA951BEB4DE0A54FC5B831527233"><enum>(B)</enum><header>Demonstration
			 projects</header><text>The Commission shall design demonstration projects to
			 test alternative models for rural health quality improvement, including with
			 respect to both personal and population health.</text>
						</subparagraph><subparagraph id="HBEC7EB13AD6B4F5E93AC8BD43CB0417"><enum>(C)</enum><header>Monitoring</header><text>The
			 Commission shall monitor progress toward the objectives identified pursuant to
			 paragraph (1)(A).</text>
						</subparagraph></paragraph><paragraph id="H12BAB889BDC24EDEB4CEA366B5EF14D"><enum>(3)</enum><header>Membership</header>
						<subparagraph id="H079B7B6631DB47FD8EBFD5FE5F224077"><enum>(A)</enum><header>Number</header><text>The
			 Commission shall be composed of 11 members appointed by the Secretary.</text>
						</subparagraph><subparagraph id="HA468CB226F67408FB83971B0E4B4D85C"><enum>(B)</enum><header>Selection</header><text>The
			 Secretary shall select the members of the Commission from among individuals
			 with significant rural health care and health care quality expertise, including
			 expertise in clinical health care, health care quality research, population or
			 public health, or purchaser organizations.</text>
						</subparagraph></paragraph><paragraph id="H6DBF6FFDA93C42D3BE486FB44B3E003C"><enum>(4)</enum><header>Contracting
			 authority</header><text>Subject to the availability of funds, the Commission
			 may enter into contracts and make other arrangements, as may be necessary to
			 carry out the duties described in paragraph (2).</text>
					</paragraph><paragraph id="H4919EFC190D94B2F9043A8F534E59F79"><enum>(5)</enum><header>Staff</header><text>Upon
			 the request of the Commission, the Secretary may detail, on a reimbursable
			 basis, any of the personnel of the Office of Rural Health Policy of the Health
			 Resources and Services Administration, the Agency for Health Care Quality and
			 Research, or the Centers for Medicare &amp; Medicaid Services to the Commission
			 to assist in carrying out this subsection.</text>
					</paragraph><paragraph id="H47C7866B9222404E9FC9DC01A7ACB6A8"><enum>(6)</enum><header>Reports to
			 congress</header><text>Not later than 1 year after the establishment of the
			 Commission, and annually thereafter, the Commission shall submit a report to
			 the Congress on rural health quality. Each such report shall include the
			 following:</text>
						<subparagraph id="H48827CB299074936BD8CE13D48C0B0A5"><enum>(A)</enum><text>An inventory of
			 relevant programs and recommendations for improved coordination and integration
			 of policy and programs.</text>
						</subparagraph><subparagraph id="H60FE1C23FFE04E2300F83EF8D88411BA"><enum>(B)</enum><text>An assessment of
			 achievement of the objectives identified in the national plan developed under
			 paragraph (2) and recommendations for realizing such objectives.</text>
						</subparagraph><subparagraph id="HC2F63CB4186D422A976D691C297D791C"><enum>(C)</enum><text>Recommendations on
			 Federal legislation, regulations, or administrative policies to enhance rural
			 health quality and outcomes.</text>
						</subparagraph></paragraph></subsection><subsection id="HA328243A80914BF08D26D02A938C874"><enum>(b)</enum><header>Rural Health
			 Quality Demonstration Projects</header>
					<paragraph id="H968D82EF28474763B32E72D258D832D6"><enum>(1)</enum><header>In
			 general</header><text>Not later than 270 days after the date of the enactment
			 of this section, the Secretary, in consultation with the Rural Health Quality
			 Advisory Commission, the Office of Rural Health Policy of the Health Resources
			 and Services Administration, the Agency for Healthcare Research and Quality,
			 and the Centers for Medicare &amp; Medicaid Services, shall make grants to
			 eligible entities for 5 demonstration projects to implement and evaluate
			 methods for improving the quality of health care in rural communities. Each
			 such demonstration project shall include—</text>
						<subparagraph id="H49ACCCF457374173A09128B7A19C117C"><enum>(A)</enum><text>alternative
			 community models that—</text>
							<clause id="H5404F4EB79B34E22921EAC0048D68DAD"><enum>(i)</enum><text>will
			 achieve greater integration of personal and population health services;
			 and</text>
							</clause><clause id="HE5B096EF0847440690BB4051CA81C500"><enum>(ii)</enum><text>address safety,
			 effectiveness, patient- or community-centeredness, timeliness, efficiency, and
			 equity (the six aims identified by the Institute of Medicine of the National
			 Academies in its report entitled <quote>Crossing the Quality Chasm: A New
			 Health System for the 21st Century</quote> released on March 1, 2001);</text>
							</clause></subparagraph><subparagraph id="H9265ADC205284943A6405F1ED05B38F9"><enum>(B)</enum><text>innovative
			 approaches to the financing and delivery of health services to achieve rural
			 health quality goals; and</text>
						</subparagraph><subparagraph id="H7B60A1FE3B1A4245B9A93EC568E4331D"><enum>(C)</enum><text>development of
			 quality improvement support structures to assist rural health systems and
			 professionals (such as workforce support structures, quality monitoring and
			 reporting, clinical care protocols, and information technology
			 applications).</text>
						</subparagraph></paragraph><paragraph id="H8A2A680574A941DB839C1CF9D7C82E06"><enum>(2)</enum><header>Eligible
			 entities</header><text>In this subsection, the term <term>eligible
			 entity</term> means a consortium that—</text>
						<subparagraph id="H9219F406A2DE41EFBB00E76EB783F32C"><enum>(A)</enum><text>shall
			 include—</text>
							<clause id="H3AC2DBFE4E964666B5001CE800EC6D68"><enum>(i)</enum><text>at
			 least one health care provider or health care delivery system located in a
			 rural area; and</text>
							</clause><clause id="H472CCC7932F1462A95AF5429498BCFF"><enum>(ii)</enum><text>at
			 least one organization representing multiple community stakeholders; and</text>
							</clause></subparagraph><subparagraph id="HCAE87617735842619C51BD2F2F16C2D8"><enum>(B)</enum><text>may include other
			 partners such as rural research centers.</text>
						</subparagraph></paragraph><paragraph id="H364AB9FF217B431CBA35D2EC7E258C5F"><enum>(3)</enum><header>Consultation</header><text>In
			 developing the program for awarding grants under this subsection, the Secretary
			 shall consult with the Administrator of the Agency for Healthcare Research and
			 Quality, rural health care providers, rural health care researchers, and
			 private and non-profit groups (including national associations) which are
			 undertaking similar efforts.</text>
					</paragraph><paragraph id="H7E4C0CAD7902426FAE56B25BA1034433"><enum>(4)</enum><header>Expedited
			 waivers</header><text>The Secretary shall expedite the processing of any waiver
			 that—</text>
						<subparagraph id="HE7CE9315745C4F66BDD102D2000120CE"><enum>(A)</enum><text>is authorized
			 under title XVIII or XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395 et seq.</external-xref>);
			 and</text>
						</subparagraph><subparagraph id="HD0624AE68A4F42AC96155DB67B28E272"><enum>(B)</enum><text>is necessary to
			 carry out a demonstration project under this subsection.</text>
