[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 2112 Introduced in Senate (IS)]







110th CONGRESS
  1st Session
                                S. 2112

 To amend the Public Health Service Act to establish the Nurse-Managed 
       Health Clinic Investment program, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           September 27, 2007

 Mr. Inouye (for himself, Mr. Alexander, and Mr. Akaka) introduced the 
 following bill; which was read twice and referred to the Committee on 
                 Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
 To amend the Public Health Service Act to establish the Nurse-Managed 
       Health Clinic Investment program, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Nurse-Managed Health Clinic 
Investment Act of 2007''.

SEC. 2. FINDINGS AND PURPOSE.

    (a) Findings.--Congress makes the following findings:
            (1) Nurse-managed health clinics (referred to in this 
        section as ``NMHCs'') offer their patients primary care based 
        on the nursing model, which emphasizes the protection, 
        promotion, and optimization of health along with the prevention 
        of illness, and the alleviation of suffering in conjunction 
        with diagnosis and treatment. Nurses are advocates and 
        educators providing care for individuals, families, 
        communities, and populations.
            (2) More than 200 NMHCs are currently in operation across 
        the United States. These clinics record over 2,000,000 client 
        encounters annually.
            (3) NMHCs meet the Institute of Medicine's definition of 
        safety-net provider by providing care regardless of their 
        patient's ability to pay. A substantial share of their patient 
        mix is made up of uninsured individuals, Medicaid recipients, 
        and other vulnerable populations. A recent study funded by the 
        Centers for Medicare & Medicaid Services reported that more 
        than 45 percent of the payor mix for NMHCs is uninsured, and 37 
        percent are Medicaid recipients.
            (4) NMHCs provide a medical home for the underserved, and 
        are viable partners with the Federal Government to reduce 
        health disparities. They provide a full range of health care 
        services, including primary care, health promotion, disease 
        prevention, and behavioral health care to the residents of 
        rural and urban underserved communities. Because NMHCs are 
        often located in public housing developments, senior living 
        arrangements, schools, and community centers, they help remove 
        barriers preventing access to care and are instrumental in 
        addressing and eliminating the factors contributing to health 
        disparities.
            (5) Nurse-managed clinics are playing an ever-increasing 
        role in the Nation's health care safety-net, and are currently 
        being under-utilized and under-funded by both Federal and State 
        governments.
            (6) Lack of adequate funding has caused 39 percent of the 
        NMHCs established between 1993 and 2001 to close. These clinics 
        are frequently the only source of health care for their 
        patients. These closures have had a negative impact on the 
        ability of the underserved to access primary care.
            (7) The goal of this Act is to provide NMHCs with access to 
        a stable source of funding that will enable them to continue 
        expanding primary care services in underserved communities, 
        while reducing the level of health disparities suffered by 
        vulnerable populations.
    (b) Purpose.--It is the purpose of this Act to fund the development 
and operation of nurse-managed health clinics to--
            (1) provide comprehensive and accessible primary health 
        care services to vulnerable populations living in underserved 
        communities around the Nation; and
            (2) reduce the level of health disparities experienced by 
        vulnerable populations.

SEC. 3. NURSE-MANAGED HEALTH CLINICS.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) 
is amended by adding at the end the following:

             ``PART S--NURSE-MANAGED HEALTH CLINIC PROGRAM

``SEC. 399JJ. GRANTS TO NURSE-MANAGED HEALTH CLINICS.

