[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3926 Introduced in House (IH)]

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115th CONGRESS
  1st Session
                                H. R. 3926

To provide for an extension for community health centers, and for other 
                               purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 3, 2017

 Mr. Bilirakis (for himself and Ms. Stefanik) introduced the following 
    bill; which was referred to the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
To provide for an extension for community health centers, 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 ``Community Coordination And Resource 
Empowerment Act'' or the ``Community CARE Act''.

SEC. 2. EXTENSION FOR COMMUNITY HEALTH CENTERS.

    (a) Community Health Centers Funding.--Section 10503(b)(1)(E) of 
the Patient Protection and Affordable Care Act (42 U.S.C. 254b-
2(b)(1)(E)) is amended by striking ``2017'' and inserting ``2019''.
    (b) Other Community Health Centers Provisions.--Section 330 of the 
Public Health Service Act (42 U.S.C. 254b) is amended--
            (1) in subsection (b)(1)(A)(ii), by striking ``abuse'' and 
        inserting ``use disorder'';
            (2) in subsection (b)(2)(A), by striking ``abuse'' and 
        inserting ``use disorder'';
            (3) in subsection (c)--
                    (A) by striking subparagraphs (B) through (D);
                    (B) by striking ``(1) In general'' and all that 
                follows through ``The Secretary'' and inserting the 
                following:
            ``(1) Centers.--The Secretary''; and
                    (C) in such paragraph (1), as amended, by 
                redesignating clauses (i) through (v) as subparagraphs 
                (A) through (E) and moving the margin of each of such 
                redesignated subparagraph 2 ems to the left;
            (4) by striking subsection (d) and inserting the following:
    ``(d) Improving Quality of Care.--
            ``(1) Supplemental awards.--The Secretary may award 
        supplemental grant funds to health centers funded under this 
        section to implement evidence-based models for increasing 
        access to high-quality primary care services, which may include 
        models related to--
                    ``(A) improving the delivery of care for 
                individuals with multiple chronic conditions;
                    ``(B) workforce configuration;
                    ``(C) reducing the cost of care;
                    ``(D) enhancing care coordination;
                    ``(E) expanding the use of telehealth and 
                technology enabled collaborative learning and capacity 
                building models;
                    ``(F) care integration, including integration of 
                behavioral health, mental health, or substance use 
                disorder services; and
                    ``(G) addressing emerging public health or 
                substance use disorder issues to meet the health needs 
                of the population served by the health center.
            ``(2) Sustainability.--In making supplemental awards under 
        this subsection, the Secretary may consider whether the health 
        center involved has submitted a plan for continuing the 
        activities funded under this subsection after supplemental 
        funding is expended.
            ``(3) Special consideration.--The Secretary may give 
        special consideration to applications for supplemental funding 
        under this subsection that seek to address significant barriers 
        to access to care in areas with a greater shortage of health 
        care providers and health services relative to the national 
        average.'';
            (5) in subsection (e)(1)--
                    (A) in subparagraph (B)--
                            (i) by striking ``2 years'' and inserting 
                        ``1 year''; and
                            (ii) by adding at the end the following: 
                        ``The Secretary shall not make a grant under 
                        this paragraph unless the applicant provides 
                        assurances to the Secretary that within 120 
                        days of receiving grant funding for the 
                        operation of the health center, the applicant 
                        will submit, for approval by the Secretary, an 
                        implementation plan to meet the requirements of 
                        subsection (l)(3). The Secretary may extend 
                        such 120-day period for achieving compliance 
                        upon a demonstration of good cause by the 
                        health center.''; and
                    (B) in subparagraph (C)--
                            (i) in the subparagraph heading, by 
                        striking ``and plans'';
                            (ii) by striking ``or plan (as described in 
                        subparagraphs (B) and (C) of subsection 
                        (c)(1))'';
                            (iii) by striking ``or plan, including the 
                        purchase'' and inserting the following: 
                        ``including--
                            ``(i) the purchase'';
                            (iv) by inserting ``, which may include 
                        data and information systems'' after ``of 
                        equipment'';
                            (v) by striking the period at the end and 
                        inserting a semicolon; and
                            (vi) by adding at the end the following:
                            ``(ii) the provision of training and 
                        technical assistance; and
                            ``(iii) other activities that--
                                    ``(I) reduce costs associated with 
                                the provision of health services;
                                    ``(II) improve access to, and 
                                availability of, health services 
                                provided to individuals served by the 