						</subparagraph></paragraph><paragraph id="HE196E5AC5F48403591DDB810570006A3"><enum>(5)</enum><header>Demonstration
			 project sites</header><text>The Secretary shall ensure that the 5 demonstration
			 projects funded under this subsection are conducted at a variety of sites
			 representing the diversity of rural communities in the Nation.</text>
					</paragraph><paragraph id="H0555790C056C40E9A72920FD8638D968"><enum>(6)</enum><header>Duration</header><text>Each
			 demonstration project under this subsection shall be for a period of 4
			 years.</text>
					</paragraph><paragraph id="HCC5A0FCA6EEC4A7EA3D1D1782057B3D"><enum>(7)</enum><header>Independent
			 evaluation</header><text>The Secretary shall enter into an arrangement with an
			 entity that has experience working directly with rural health systems for the
			 conduct of an independent evaluation of the program carried out under this
			 subsection.</text>
					</paragraph><paragraph id="H10B50153A2864FEFB6F76417B82C0226"><enum>(8)</enum><header>Report</header><text>Not
			 later than one year after the conclusion of all of the demonstration projects
			 funded under this subsection, the Secretary shall submit a report to the
			 Congress on the results of such projects. The report shall include—</text>
						<subparagraph id="H4016D6C771EF45189B01395D527C811E"><enum>(A)</enum><text>an evaluation of
			 patient access to care, patient outcomes, and an analysis of the cost
			 effectiveness of each such project; and</text>
						</subparagraph><subparagraph id="H0A571D5C97FC4344BB16B301A28FDE87"><enum>(B)</enum><text>recommendations on
			 Federal legislation, regulations, or administrative policies to enhance rural
			 health quality and outcomes.</text>
						</subparagraph></paragraph></subsection><subsection id="H92342ED6255B47DAB73DE8ED9FF1AFF2"><enum>(c)</enum><header>Appropriation</header>
					<paragraph id="H7CF68F6476BD46A39C214918B87EC15D"><enum>(1)</enum><header>In
			 general</header><text>Out of funds in the Treasury not otherwise appropriated,
			 there are appropriated to the Secretary to carry out this section $30,000,000
			 for the period of fiscal years 2008 through 2012.</text>
					</paragraph><paragraph id="HD0BE790D0BA94994A9FD236DBDBD45A1"><enum>(2)</enum><header>Availability</header>
						<subparagraph id="H87D0AC85F63C41C3AC36C8F9602E5C16"><enum>(A)</enum><header>In
			 general</header><text>Funds appropriated under paragraph (1) shall remain
			 available for expenditure through fiscal year 2012.</text>
						</subparagraph><subparagraph id="H4ABC143C2F204E43B4749CE9C03C72C4"><enum>(B)</enum><header>Report</header><text>For
			 purposes of carrying out subsection (b)(8), funds appropriated under paragraph
			 (1) shall remain available for expenditure through fiscal year 2013.</text>
						</subparagraph></paragraph><paragraph id="H559773CC70024037A233E586D0BAB135"><enum>(3)</enum><header>Reservation</header><text>Of
			 the amount appropriated under paragraph (1), the Secretary shall
			 reserve—</text>
						<subparagraph id="H2BB8B170834D4DBAB86D54E16B932FD3"><enum>(A)</enum><text>$5,000,000 to
			 carry out subsection (a); and</text>
						</subparagraph><subparagraph id="H1B6FE3C903BC49A493FB071378322CF9"><enum>(B)</enum><text>$25,000,000 to
			 carry out subsection (b), of which—</text>
							<clause id="HC860B326288540CBA4CED2BCC0A2FAF6"><enum>(i)</enum><text>2
			 percent shall be for the provision of technical assistance to grant recipients;
			 and</text>
							</clause><clause id="H6D73A7C1AA9F4951A433398F8CDC8DD7"><enum>(ii)</enum><text>5
			 percent shall be for independent evaluation under subsection (b)(7).</text>
							</clause></subparagraph></paragraph></subsection></section><section display-inline="no-display-inline" id="H8403C84486DF47BCA8625968EB463F9" section-type="subsequent-section"><enum>403.</enum><header>Rural health care
			 services</header><text display-inline="no-display-inline">Section 330A of the
			 Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/254c">42 U.S.C. 254c</external-xref>) is amended to read as
			 follows:</text>
				<quoted-block display-inline="no-display-inline" id="H3115B4AA9E66431FA097DB8292DE09D6" style="OLC">
					<section id="HC48DE803E4B743E382669E60CB394E50"><enum>330A.</enum><header>Rural health
				care services outreach, rural health network development, Delta rural
				disparities and health systems development, and small rural health care
				provider quality improvement grant programs</header>
						<subsection id="H9B786354ACE64224A25987F066CDC09"><enum>(a)</enum><header>Purpose</header><text>The
				purpose of this section is to provide for grants—</text>
							<paragraph id="H0D5FEF3E98EC4280B7F600222C2FFB83"><enum>(1)</enum><text>under subsection
				(b), to promote rural health care services outreach;</text>
							</paragraph><paragraph id="H96D1C9A3DE2A4352815D7937D3F0EA5D"><enum>(2)</enum><text display-inline="yes-display-inline">under subsection (c), to provide for the
				planning and implementation of integrated health care networks in rural
				areas;</text>
							</paragraph><paragraph id="HD116944DF9AE4C19BEECD648FFA7FBA"><enum>(3)</enum><text display-inline="yes-display-inline">under subsection (d), to assist rural
				communities in the Delta Region to reduce health disparities and to promote and
				enhance health system development; and</text>
							</paragraph><paragraph id="H67F6F5817FDE48FAA22FCABECCAE7022"><enum>(4)</enum><text display-inline="yes-display-inline">under subsection (e), to provide for the
				planning and implementation of small rural health care provider quality
				improvement activities.</text>
							</paragraph></subsection><subsection id="H0FA577D2C57D4353AEDAE0095B2B62C9"><enum>(b)</enum><header>Rural health
				care services outreach grants</header>
							<paragraph id="HE7F28C15E1304D17A5DED5D69FFF3500"><enum>(1)</enum><header>Grants</header><text display-inline="yes-display-inline">The Director of the Office of Rural Health
				Policy of the Health Resources and Services Administration may award grants to
				eligible entities to promote rural health care services outreach by expanding
				the delivery of health care services to include new and enhanced services in
				rural areas. The Director may award the grants for periods of not more than 3
				years.</text>
							</paragraph><paragraph id="H5269D7D85221427CA1A4278C98ED0037"><enum>(2)</enum><header>Eligibility</header><text>To
				be eligible to receive a grant under this subsection for a project, an
				entity—</text>
								<subparagraph id="H4A98C9BC8E804FAC880200BDBF29F16"><enum>(A)</enum><text display-inline="yes-display-inline">shall be a rural public or rural nonprofit
				private entity, a facility that qualifies as a rural health clinic under title
				XVIII of the Social Security Act, a public or nonprofit entity existing
				exclusively to provide services to migrant and seasonal farm workers in rural
				areas, or a tribal government whose grant-funded activities will be conducted
				within federally recognized tribal areas;</text>
								</subparagraph><subparagraph id="H8E28AB00F7264F1DB88802CF2434D5AC"><enum>(B)</enum><text>shall represent a
				consortium composed of members—</text>
