[Congressional Record Volume 147, Number 109 (Tuesday, July 31, 2001)]
[Senate]
[Pages S8467-S8469]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. HARKIN:
  S. 1273. A bill to amend the Public Health Service Act to provide for 
rural health services outreach, rural health network planning and 
implementation, and small health care provider quality improvement 
grant programs, and telehomecare demonstration projects; to the 
Committee on Health, Education, Labor, and Pensions.
  Mr. HARKIN. Mr. President, I have introduced the ``Improving Health 
Care in Rural America Act'' that continues a rural health outreach 
program that I worked to establish as a part of the fiscal year 1991 
Labor, Health and Human Services appropriations bill. We began this 
innovative program to demonstrate the effectiveness of outreach 
programs to populations in rural areas that have trouble obtaining 
health and mental health services. Too often, these people are not able 
to obtain health care until they are acutely ill and need extensive and 
expensive hospital care.
  Indeed, rural Americans are at triple jeopardy, they are more often 
poor, more often uninsured, and more often without access to health 
care. Rural America is home to a disproportionately large segment of 
older citizens who more often require long-term care for their 
illnesses and disabilities. And rural America is not immune from the 
social stresses of modern society. This is manifest by escalating needs 
for mental health services to deal with necessary alcohol- and drug-
related treatment, and by the significantly higher rate of suicide in 
rural areas. Yet, rural Americans are increasingly becoming commuters 
for their health care. Rural Americans deserve to be treated equitably 
and the legislation that I rise to describe today helps bring high 
quality health care to rural communities to meet their specific needs.
  This grant program has proven itself highly successful because it 
responds to local community needs and is directed by the people in the 
community. These innovative grants bring needed primary and preventive 
care to those people who have few other options. These grants also help 
link health and social services, thereby reaching the people that most 
need these services.
  This program has received overwhelmingly positive response from all 
fifty States because it has had a tremendous impact on improving 
coordination between health care providers and expanding access to 
needed health care.
  In Iowa, the Ida County Community Hospital receives funds to improve 
the quality of life for older people who are chronically ill by making 
home visits, providing pain management, and telmonitoring, and other 
needed services.
  In Maquoketa, IA, every school-age child is being given timely, high 
quality care because the local school district used their grant to team 
up with almost every health care provider in the county to provide 
services.
  In Mason City, IA, the North Iowa Mercy Health Center is 
collaborating

[[Page S8468]]

with the Easter Seals Society of Northern Iowa, Rockwell Community 
Nursing, and the Pony Express Riders of Iowa to make sure seniors have 
access to physician, therapy, and dental services. This program also 
recycles and repairs assistive technology equipment to help seniors 
that are unable to afford new equipment.
  The ``Improving Health Care in Rural America Act'' also establishes a 
telehomecare demonstration program for five separate projects to allow 
home health care professionals to provide some services through 
telehealth technologies. This program will allow rural residents to 
have better access to daily health care services and will reduce health 
care costs. This program is designed to improve patient access to care, 
quality of care, patient satisfaction with care while reducing the 
costs of providing care. Nurses and other health care professionals 
will be trained in how to use this advanced technology to provide 
better, more effective care. This programs applies the highly effective 
telehealth technology to an area of health care that will benefit 
greatly.
  As ranking member and as chairman of the Labor-HHS Appropriations 
Subcommittee, I have been pleased to be able to provide funding for 
this program during the previous decade. This bill will extend this 
highly successful program for 5 more years and I look forward to 
provide its funding. Programs that work this well deserve the support 
of Congress.
  I urge my colleagues to join me in supporting this important 
legislation and ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                S. 1273

       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 ``Improving Health Care in 
     Rural America Act''.

     SEC. 2. GRANT PROGRAMS.

       Section 330A of the Public Health Service Act (42 U.S.C. 
     254c) is amended to read as follows:

     ``SEC. 330A. RURAL HEALTH SERVICES OUTREACH, RURAL HEALTH 
                   NETWORK DEVELOPMENT, AND SMALL HEALTH CARE 
                   PROVIDER QUALITY IMPROVEMENT GRANT PROGRAMS.