                                centers;
                                    ``(III) enhance the quality and 
                                coordination of health services; or
                                    ``(IV) improve the health status of 
                                communities.'';
            (6) in subsection (e)(5)(B), by striking ``and 
        subparagraphs (B) and (C) of subsection (c)(1) to a health 
        center or to a network or plan'' and inserting ``to a health 
        center'';
            (7) by striking subsection (s);
            (8) by redesignating subsections (g) through (r) as 
        subsections (h) through (s), respectively;
            (9) by inserting after subsection (f), the following:
    ``(g) New Access Points and Expanded Services.--
            ``(1) Approval of new access points.--
                    ``(A) In general.--The Secretary may approve 
                applications for grants under subparagraph (A) or (B) 
                of subsection (e)(1), subsection (h), subsection (i), 
                and subsection (j) to establish new delivery sites.
                    ``(B) Special consideration.--In carrying out 
                subparagraph (A), the Secretary may give special 
                consideration to applicants that have demonstrated the 
                new delivery site will be located within a sparsely 
                populated area, or an area which has a level of unmet 
                need that is higher relative to other applicants.
                    ``(C) Consideration of applications.--In carrying 
                subparagraph (A), the Secretary shall approve 
                applications for grants under subparagraphs (A) and (B) 
                of subsection (e)(1) in such a manner that the ratio of 
                the medically underserved populations in rural areas 
                which may be expected to use the services provided by 
                the applicants involved to the medically underserved 
                populations in urban areas which may be expected to use 
                the services provided by the applicants is not less 
                than two to three or greater than three to two.
                    ``(D) Service area overlap.--If in carrying out 
                subparagraph (A) the applicant proposes to serve an 
                area that is currently served by another health center 
                funded under this section, the Secretary may consider 
                whether the award of funding to an additional health 
                center in the area can be justified based on the unmet 
                need for additional services within the catchment area.
            ``(2) Approval of expanded service applications.--
                    ``(A) In general.--The Secretary may approve 
                applications for grants under subparagraph (A) or (B) 
                of subsection (e)(1) to expand the capacity of the 
                applicant to provide required primary health services 
                described in subsection (b)(1) or additional health 
                services described in subsection (b)(2).
                    ``(B) Priority expansion projects.--In carrying out 
                subparagraph (A), the Secretary may give special 
                consideration to expanded service applications that 
                seek to address emerging public health or behavioral 
                health, mental health, or substance abuse issues 
                through increasing the availability of additional 
                health services described in subsection (b)(2) in an 
                area in which there are significant barriers to 
                accessing care.
                    ``(C) Consideration of applications.--In carrying 
                out subparagraph (A), the Secretary shall approve 
                applications for applicants in such a manner that the 
                ratio of the medically underserved populations in rural 
                areas which may be expected to use the services 
                provided by the applicants involved to the medically 
                underserved populations in urban areas which may be 
                expected to use the services provided by such 
                applicants is not less than two to three or greater 
                than three to two.'';
            (10) in subsection (i) (as so redesignated)--
                    (A) in paragraph (1), by striking ``and children 
                and youth at risk of homelessness'' and inserting ``, 
                children and youth at risk of homelessness, homeless 
                veterans, and veterans at risk of homelessness''; and
                    (B) in paragraph (5)--
                            (i) by striking subparagraph (B);
                            (ii) by redesignating subparagraph (C) as 
                        subparagraph (B); and
                            (iii) in subparagraph (B) (as so 
                        redesignated)--
                                    (I) in the subparagraph heading, by 
                                striking ``abuse'' and inserting ``use 
                                disorder''; and
                                    (II) by striking ``abuse'' and 
                                inserting ``use disorder'';
            (11) in subsection (l) (as so redesignated)--
                    (A) in paragraph (2)--
                            (i) in the paragraph heading, by inserting 
                        ``unmet'' before ``need'';
                            (ii) in the matter preceding subparagraph 
                        (A), by inserting ``and an application for a 
                        grant under subsection (g)'' after ``subsection 
                        (e)(1)'';
                            (iii) in subparagraph (A), by inserting 
                        ``unmet'' before ``need for health services'';
                            (iv) in subparagraph (B), by striking 
                        ``and'' at the end;
                            (v) in subparagraph (C), by striking the 
                        period at the end and inserting ``; and''; and