									<clause id="H7EE1DA9CF61A4D1C92CA303145EE7671"><enum>(i)</enum><text>that include 3 or
				more independently-owned health care entities; and</text>
									</clause><clause id="H420ED53E323347CE9839948BFE6C54CA"><enum>(ii)</enum><text>that may be
				nonprofit or for-profit entities; and</text>
									</clause></subparagraph><subparagraph id="HCBDA2B6853E6487F97E3315D7348FC30"><enum>(C)</enum><text>shall not
				previously have received a grant under this subsection for the same or a
				similar project, unless the entity is proposing to expand the scope of the
				project or the area that will be served through the project.</text>
								</subparagraph></paragraph><paragraph id="HC39B4766F6EA4218B7A4A712F3E540F"><enum>(3)</enum><header>Applications</header><text>To
				be eligible to receive a grant under this subsection, an eligible entity shall
				prepare and submit to the Director an application at such time, in such manner,
				and containing such information as the Director may require, including—</text>
								<subparagraph id="HB499FC68C4064BAAA6E728671D516860"><enum>(A)</enum><text>a description of
				the project that the eligible entity will carry out using the funds provided
				under the grant;</text>
								</subparagraph><subparagraph id="H7FB32D0DD2594E1EA8C9002B4EC6D15"><enum>(B)</enum><text>a description of
				the manner in which the project funded under the grant will meet the health
				care needs of rural populations in the local community or region to be
				served;</text>
								</subparagraph><subparagraph id="H360D584871084B448E004C3029D96AC"><enum>(C)</enum><text>a plan for
				quantifying how health care needs will be met through identification of the
				target population and benchmarks of service delivery or health status, such
				as—</text>
									<clause id="HE3A125529B3C4C968F528B605CB6A5A0"><enum>(i)</enum><text>quantifiable
				measurements of health status improvement for projects focusing on health
				promotion; or</text>
									</clause><clause id="HBE5E285F788841AD8D6FF8CAF26C3814"><enum>(ii)</enum><text>benchmarks of
				increased access to primary care, including tracking factors such as the number
				and type of primary care visits, identification of a medical home, or other
				general measures of such access;</text>
									</clause></subparagraph><subparagraph id="HB3B43329709D48FD9567E92C49523321"><enum>(D)</enum><text>a description of
				how the local community or region to be served will be involved in the
				development and ongoing operations of the project;</text>
								</subparagraph><subparagraph id="H006C11B3F62D4DABA882008F315FB503"><enum>(E)</enum><text>a plan for
				sustaining the project after Federal support for the project has ended;</text>
								</subparagraph><subparagraph id="H119B46FD5869418FA7171D5BF2664B00"><enum>(F)</enum><text>a description of
				how the project will be evaluated;</text>
								</subparagraph><subparagraph id="HD69EE96E0AB04BA796C87F7E5003D7F"><enum>(G)</enum><text>the administrative
				capacity to submit annual performance data electronically as specified by the
				Director; and</text>
								</subparagraph><subparagraph id="HE5C220D2F4A84F0789E87438BA3C7909"><enum>(H)</enum><text>other such
				information as the Director determines to be appropriate.</text>
								</subparagraph></paragraph></subsection><subsection id="H3FF0B04B2A65448B9CC528A3A5F014C2"><enum>(c)</enum><header>Rural health
				network development grants</header>
							<paragraph id="HC6C828C923E04CE3B2001F802E5734B4"><enum>(1)</enum><header>Grants</header>
								<subparagraph id="H73ECF80E76B0464A9630FA4DB7E8BE1"><enum>(A)</enum><header>In
				general</header><text>The Director may award rural health network development
				grants to eligible entities to promote, through planning and implementation,
				the development of integrated health care networks that have combined the
				functions of the entities participating in the networks in order to—</text>
									<clause id="H4ADE7B43432344BC92861D4BCF51765"><enum>(i)</enum><text>achieve
				efficiencies and economies of scale;</text>
									</clause><clause id="H4D25556EC0734185A3541FD3A4765C17"><enum>(ii)</enum><text>expand access to,
				coordinate, and improve the quality of the health care delivery system through
				development of organizational efficiencies;</text>
									</clause><clause id="HEC63710AAB9A403BADD6002EE191B5ED"><enum>(iii)</enum><text>implement health
				information technology to achieve efficiencies, reduce medical errors, and
				improve quality;</text>
									</clause><clause id="H856C3FAB063C4D0F8FA610EB1C35D083"><enum>(iv)</enum><text>coordinate care
				and manage chronic illness; and</text>
									</clause><clause id="H5B735169AE2D4ED1A4683C0073F72B50"><enum>(v)</enum><text>strengthen the
				rural health care system as a whole in such a manner as to show a quantifiable
				return on investment to the participants in the network.</text>
									</clause></subparagraph><subparagraph id="HAF562BD47CDA41C1A55C996FA684F2D0"><enum>(B)</enum><header>Grant
				periods</header><text>The Director may award such a rural health network
				development grant—</text>
									<clause id="H7CCC6D99EB424D3C9427135337366878"><enum>(i)</enum><text>for a period of 3
				years for implementation activities; or</text>
									</clause><clause id="HF2F9E44D9A044C22801FE92244FBEB1E"><enum>(ii)</enum><text display-inline="yes-display-inline">for a period of 1 year for planning
				activities to assist in the initial development of an integrated health care
				network, if the proposed participants in the network do not have a history of
				collaborative efforts and a 3-year grant would be inappropriate.</text>
									</clause></subparagraph></paragraph><paragraph id="H2BC935FE8E934CA996F1E030C2FD31D5"><enum>(2)</enum><header>Eligibility</header><text>To
				be eligible to receive a grant under this subsection, an entity—</text>
								<subparagraph id="H64B1CA9C68AC49B49CFFC0828DFBC086"><enum>(A)</enum><text display-inline="yes-display-inline">shall be a rural public or rural nonprofit
				private entity, a facility that qualifies as a rural health clinic under title
				XVIII of the Social Security Act, a public or nonprofit entity existing
				exclusively to provide services to migrant and seasonal farm workers in rural
				areas, or a tribal government whose grant-funded activities will be conducted
				within federally recognized tribal areas;</text>
								</subparagraph><subparagraph id="HDAE621577D094A0E97B89CE5F500A9A8"><enum>(B)</enum><text>shall represent a
				network composed of participants—</text>
									<clause id="H2EB9642F87A34701BAD5E319B00FBA9"><enum>(i)</enum><text>that include 3 or
				more independently-owned health care entities; and</text>
									</clause><clause id="H66D4526896CA404F89BFD35C4BD9D1E9"><enum>(ii)</enum><text>that may be
				nonprofit or for-profit entities; and</text>
									</clause></subparagraph><subparagraph id="H63B7BD10255D4259BE09FD852D7FF327"><enum>(C)</enum><text>shall not
				previously have received a grant under this subsection (other than a 1-year
				grant for planning activities) for the same or a similar project.</text>
								</subparagraph></paragraph><paragraph id="H8B6DAF951B0A4569A6F156003C9F8496"><enum>(3)</enum><header>Applications</header><text>To