       ``(a) Purpose.--The purpose of this section is to provide 
     grants for expanded delivery of health services in rural 
     areas, for the planning and implementation of integrated 
     health care networks in rural areas, and for the planning and 
     implementation of small health care provider quality 
     improvement activities.
       ``(b) Definitions.--
       ``(1) Director.--The term `Director' means the Director 
     specified in subsection (d).
       ``(2) Federally qualified health center; rural health 
     clinic.--The terms `Federally qualified health center' and 
     `rural health clinic' have the meanings given the terms in 
     section 1861(aa) of the Social Security Act (42 U.S.C. 
     1395x(aa)).
       ``(3) Health professional shortage area.--The term `health 
     professional shortage area' means a health professional 
     shortage area designated under section 332.
       ``(4) Health services.--The term `health services' includes 
     mental and behavioral health services and substance abuse 
     services.
       ``(5) Medically underserved area.--The term `medically 
     underserved area' has the meaning given the term in section 
     799B.
       ``(6) Medically underserved population.--The term 
     `medically underserved population' has the meaning given the 
     term in section 330(b)(3).
       ``(c) Program.--The Secretary shall establish, under 
     section 301, a small health care provider quality improvement 
     grant program.
       ``(d) Administration.--
       ``(1) Programs.--The rural health services outreach, rural 
     health network development, and small health care provider 
     quality improvement grant programs established under section 
     301 shall be administered by the Director of the Office of 
     Rural Health Policy of the Health Resources and Services 
     Administration, in consultation with State offices of rural 
     health or other appropriate State government entities.
       ``(2) Grants.--
       ``(A) In general.--In carrying out the programs described 
     in paragraph (1), the Director may award grants under 
     subsections (e), (f), and (g) to expand access to, 
     coordinate, and improve the quality of essential health 
     services, and enhance the delivery of health care, in rural 
     areas.
       ``(B) Types of grants.--The Director may award the grants--
       ``(i) to promote expanded delivery of health services in 
     rural areas under subsection (e);
       ``(ii) to provide for the planning and implementation of 
     integrated health care networks in rural areas under 
     subsection (f); and
       ``(iii) to provide for the planning and implementation of 
     small health care provider quality improvement activities 
     under subsection (g).
       ``(e) Rural Health Services Outreach Grants.--
       ``(1) Grants.--The Director may award grants to eligible 
     entities to promote rural health services outreach by 
     expanding the delivery of health services to include new and 
     enhanced services in rural areas. The Director may award the 
     grants for periods of not more than 3 years.
       ``(2) Eligibility.--To be eligible to receive a grant under 
     this subsection for a project, an entity--
       ``(A) shall be a rural public or nonprofit private entity;
       ``(B) shall represent a consortium composed of members--
       ``(i) that include 3 or more health care providers or 
     providers of services; and
       ``(ii) that may be nonprofit or for-profit entities; and
       ``(C) shall not previously have received a grant under this 
     subsection or section 330A for the project.
       ``(3) Applications.--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 
     Secretary an application, at such time, in such manner, and 
     containing such information as the Secretary may require, 
     including--
       ``(A) a description of the project that the applicant will 
     carry out using the funds provided under the grant;
       ``(B) a description of the manner in which the project 
     funded under the grant will meet the health care needs of 
     rural underserved populations in the local community or 
     region to be served;
       ``(C) a description of how the local community or region to 
     be served will be involved in the development and ongoing 
     operations of the project;
       ``(D) a plan for sustainability of the project after 
     Federal support for the project has ended; and
       ``(E) a description of how the project will be evaluated.
       ``(f) Rural Health Network Development Grants.--
       ``(1) Grants.--
       ``(A) In general.--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 integrated the 
     functions of the entities participating in the networks in 
     order to--
       ``(i) achieve efficiencies;
       ``(ii) expand access to, coordinate, and improve the 
     quality of essential health services; and
       ``(iii) strengthen the rural health care system as a whole.
       ``(B) Grant periods.--The Director may award such a rural 
     health network development grant for implementation 
     activities for a period of 3 years. The Director may also 
     award such a rural health network development grant for 
     planning activities for a period of 1 year, to assist in the 
     development of an integrated health care networks, if the 
     proposed participants in the network have a history of 
     collaborative efforts and a 3-year implementation grant would 
     be inappropriate.
       ``(2) Eligibility.--To be eligible to receive a grant under 
     this subsection, an entity--
       ``(A) shall be a rural public or nonprofit private entity;
       ``(B) shall represent a network composed of members--
       ``(i) that include 3 or more health care providers or 
     providers of services; and
       ``(ii) that may be nonprofit or for-profit entities; and
       ``(C) shall not previously have received a grant (other 
     than a 1-year grant for planning activities) under this 
     subsection or section 330A for the project.
       ``(3) Applications.--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 
     Secretary an application, at such time, in such manner, and 
     containing such information as the Secretary may require, 
     including--
       ``(A) a description of the project that the applicant will 
     carry out using the funds provided under the grant;
       ``(B) an explanation of the reasons why Federal assistance 
     is required to carry out the project;
       ``(C) a description of--
       ``(i) the history of collaborative activities carried out 
     by the participants in the network;
       ``(ii) the degree to which the participants are ready to 
     integrate their functions; and
       ``(iii) how the local community or region to be served will 
     benefit from and be involved in the activities carried out by 
     the network;
       ``(D) a description of how the local community or region to 
     be served will experience increased access to quality health 
     services across the continuum of care as a result of the 
     integration activities carried out by the network;
       ``(E) a plan for sustainability of the project after 
     Federal support for the project has ended; and

[[Page S8469]]