    ``(a) Definition; Establishment of Criteria.--In this section:
            ``(1) Comprehensive primary health care services.--The term 
        `comprehensive primary health care services' means health care 
        related to adult, family, and pediatric health consisting of 
        adult health, pediatrics, obstetrics, or gynecology services 
        that are furnished by nurse practitioners, physician 
        assistants, physicians, nurse midwives, and other qualified 
        health care professionals. In addition to primary care 
        services, specific services may include--
                    ``(A) preventive health services;
                    ``(B) prenatal and perinatal services;
                    ``(C) appropriate cancer screening;
                    ``(D) well-child services;
                    ``(E) immunizations against vaccine-preventable 
                diseases;
                    ``(F) screenings for elevated blood lead levels;
                    ``(G) screening for communicable diseases;
                    ``(H) cholesterol screenings;
                    ``(I) pediatric eye and ear screenings to determine 
                the need for vision and hearing correction;
                    ``(J) emergency medical services;
                    ``(K) diagnostic laboratory and radiologic 
                services;
                    ``(L) care navigation services;
                    ``(M) pharmaceutical services as may be appropriate 
                for each clinic; and
                    ``(N) voluntary family planning.
            ``(2) Health promotion and disease prevention services.--
        The term `health promotion and disease prevention services' 
        means the full continuum of educational services as well as 
        physical and mental assessment services designed to enable 
        patients to take control over and improve their health through 
        the prevention of disease as well as the reduction of existing 
        symptoms.
            ``(3) Medically underserved populations.--The term 
        `medically underserved population' has the meaning given such 
        term in section 330(b)(3).
            ``(4) Nurse-managed health clinic.--The term `nurse-managed 
        health clinic' means a nurse-practice arrangement, managed by 
        advanced practice nurses, that provides primary care for 
        underserved or vulnerable populations and is associated with a 
        school, college, or department of nursing, federally qualified 
        health center, or an independent nonprofit health or social 
        services agency.
            ``(5) Vulnerable population.--The term `vulnerable 
        population' means a population that lacks access to adequate 
        primary care or suffers from increased health disparities due 
        to factors such as health, age, race, ethnicity, sex, insurance 
        status, income level, or ability to communicate effectively.
    ``(b) Authority To Award Grants.--The Secretary shall award grants 
for the cost of the operation of nurse-managed health clinics that meet 
the requirements of this section.
    ``(c) Applications.--To be eligible to receive a grant under this 
section, an entity shall--
            ``(1) be a nurse-managed health clinic (as defined in 
        subsection (a)(4)); and
            ``(2) submit to the Secretary an application at such time, 
        in such manner, and containing an assurance that--
                    ``(A) the nurse-managed health clinic will continue 
                providing comprehensive primary care services (as 
                defined in subsection (a)(1)) for the duration of the 
                grant period; and
                    ``(B) the nurse-managed health clinic will 
                establish, within 90 days of receiving a grant under 
                this section, a community advisory committee composed 
                of individuals, a majority of whom are being served by 
                the clinic, the purpose of which is to provide input 
                into the nurse-managed health clinic decisionmaking 
                process.
    ``(d) Waiver of Requirements.--The Secretary may, upon a showing of 
good cause, waive the requirement that the nurse-managed health clinic 
provide all required comprehensive primary health services for a period 
of not to exceed 2 years.
    ``(e) Use of Funds.--
            ``(1) In general.--Funds awarded under a grant under this 
        section may be used for the provision of primary care services 
        and additional health services, for the management of nurse-
        managed health clinic programs, for the payment of salaries for 
        nurse-managed health clinic personnel, and for providing 
        training for the provision of required health services. Funds 
        may also be used for acquiring, and the leasing of, buildings 
        and equipment (including the cost of amortizing the principle 
        of, and paying interest on, loans for such buildings and 
        equipment).
            ``(2) Amount.--The amount of any grant made in any fiscal 
        year to a nurse-managed health clinic shall be determined by 
        the Secretary, taking into account--
                    ``(A) the financial need of the nurse-managed 
                health clinic;
                    ``(B) State, local, and other operational funding 
                provided to the nurse-managed health clinic; and
                    ``(C) other factors as determined appropriate by 
                the Secretary.
    ``(f) Technical Assistance.--The Secretary shall establish a 
program through which the Secretary shall provide (either through the 
Department of Health and Human Services or by grant or contract) 
technical and other assistance to nurse-managed health clinics to 
assist such clinics in meeting the requirements of this section. 
Services provided under this section may include necessary technical 
and nonfinancial assistance, including fiscal and program management 
assistance, training in fiscal and program management, operational and 
administrative support, and the provision of information to nurse-
managed health clinics regarding the various resources available under 
this section and how those resources can best be used to meet the 
health needs of the communities served by nurse-managed health clinics.
    ``(g) Evaluation.--The Secretary shall develop and implement a plan 
for evaluating nurse-managed health clinics funded under this section. 
Such evaluations shall monitor and track the performance of the grantee 
as well as the quality of the services that are provided under the 
grant.
    ``(h) Authorization of Appropriations.--For the purposes of 
carrying out this section, there are authorized to be appropriated 
$50,000,000 for the fiscal year 2008, and such sums as may be necessary 
for each of the fiscal years 2009 through 2012.''.
                                 <all>