				be eligible to receive a grant under this subsection, an eligible entity, in
				consultation with the appropriate State office of rural health or another
				appropriate State entity, shall prepare and submit to the Director an
				application at such time, in such manner, and containing such information as
				the Director may require, including—</text>
								<subparagraph id="H037B961F21A848FDA34F79686C3915E5"><enum>(A)</enum><text>a description of
				the project that the eligible entity will carry out using the funds provided
				under the grant;</text>
								</subparagraph><subparagraph id="H6876588826F24CCFBDF4B85CE75EA1CF"><enum>(B)</enum><text>an explanation of
				the reasons why Federal assistance is required to carry out the project;</text>
								</subparagraph><subparagraph id="HC3FE2919DBDA4C73A18F6E008E9E4500"><enum>(C)</enum><text>a description
				of—</text>
									<clause id="H6309D77858264479B9251D3764000063"><enum>(i)</enum><text>the history of
				collaborative activities carried out by the participants in the network;</text>
									</clause><clause id="H2DEBCF665073407C9E86F682BF849C12"><enum>(ii)</enum><text>the degree to
				which the participants are ready to integrate their functions; and</text>
									</clause><clause id="H38FD61ECE552444BB674AF9F96C09665"><enum>(iii)</enum><text>how the local
				community or region to be served will benefit from and be involved in the
				activities carried out by the network;</text>
									</clause></subparagraph><subparagraph id="HE05686F176B346B0965F32B19B47C4B0"><enum>(D)</enum><text>a description of
				how the local community or region to be served will experience increased access
				to quality health care services across the continuum of care as a result of the
				integration activities carried out by the network, including a description
				of—</text>
									<clause id="H11A74CB0EDE34B1894636D00FB82C6ED"><enum>(i)</enum><text>return on
				investment for the community and the network members; and</text>
									</clause><clause id="HE250C68456D849A8AD08F0D9C7B5306"><enum>(ii)</enum><text>other quantifiable
				performance measures that show the benefit of the network activities;</text>
									</clause></subparagraph><subparagraph id="HE66F3547FF224C0E8F9226FA00689C81"><enum>(E)</enum><text>a plan for
				sustaining the project after Federal support for the project has ended;</text>
								</subparagraph><subparagraph id="HEC7C1A417096474EAD116B952904E761"><enum>(F)</enum><text>a description of
				how the project will be evaluated;</text>
								</subparagraph><subparagraph id="HA0C7E8194DC1440F8F754B71D1E69729"><enum>(G)</enum><text>the administrative
				capacity to submit annual performance data electronically as specified by the
				Director; and</text>
								</subparagraph><subparagraph id="H5F227A3567AC443F93C09B3DA9028E30"><enum>(H)</enum><text>other such
				information as the Director determines to be appropriate.</text>
								</subparagraph></paragraph></subsection><subsection id="H6D040E1CF8EB4F698775962636DC41E"><enum>(d)</enum><header>Delta rural
				disparities and health systems development grants</header>
							<paragraph id="H8AFF59ED596F4ACAAD144B553DBDCA07"><enum>(1)</enum><header>Grants</header><text>The
				Director may award grants to eligible entities to support reduction of health
				disparities, improve access to health care, and enhance rural health system
				development in the Delta Region.</text>
							</paragraph><paragraph id="HA1E9E53CF517421BB940D473399E6FF"><enum>(2)</enum><header>Eligibility</header><text display-inline="yes-display-inline">To be eligible to receive a grant under
				this subsection, an entity shall be a rural public or rural nonprofit private
				entity, a facility that qualifies as a rural health clinic under title XVIII of
				the Social Security Act, a public or nonprofit entity existing exclusively to
				provide services to migrant and seasonal farm workers in rural areas, or a
				tribal government whose grant-funded activities will be conducted within
				federally recognized tribal areas.</text>
							</paragraph><paragraph id="HB7F1258BACCC4AF89BBBFAB7DF04C487"><enum>(3)</enum><header>Applications</header><text>To
				be eligible to receive a grant under this subsection, an eligible entity shall
				prepare and submit to the Director an application at such time, in such manner,
				and containing such information as the Director may require, including—</text>
								<subparagraph id="H394845C29E3D45749D94005C21EEBAB1"><enum>(A)</enum><text>a description of
				the project that the eligible entity will carry out using the funds provided
				under the grant;</text>
								</subparagraph><subparagraph id="H0A712D5574A44CEC93B0FEFFF782E958"><enum>(B)</enum><text>an explanation of
				the reasons why Federal assistance is required to carry out the project;</text>
								</subparagraph><subparagraph id="HF6F4C4500174402C8EFAD5164D68A2C3"><enum>(C)</enum><text>a description of
				the manner in which the project funded under the grant will meet the health
				care needs of the Delta Region;</text>
								</subparagraph><subparagraph id="H67C2149FEA1843EFBCBA8FFE4432F317"><enum>(D)</enum><text>a description of
				how the local community or region to be served will experience increased access
				to quality health care services as a result of the activities carried out by
				the entity;</text>
								</subparagraph><subparagraph id="H7C1484C088844DD396577EC91C16BAC9"><enum>(E)</enum><text>a description of
				how health disparities will be reduced or the health system will be
				improved;</text>
								</subparagraph><subparagraph id="HCACB215A50E441A2B8C5AE80EE5C91EA"><enum>(F)</enum><text>a plan for
				sustaining the project after Federal support for the project has ended;</text>
								</subparagraph><subparagraph id="H9202B2C7AF3A47ADA41B55388D01EEFD"><enum>(G)</enum><text>a description of
				how the project will be evaluated including process and outcome measures
				related to the quality of care provided or how the health care system improves
				its performance;</text>
								</subparagraph><subparagraph id="H6292838DCD8C45C1B485FBB8F529AA86"><enum>(H)</enum><text>a description of
				how the grantee will develop an advisory group made up of representatives of
				the communities to be served to provide guidance to the grantee to best meet
				community need; and</text>
								</subparagraph><subparagraph id="HC727D357BFC24F13B99F1BB662F9C8DB"><enum>(I)</enum><text>other such
				information as the Director determines to be appropriate.</text>
								</subparagraph></paragraph></subsection><subsection id="HC8687B0ADCED438A9C280010EC8C46A6"><enum>(e)</enum><header>Small rural
				health care provider quality improvement grants</header>
							<paragraph id="H86E62DB70B5C49C8B9AB1670C9470859"><enum>(1)</enum><header>Grants</header><text>The
				Director may award grants to provide for the planning and implementation of
				small rural health care provider quality improvement activities. The Director
				may award the grants for periods of 1 to 3 years.</text>
							</paragraph><paragraph id="HC3FC914F18B547FEA7FF7B241FBA569F"><enum>(2)</enum><header>Eligibility</header><text>To