                            (vi) by adding after subparagraph (C) the 
                        following:
                    ``(D) in the case of an application for a grant 
                pursuant to subsection (g)(1), a demonstration that the 
                applicant has consulted with appropriate State and 
                local government agencies, and health care providers 
                regarding the need for the heath services to be 
                provided at the proposed delivery site.'';
                    (B) in paragraph (3)--
                            (i) in the matter preceding subparagraph 
                        (A), by inserting ``or subsection (g)'' after 
                        ``subsection (e)(1)(B)'';
                            (ii) in subparagraph (B), by striking ``in 
                        the catchment area of the center'' and 
                        inserting ``, including other health care 
                        providers that provide care within the 
                        catchment area, local hospitals, and specialty 
                        providers in the catchment area of the center, 
                        to provide access to services not available 
                        through the health center and to reduce the 
                        non-urgent use of hospital emergency 
                        departments'';
                            (iii) in subparagraph (H)(ii), by inserting 
                        ``who shall be directly employed by the 
                        center'' after ``approves the selection of a 
                        director for the center'';
                            (iv) in subparagraph (L), by striking 
                        ``and'' at the end;
                            (v) in subparagraph (M), by striking the 
                        period and inserting ``; and''; and
                            (vi) by inserting after subparagraph (M), 
                        the following:
                    ``(N) the center has written policies and 
                procedures in place to ensure the appropriate use of 
                Federal funds in compliance with applicable Federal 
                statutes, regulations, and the terms and conditions of 
                the Federal award.''; and
                    (C) by striking paragraph (4);
            (12) in subsection (m) (as so redesignated), by adding at 
        the end the following: ``Funds expended to carry out activities 
        under this subsection and operational support activities under 
        subsection (n) shall not exceed three percent of the amount 
        appropriated for this section for the fiscal year involved.'';
            (13) in subsection (q) (as so redesignated), by striking 
        ``grants for new health centers under subsections (c) and (e)'' 
        and inserting ``operating grants under subsection (e), 
        applications for new access points and expanded service 
        pursuant to subsection (g)'';
            (14) in subsection (r)(4) (as so redesignated), by adding 
        at the end the following: ``A waiver provided by the Secretary 
        under this paragraph may not remain in effect for more than 1 
        year and may not be extended after such period. An entity may 
        not receive more than one waiver under this paragraph in 
        consecutive years.''; and
            (15) in subsection (s)(3) (as so redesignated)--
                    (A) by striking ``appropriate committees of 
                Congress a report concerning the distribution of funds 
                under this section'' and inserting the following: 
                ``Committee on Health, Education, Labor, and Pensions 
                of the Senate, and the Committee on Energy and Commerce 
                of the House of Representatives, a report including, at 
                a minimum--
                    ``(A) the distribution of funds for carrying out 
                this section'';
                    (B) by striking ``populations. Such report shall 
                include an assessment'' and inserting the following: 
                ``populations;
                    ``(B) an assessment'';
                    (C) by striking ``and the rationale for any 
                substantial changes in the distribution of funds.'' and 
                inserting a semicolon; and
                    (D) by adding at the end the following:
                    ``(C) the distribution of awards and funding for 
                new or expanded services in each of rural areas and 
                urban areas;
                    ``(D) the distribution of awards and funding for 
                establishing new access points, and the number of new 
                access points created;
                    ``(E) the amount of unexpended funding for loan 
                guarantees and loan guarantee authority under title 
                XVI;
                    ``(F) the rationale for any substantial changes in 
                the distribution of funds;
                    ``(G) the rate of closures for health centers and 
                access points;
                    ``(H) the number and reason for any grants awarded 
                pursuant to subsection (e)(1)(B); and
                    ``(I) the number and reason for any waivers 
                provided pursuant to subsection (r)(4).''.
    (c) Application.--Amounts appropriated pursuant to this section for 
fiscal year 2018 or 2019 are subject to the requirements contained in 
Public Law 115-31 for funds for programs authorized under sections 330 
through 340 of the Public Health Service Act (42 U.S.C. 254b-256).
    (d) Conforming Amendments.--Section 3014(h) of title 18, United 
States Code, is amended--
            (1) in paragraph (1), by striking ``, as amended by section 
        221 of the Medicare Access and CHIP Reauthorization Act of 
        2015,''; and
            (2) in paragraph (4), by inserting ``and section 101(d) of 
        the CARE Act'' after ``section 221(c) of the Medicare Access 
        and CHIP Reauthorization Act of 2015''.
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