       ``(F) a description of how the project will be evaluated.
       ``(g) Small Health Care Provider Quality Improvement 
     Grants.--
       ``(1) Grants.--The Director may award grants to provide for 
     the planning and implementation of small health care provider 
     quality improvement activities. The Director may award the 
     grants for periods of 1 to 3 years.
       ``(2) Eligibility.--In order to be eligible for a grant 
     under this subsection, an entity--
       ``(A) shall be a rural public or nonprofit private health 
     care provider, such as a critical access hospital or a rural 
     health clinic;
       ``(B) shall be another rural provider or network of small 
     rural providers identified by the Secretary as a key source 
     of local care; or
       ``(C) shall not previously have received a grant under this 
     subsection for the project.
       ``(3) Applications.--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 
     Secretary an application, at such time, in such manner, and 
     containing such information as the Secretary may require, 
     including--
       ``(A) a description of the project that the applicant will 
     carry out using the funds provided under the grant;
       ``(B) an explanation of the reasons why Federal assistance 
     is required to carry out the project;
       ``(C) 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;
       ``(D) a description of how the local community or region to 
     be served will experience increased access to quality health 
     services across the continuum of care as a result of the 
     activities carried out by the entity;
       ``(E) a plan for sustainability of the project after 
     Federal support for the project has ended; and
       ``(F) a description of how the project will be evaluated.
       ``(4) Preference.--In awarding grants under this 
     subsection, the Secretary shall give preference to entities 
     that--
       ``(A) are located in health professional shortage areas or 
     medically underserved areas, or serve medically underserved 
     populations; or
       ``(B) propose to develop projects with a focus on primary 
     care, and wellness and prevention strategies.
       ``(h) Coordination With Other Agencies.--The Secretary 
     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.
       ``(i) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section such 
     sums as may be necessary for each of fiscal years 2002 
     through 2006.''.

     SEC. 3. CONSOLIDATION AND REAUTHORIZATION OF PROVISIONS.

       Subpart I of part D of title III of the Public Health 
     Service Act (42 U.S.C. 254b et seq) is amended by adding at 
     the end the following:

     ``SEC. 330I. TELEHOMECARE DEMONSTRATION PROJECT.

       ``(a) Definitions.--In this section:
       ``(1) Distant site.--The term `distant site' means a site 
     at which a certified home care provider is located at the 
     time at which a health service (including a health care item) 
     is provided through a telecommunications system.
       ``(2) Telehomecare.--The term `telehomecare' means the 
     provision of health services through technology relating to 
     the use of electronic information, or through telemedicine or 
     telecommunication technology, to support and promote, at a 
     distant site, the monitoring and management of home health 
     services for a resident of a rural area.
       ``(b) Establishment.--Not later than 9 months after the 
     date of enactment of the Health Care Safety Net Amendments of 
     2001, the Secretary may establish and carry out a 
     telehomecare demonstration project.
       ``(c) Grants.--In carrying out the demonstration project 
     referred to in subsection (b), the Secretary shall make not 
     more than 5 grants to eligible certified home care providers, 
     individually or as part of a network of home health agencies, 
     for the provision of telehomecare to improve patient care, 
     prevent health care complications, improve patient outcomes, 
     and achieve efficiencies in the delivery of care to patients 
     who reside in rural areas.
       ``(d) Periods.--The Secretary shall make the grants for 
     periods of not more than 3 years.
       ``(e) Applications.--To be eligible to receive a grant 
     under this section, a certified home care provider shall 
     submit an application to the Secretary at such time, in such 
     manner, and containing such information as the Secretary may 
     require.
       ``(f) Use of Funds.--A provider that receives a grant under 
     this section shall use the funds made available through the 
     grant to carry out objectives that include--
       ``(1) improving access to care for home care patients 
     served by home health care agencies, improving the quality of 
     that care, increasing patient satisfaction with that care, 
     and reducing the cost of that care through direct 
     telecommunications links that connect the provider with 
     information networks;
       ``(2) developing effective care management practices and 
     educational curricula to train home care registered nurses 
     and increase their general level of competency through that 
     training; and
       ``(3) developing curricula to train health care 
     professionals, particularly registered nurses, serving home 
     care agencies in the use of telecommunications.
       ``(g) Coverage.--Nothing in this section shall be construed 
     to supercede or modify the provisions relating to exclusion 
     of coverage under section 1862(a) of the Social Security Act 
     (42 U.S.C 1395y(a)), or the provisions relating to the amount 
     payable to a home health agency under section 1895 of that 
     Act (42 U.S.C. 1395fff).
       ``(h) Report.--
       ``(1) Interim report.--The Secretary shall submit to 
     Congress an interim report describing the results of the 
     demonstration project.
       ``(2) Final report.--Not later than 6 months after the end 
     of the last grant period for a grant made under this section, 
     the Secretary shall submit to Congress a final report--
       ``(A) describing the results of the demonstration project; 
     and
       ``(B) including an evaluation of the impact of the use of 
     telehomecare, including telemedicine and telecommunications, 
     on--
       ``(i) access to care for home care patients; and
       ``(ii) the quality of, patient satisfaction with, and the 
     cost of, that care.
       ``(i) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section such 
     sums as may be necessary for each of fiscal years 2002 
     through 2006.''.
                                 ______