				be eligible for a grant under this subsection, an entity—</text>
								<subparagraph id="HB1D95797D18A4C6D86A2968D6D8E60E5"><enum>(A)</enum><text>shall be—</text>
									<clause id="H4D5E4A7227C0456CA18FF0BF5DA91A5"><enum>(i)</enum><text display-inline="yes-display-inline">a rural public or rural nonprofit private
				health care provider or provider of health care services, such as a rural
				health clinic; or</text>
									</clause><clause id="H8DCABE1406DF4FAD92612DAD3705E742"><enum>(ii)</enum><text display-inline="yes-display-inline">another rural provider or network of small
				rural providers identified by the Director as a key source of local care;
				and</text>
									</clause></subparagraph><subparagraph id="H562BB388B2514EF8BC8F60B3B1E43BE6"><enum>(B)</enum><text>shall not
				previously have received a grant under this subsection for the same or a
				similar project.</text>
								</subparagraph></paragraph><paragraph id="HC9CB9C5A0EAF4996B01D330083FC7400"><enum>(3)</enum><header>Preference</header><text display-inline="yes-display-inline">In awarding grants under this subsection,
				the Director shall give preference to facilities that qualify as rural health
				clinics under title XVIII of the Social Security Act.</text>
							</paragraph><paragraph id="H58BF42118451495E8E686200E8C41500"><enum>(4)</enum><header>Applications</header><text>To
				be eligible to receive a grant under this subsection, an eligible entity shall
				prepare and submit to the Director an application at such time, in such manner,
				and containing such information as the Director may require, including—</text>
								<subparagraph id="HAFE1FE7D68D64F30B9DC60F64CFE15BC"><enum>(A)</enum><text>a description of
				the project that the eligible entity will carry out using the funds provided
				under the grant;</text>
								</subparagraph><subparagraph id="H30C95D6B40E944D5A18F5924E836EA2"><enum>(B)</enum><text>an explanation of
				the reasons why Federal assistance is required to carry out the project;</text>
								</subparagraph><subparagraph id="H89B2121260AC49EE9CF5C1EDDC0011AB"><enum>(C)</enum><text>a description of
				the manner in which the project funded under the grant will assure continuous
				quality improvement in the provision of services by the entity;</text>
								</subparagraph><subparagraph id="H7FD4D3E8C55C43DB9C25C3629328BA71"><enum>(D)</enum><text>a description of
				how the local community or region to be served will experience increased access
				to quality health care services as a result of the activities carried out by
				the entity;</text>
								</subparagraph><subparagraph id="H8912339C5B1C4F7F974C67F0343B8500"><enum>(E)</enum><text>a plan for
				sustaining the project after Federal support for the project has ended;</text>
								</subparagraph><subparagraph id="H124B807A90874E7DA589CC7BE8784791"><enum>(F)</enum><text>a description of
				how the project will be evaluated including process and outcome measures
				related to the quality of care provided; and</text>
								</subparagraph><subparagraph id="H4C3F31AF96394DD98475E0EC49141071"><enum>(G)</enum><text>other such
				information as the Director determines to be appropriate.</text>
								</subparagraph></paragraph></subsection><subsection id="H93E915EA276D46D48D7E353EF6B079FE"><enum>(f)</enum><header>General
				requirements</header>
							<paragraph id="H571EB88090B648059488A0F789115DF9"><enum>(1)</enum><header>Prohibited uses
				of funds</header><text>An entity that receives a grant under this section may
				not use funds provided through the grant—</text>
								<subparagraph id="HF70AB4733DAE414FAA852DF8916C4800"><enum>(A)</enum><text>to build or
				acquire real property; or</text>
								</subparagraph><subparagraph id="HDCDB8D29D7354ABC8F2216B2D4A9A613"><enum>(B)</enum><text>for
				construction.</text>
								</subparagraph></paragraph><paragraph id="H435A5FB9319A4E778D2632871D1DFFB4"><enum>(2)</enum><header>Coordination
				with other agencies</header><text>The Director shall coordinate activities
				carried out under grant programs described in this section, to the extent
				practicable, with Federal and State agencies and nonprofit organizations that
				are operating similar grant programs, to maximize the effect of public dollars
				in funding meritorious proposals.</text>
							</paragraph></subsection><subsection id="H23F08BC814004DFF8EACA62B47BED9F9"><enum>(g)</enum><header>Report</header><text>Not
				later than September 30, 2010, the Secretary shall prepare and submit to the
				appropriate committees of Congress a report on the progress and accomplishments
				of the grant programs described in subsections (b), (c), (d), and (e).</text>
						</subsection><subsection id="H7F4F823946D148939D6B58742F6956D3"><enum>(h)</enum><header>Definitions</header><text>In
				this section:</text>
							<paragraph id="HE936D3484E094D73B6D116961D102CC8"><enum>(1)</enum><text display-inline="yes-display-inline">The term <term>Delta Region</term> has the
				meaning given to the term <term>region</term> in section 382A of the
				Consolidated Farm and Rural Development Act (<external-xref legal-doc="usc" parsable-cite="usc/7/2009aa">7 U.S.C. 2009aa</external-xref>).</text>
							</paragraph><paragraph id="HC1E6A42AB4814DB09FA52BE8009D22B9"><enum>(2)</enum><text>The term
				<term>Director</term> means the Director of the Office of Rural Health Policy
				of the Health Resources and Services Administration.</text>
							</paragraph></subsection><subsection id="H20EA3948BA2848B29CCF893788AA8DE9"><enum>(i)</enum><header>Authorization of
				appropriations</header><text>There are authorized to be appropriated to carry
				out this section $40,000,000 for fiscal year 2008, and such sums as may be
				necessary for each of fiscal years 2009 through
				2012.</text>
						</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
			</section><section id="H2BC477912F8F4CB6B57131E9AE6E52D0"><enum>404.</enum><header>Community
			 health center collaborative access expansion</header><text display-inline="no-display-inline">Section 330 of the
			 <act-name parsable-cite="PHSA">Public Health Service Act</act-name> (42 U.S.C.
			 254b) is amended by adding at the end the following:</text>
				<quoted-block act-name="Public Health Service Act" display-inline="no-display-inline" id="HA686E63C4149425C8FA0DEBA723E1D08" style="OLC">
					<subsection id="H72E9DD64A274420387CC3727B962F404"><enum>(s)</enum><header>Miscellaneous
				Provisions</header>
						<paragraph id="HB264451C8E604AD8B1CA76F6741480DD"><enum>(1)</enum><header>Rule of
				construction with respect to rural health clinics</header>
							<subparagraph id="H3196EDADB505486C9722325BF3DA00C"><enum>(A)</enum><header>In
				general</header><text>Nothing in this section shall be construed to prevent a
				community health center from contracting with a federally certified rural
				health clinic (as defined by section 1861(aa)(2) of the
				<act-name parsable-cite="SSA">Social Security Act</act-name>) for the delivery
				of primary health care services that are available at the rural health clinic
				to individuals who would otherwise be eligible for free or reduced cost care if
				that individual were able to obtain that care at the community health center.
				Such services may be limited in scope to those primary health care services
				available in that rural health clinic.</text>
							</subparagraph><subparagraph id="HF39344919F72414C818E13485C2F58D7"><enum>(B)</enum><header>Assurances</header><text>In
				order for a rural health clinic to receive funds under this section through a
				contract with a community health center under paragraph (1), such rural health
				clinic shall establish policies to ensure—</text>
								<clause id="H06BE8702D5834628AD068138BA5750EC"><enum>(i)</enum><text>nondiscrimination
				based upon the ability of a patient to pay; and</text>
								</clause><clause commented="no" display-inline="no-display-inline" id="HB91E72C41F5841BC829E66C7E9C772D7"><enum>(ii)</enum><text>the establishment
				of a sliding fee scale for low-income
				patients.</text>
								</clause></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
			</section><section id="H6BF8C633E42D4DFD9813D856E90019EE"><enum>405.</enum><header>Facilitating
			 the provision of telehealth services across State lines</header>
				<subsection id="HD5FD786160144EEBB7E1006407B50000"><enum>(a)</enum><header>In
			 general</header><text>For purposes of expediting the provision of telehealth
			 services, for which payment is made under the Medicare program, across State
			 lines, the Secretary of Health and Human Services shall, in consultation with
			 representatives of States, physicians, health care practitioners, and patient
			 advocates, encourage and facilitate the adoption of provisions allowing for
			 multistate practitioner practice across State lines.</text>
				</subsection><subsection id="H3C5EA05903E444E8A6D130469B62E534"><enum>(b)</enum><header>Definitions</header><text>In
			 subsection (a):</text>
					<paragraph id="H3DC5357EA4F04F5300609016943325F0"><enum>(1)</enum><header>Telehealth
			 service</header><text>The term <term>telehealth service</term> has the meaning
			 given that term in subparagraph (F) of section 1834(m)(4) of the
			 <act-name parsable-cite="SSA">Social Security Act</act-name> (42 U.S.C.
			 1395m(m)(4)).</text>
					</paragraph><paragraph id="H98A6877A1D4045AB972900F6B320A22"><enum>(2)</enum><header>Physician,
			 practitioner</header><text>The terms <term>physician</term> and
			 <term>practitioner</term> have the meaning given those terms in subparagraphs
			 (D) and (E), respectively, of such section.</text>
					</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HF56238A305004C75BDCC52DE38C38BBB"><enum>(3)</enum><header>Medicare
			 program</header><text>The term <term>Medicare program</term> means the program
			 of health insurance administered by the Secretary of Health and Human Services
			 under title XVIII of the <act-name parsable-cite="SSA">Social Security
			 Act</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395 et seq.</external-xref>).</text>
					</paragraph></subsection></section><section id="H4602E1219E3F4683A03F62877985DD07"><enum>406.</enum><header>Expanded
			 application of the 340B program to drugs provided in rural hospitals</header>
				<subsection id="H99055A73347742E1959E51D87BA0EA14"><enum>(a)</enum><header>Expanded
			 participation in 340B program to certain rural hospitals</header><text display-inline="yes-display-inline">Section 340B(a)(4) of the Public Health
			 Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/256b">42 U.S.C. 256b(a)(4)</external-xref>) is amended by adding at the end the
			 following new subparagraphs:</text>
					<quoted-block id="HD37914AA71874776A3E8A950177140A" style="OLC">
						<subparagraph id="HB2F988EC3F224A4A832B5715C55E70"><enum>(M)</enum><text>An entity that is a
				critical access hospital (as determined under section 1820(c)(2) of the Social
				Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395i-4">42 U.S.C. 1395i–4(c)(2)</external-xref>).</text>
						</subparagraph><subparagraph id="HAE92997CD8DB415F8EEB82CFE3A3A13E"><enum>(N)</enum><text>An entity that is
				a Medicare-dependent, small rural hospital (as defined in section
				1886(d)(5)(G)(iv) of the Social Security Act).</text>
						</subparagraph><subparagraph id="H009810C1B5E94B3C95ABD53FBFE2A6D"><enum>(O)</enum><text display-inline="yes-display-inline">An entity that is a sole community hospital
				(as defined in section 1886(d)(5)(D)(iii) of the Social Security Act).</text>
						</subparagraph><subparagraph id="H9D2A41BC5F3E49FF8536FC5FE88C5B52"><enum>(P)</enum><text>An entity that is
				classified as a rural referral center under section 1886(d)(5)(C) of the Social
				Security
				Act.</text>
						</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
				</subsection><subsection display-inline="no-display-inline" id="H0917F04DF4114328A8241FF4641471DC"><enum>(b)</enum><header>Extension of
			 discounts to inpatient drugs</header>
					<paragraph id="H92C350D0E86740B5AA6E83B0A4A326E0"><enum>(1)</enum><header>In
			 general</header><text>Section 340B of the Public Health Service Act (42 U.S.C.
			 256b) is amended—</text>
						<subparagraph id="HF7A9D98B00A34D9594FD979FDC52994C"><enum>(A)</enum><text>in subsection
			 (b)—</text>
							<clause id="HDAFCA87C1795450B91F700E83D322D2C"><enum>(i)</enum><text>by
			 designating the matter beginning <quote>In this section</quote> as a paragraph
			 (1) with the heading <quote><header-in-text level="paragraph" style="OLC">In
			 general</header-in-text></quote> ; and</text>
							</clause><clause id="H436A397176604D44B50073AA4F3C58F6"><enum>(ii)</enum><text>by
			 adding at the end the following new paragraph:</text>
								<quoted-block display-inline="no-display-inline" id="HB7AC3AE7CB8E4CD9B11FBF006F358F9B" style="OLC">
									<paragraph id="HFC4EB00405714789BD6CCA9BA5B8AE10"><enum>(2)</enum><header>Covered
				drug</header><text>In this section, the term <term>covered drug</term>—</text>
										<subparagraph id="HB97A5BA511424812A74E93716C89C6FC"><enum>(A)</enum><text>means a covered
				outpatient drug (as defined in section 1927(k)(2) of the Social Security Act);
				and</text>
										</subparagraph><subparagraph id="H2A80E4127CD14F0B9F03692022CE8853"><enum>(B)</enum><text display-inline="yes-display-inline">includes, notwithstanding the section
				1927(k)(3)(A) of such Act, a drug used in connection with an inpatient or
				outpatient service provided by a hospital described in subparagraph (M), (N),
				(O), or (P) of subsection (a)(4) that is enrolled to participate in the drug
				discount program under this section.</text>
										</subparagraph></paragraph><after-quoted-block>;
				and</after-quoted-block></quoted-block>
							</clause></subparagraph><subparagraph id="H2141662D25F34447A362136176F1F6CE"><enum>(B)</enum><text>in paragraphs (5),
			 (7), and (9), by striking <quote>outpatient</quote> each place it
			 appears.</text>
						</subparagraph></paragraph><paragraph id="HB880259169C94BFBADD89B004D2E94F8"><enum>(2)</enum><header>Medicaid credits
			 on inpatient drugs</header><text>Subsection (c) of section 340B of the Public
			 Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/256b">42 U.S.C. 256b(c)</external-xref>) is amended to read as follows:</text>
						<quoted-block id="HE238FEFEE1274A62B8EEB5445E233D65" style="OLC">
							<subsection id="H4B048816044C4F96ADC64D26B0D319EA"><enum>(c)</enum><header>Medicaid Credits
				on Inpatient Drugs</header>
								<paragraph id="H3BDDA774240843F69FD0938256A9F96D"><enum>(1)</enum><header>In
				General</header><text display-inline="yes-display-inline">For the cost
				reporting period covered by the most recently filed Medicare cost report under
				title XVIII of the Social Security Act, a hospital described in subparagraph
				(M), (N), (O), or (P) of subsection (a)(4) and enrolled to participate in the
				drug discount program under this section shall provide to each State under its
				plan under title XIX of such Act —</text>
									<subparagraph id="H0BDDC08249A441AE8BAB80B933CAC9C7"><enum>(A)</enum><text>a credit on the
				estimated annual costs to such hospital of single source and innovator multiple
				source drugs provided to Medicaid recipients for inpatient use; and</text>
									</subparagraph><subparagraph id="HB8810F0E6582447AA26DFC20AE45398F"><enum>(B)</enum><text>a credit on the
				estimated annual costs to such hospital of noninnovator multiple source drugs
				provided to Medicaid recipients for inpatient use.</text>
									</subparagraph></paragraph><paragraph id="H78CFB5B8C83D4DF4893B483E4852BAF0"><enum>(2)</enum><header>Calculation of
				Credits</header>
									<subparagraph id="H464478792D4F42DDAB7B6863DFE3335"><enum>(A)</enum><header>Single Source and
				Innovator Multiple Source Drugs</header><text>For purposes of paragraph
				(1)(A)—</text>
										<clause id="H6FCA18CA629F4D9DB6A58900ED20C4D6"><enum>(i)</enum><text>the credit under
				such paragraph shall be equal to the product of—</text>
											<subclause id="HE83110DEC54D458EAFB4BBF815B9D6EA"><enum>(I)</enum><text>the estimated
				annual costs of single source and innovator multiple source drugs provided by
				the hospital to Medicaid recipients for inpatient use;</text>
											</subclause><subclause id="HB9DF32CB928C40E400D11FA4668129C7"><enum>(II)</enum><text>the average
				manufacturer price adjustment; and</text>
											</subclause><subclause id="HB3175FCD4052407BB31EDB8161EFC58E"><enum>(III)</enum><text>the minimum
				rebate percentage described in section 1927(c)(1)(B) of the Social Security
				Act;</text>
											</subclause></clause><clause id="H0AFB41F4C8044EEC0018E0C4D4DEC6D2"><enum>(ii)</enum><text>the estimated
				annual costs of single source drugs and innovator multiple source drugs
				provided by the hospital to Medicaid recipients for inpatient use under clause
				(i)(I) shall be equal to the product of—</text>
											<subclause id="H7BC1B39DE58B47CB84EA3458DBBC64AF"><enum>(I)</enum><text>the hospital’s
				actual acquisition costs of all drugs purchased during the cost reporting
				period for inpatient use;</text>
											</subclause><subclause id="H48251293715647FDB081BF49BD1CA73C"><enum>(II)</enum><text>the Medicaid
				inpatient drug charges as reported on the hospital’s most recently filed
				Medicare cost report divided by total inpatient drug charges reported on the
				cost report; and</text>
											</subclause><subclause id="HA2A078207F114F8598F88C470007799B"><enum>(III)</enum><text>the percent of
				the hospital’s annual inpatient drug costs described in subclause (I) arising
				out of the purchase of single source and innovator multiple source
				drugs;</text>
											</subclause></clause><clause id="HCDD52FEA163F4203A74311DEC004522"><enum>(iii)</enum><text>the average
				manufacturer price adjustment referenced in clause (i)(II) shall be determined
				annually by the Secretary for single source and innovator multiple source drugs
				by dividing on an aggregate basis the average manufacturer price as defined in
				section 1927(k)(1)(D) of the Social Security Act, averaged across all covered
				drugs reported to the Secretary pursuant to section 1927(b)(3) of such Act by
				the average 340B ceiling price for covered drugs calculated pursuant to
				subsection (a)(1); and</text>
										</clause><clause id="H7ECD14F9ACE84289B673A49711E3437F"><enum>(iv)</enum><text>the terms
				<term>single source drug</term> and <term>innovator multiple source drug</term>
				have the meanings given such terms in section 1927(k)(7) of the Social Security
				Act.</text>
										</clause></subparagraph><subparagraph id="H96196A455B9242AEAF4D67975C1FB1F2"><enum>(B)</enum><header>Noninnovator
				Multiple Source Drugs</header><text>For purposes of subparagraph (1)(B)—</text>
										<clause id="H675864379A10410BABEAFA8DCD454CB6"><enum>(i)</enum><text>the credit under
				such paragraph shall be calculated by multiplying—</text>
											<subclause id="HF18C7B40E18F4610922F4FD24EECD8F2"><enum>(I)</enum><text>the estimated
				annual costs to the hospital of noninnovator multiple source drugs provided to
				Medicaid recipients for inpatient use,</text>
											</subclause><subclause id="HA83C70001FD24E0594004CAD6E88B173"><enum>(II)</enum><text>the average
				manufacturer price adjustment, and</text>
											</subclause><subclause id="H6B6DB7308F70407F8109F482EE38C9A5"><enum>(III)</enum><text>the applicable
				percentage as defined in section 1927(c)(3)(B) of the Social Security
				Act;</text>
											</subclause></clause><clause id="H2EEF36FC900D46BC95E0002E76831813"><enum>(ii)</enum><text>the estimated
				annual costs to a hospital of noninnovator multiple source drugs provided to
				Medicaid recipients for inpatient use under clause (i)(I) shall be equal to the
				product of—</text>
											<subclause id="HD105615E3C1148B9A5177547558E0564"><enum>(I)</enum><text>the hospital’s
				actual acquisition cost of all drugs purchased during the cost reporting period
				for inpatient use;</text>
											</subclause><subclause id="HFDC5AA5CC51B4B69A8E8B6E4BFD52ED"><enum>(II)</enum><text>the Medicaid
				inpatient drug charges as reported on the hospital’s most recently filed
				Medicare cost report divided by total inpatient drug charges reported on the
				cost report;</text>
											</subclause><subclause id="HF9B7027E37C640AE9805AA0075A5FB2"><enum>(III)</enum><text>the percent of
				the hospital’s annual inpatient drug costs described in subclause (I) arising
				out of the purchase of noninnovator multiple source drugs;</text>
											</subclause></clause><clause id="HAC8DBA0B734846F6BD141411CAC46EDE"><enum>(iii)</enum><text>the average
				manufacturer price adjustment referenced in clause (i)(II) shall be determined
				annually by the Secretary for noninnovator multiple source drugs by dividing on
				an aggregate basis the average manufacturer price as defined in Section
				1927(k)(1)(D) of the Social Security Act, averaged across all covered drugs
				reported to the Secretary pursuant to Section 1927(b)(3) of such Act by the
				average 340B ceiling price for covered drugs calculated pursuant to section
				340B(a)(1) of the Public Health Service Act; and</text>
										</clause><clause id="HE92BDB860A184794B6E900C34FA538D8"><enum>(iv)</enum><text>the term
				<term>noninnovator multiple source drug</term> has the meaning given such term
				in section 1927(k)(7) of the Social Security Act.</text>
										</clause></subparagraph></paragraph><paragraph id="HCEB091ABFE8C40CDA639006FB0638CAC"><enum>(3)</enum><header>Payment
				Deadline</header><text>The credits provided by a hospital under paragraph (1)
				shall be paid within 90 days of the filing of the hospital’s most recently
				filed Medicare cost report.</text>
								</paragraph><paragraph id="H82ECFEF4FB9142D687F68BC67493D6C"><enum>(4)</enum><header>Opt
				out</header><text display-inline="yes-display-inline">A hospital shall not be
				required to provide the Medicaid credit required under paragraph (1) if—</text>
									<subparagraph id="HAC5ABCCE44344781BE0288A8E7F15F7F"><enum>(A)</enum><text>it can demonstrate
				to the State that the amount of the credit would not exceed the loss of
				reimbursement under the State plan resulting from the extension of discounts to
				inpatient drugs under subsection (b)(2); or</text>
									</subparagraph><subparagraph id="HFE04046C06F54DDB8D97B48FFDE6D870"><enum>(B)</enum><text>the hospital and
				State agree to an alternative arrangement.</text>
									</subparagraph><continuation-text continuation-text-level="paragraph">Any
				dispute between the hospital and the State under this paragraph shall be
				adjudicated through the administrative dispute resolution process under this
				section.</continuation-text></paragraph><paragraph id="HAE4B3C6E9BE944A0BB75FEE87819D836"><enum>(5)</enum><header>Offset Against
				Medical Assistance</header><text>Amounts received by a State under this
				subsection in any quarter shall be considered to be a reduction in the amount
				expended under the State plan in the quarter for medical assistance for
				purposes of section 1903(a)(1) of the Social Security Act.</text>
								</paragraph><paragraph id="H9A06A6DD17FB46E6A3CB27FC3102563E"><enum>(6)</enum><header>References to
				social security act provisions</header><text display-inline="yes-display-inline">Notwithstanding any other provision of law,
				all references to provisions of the Social Security Act in this section shall
				be deemed to be references to the Social Security Act as in effect on the
				effective date specified in section 406(c)(1) of the
				<short-title>Health Care Access and Rural Equity (H–CARE)
				Act of
				2007</short-title>.</text>
								</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
					</paragraph><paragraph id="H24DB981E496D4E3DB8C1D8EE397FFBB"><enum>(3)</enum><header>Conforming
			 amendments</header><text>Section 1927 of the Social Security Act (42 U.S.C.
			 1396r–8), is amended—</text>
						<subparagraph id="H21D8F94DCE8843F7B2E97523AB5EEC7C"><enum>(A)</enum><text>in subsection
			 (a)(5)(A), by striking <quote>covered outpatient drugs</quote> and inserting
			 <quote>covered drugs (as defined in section 340B(b)(2) of the Public Health
			 Service Act)</quote>;</text>
						</subparagraph><subparagraph id="H5502582397D84DCE995F6022CB9DBD6D"><enum>(B)</enum><text>in subsection
			 (a)(5)(D), by striking <quote>title VI of the Veterans Health Care Act of
			 1992</quote> and inserting the <quote>H<short-title>ealth
			 Care Access and Rural Equity (H–CARE) Act of 2007</short-title></quote>;</text>
						</subparagraph><subparagraph id="HE7D583C8D7DF46B2BDF6BF1124D91FD3"><enum>(C)</enum><text>in subsection
			 (c)(1)(C)(i), by redesignating subclauses (II) through (IV) as subclauses (III)
			 through (V), respectively and by inserting after subclause (I) the following
			 new subclause:</text>
							<quoted-block display-inline="no-display-inline" id="H3496DD93EFA44FB583C8C4D69EE5D709" style="OLC">
								<subclause id="H21A992A102054784A281AC2134DE6510"><enum>(II)</enum><text>any prices
				charged for a covered drug as defined in section 340B(b)(2) of the Public
				Health Service Act;</text>
								</subclause><after-quoted-block>;
				and</after-quoted-block></quoted-block>
						</subparagraph><subparagraph id="H1762F853B0284E4087ACEE431460E731"><enum>(D)</enum><text>in subsection
			 (k)(1)—</text>
							<clause id="H51667E3C2DB14406A66578409F00C099"><enum>(i)</enum><text>in
			 subparagraph (A), by striking <quote>subparagraph (B)</quote> and inserting
			 <quote>subparagraph (B) and (D)</quote>; and</text>
							</clause><clause id="H6A45FBB7D71747FD8545F4449FD29B89"><enum>(ii)</enum><text>by
			 adding at the end the following new subparagraph:</text>
								<quoted-block display-inline="no-display-inline" id="H5FB3B4EC1ED9400E93BAB6DC5044FBC7" style="OLC">
									<subparagraph id="H1DDCFA11DA7D4915B91DD7C6C320219F"><enum>(D)</enum><header>Calculation for
				covered drugs</header><text>With respect to a covered drug (as defined in
				section 340B(b)(2) of the Public Health Service Act), the average manufacturer
				price is the average price paid to the manufacturer for the drug in the United
				States by wholesalers for drugs distributed to both the retail pharmacy and
				acute care classes of trade, after deducting customary prompt pay
				discounts.</text>
									</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
							</clause></subparagraph></paragraph></subsection><subsection display-inline="no-display-inline" id="H1EC8E8E1B5794FCBAF9080A03528A8DA"><enum>(c)</enum><header>Effective
			 dates</header>
					<paragraph id="H4B655BE7325F4BA6B303402886BDE6F6"><enum>(1)</enum><header>In
			 general</header><text>The amendments made by this section shall take effect on
			 January 1, 2008, and shall apply to drugs purchased on or after January 1,
			 2008.</text>
					</paragraph><paragraph id="HE520CFAC435946B5AE28001FD5315D27"><enum>(2)</enum><header>General
			 conforming reference</header><text display-inline="yes-display-inline">Section
			 340B(d) of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/256b">42 U.S.C. 256b(d)</external-xref>) is amended by
			 striking <quote>Veterans Health Care Act of 1992</quote> and inserting
			 <quote>the effective date specified in section 406(c)(1) of the
			 <short-title>Health Care Access and Rural Equity (H–CARE)
			 Act of 2007</short-title></quote>.</text>
					</paragraph><paragraph id="H7E3F20F460DA4BEF84D3F600F59553A8"><enum>(3)</enum><header>Effectiveness</header><text display-inline="yes-display-inline">The amendments made by this section shall
			 be effective, and shall be taken into account in determining whether a
			 manufacturer is deemed to meet the requirements of section 340B(a) of the
			 Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/256b">42 U.S.C. 256b(a)</external-xref>) and of section 1927(a)(5) of the
			 Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396r-8">42 U.S.C. 1396r–8(a)(5)</external-xref>), notwithstanding any other
			 provision of law.</text>
					</paragraph></subsection></section></title></legis-body>
</bill>


