[Congressional Record Volume 148, Number 126 (Tuesday, October 1, 2002)]
[House]
[Pages H6793-H6808]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                 HEALTH CARE SAFETY NET IMPROVEMENT ACT

  Mr. BILIRAKIS. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 3450) to amend the Public Health Service Act to reauthorize 
and strengthen the health centers program and the National Health 
Service Corps, and for other purposes.
  The Clerk read as follows:

                               H.R. 3450

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

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Health 
     Care Safety Net Improvement Act''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:

Sec. 1. Short title; table of contents.

         TITLE I--CONSOLIDATED HEALTH CENTER PROGRAM AMENDMENTS

Sec. 101. Health centers.
Sec. 102. Migratory and seasonal agricultural workers.

                         TITLE II--RURAL HEALTH

 Subtitle A--Rural Health Care Services Outreach, Rural Health Network 
 Development, and Small Health Care Provider Quality Improvement Grant 
                                Programs

Sec. 201. Grant programs.

               Subtitle B--Telehealth Grant Consolidation

Sec. 211. Short title.
Sec. 212. Consolidation and reauthorization of provisions.

    Subtitle C--Mental Health Services Telehealth Program and Rural 
  Emergency Medical Service Training and Equipment Assistance Program

Sec. 221. Programs.

            TITLE III--NATIONAL HEALTH SERVICE CORPS PROGRAM

Sec. 301. National Health Service Corps.
Sec. 302. Designation of health professional shortage areas.
Sec. 303. Assignment of Corps personnel.
Sec. 304. Priorities in assignment of Corps personnel.
Sec. 305. Cost-sharing.
Sec. 306. Eligibility for Federal funds.
Sec. 307. Facilitation of effective provision of Corps services.
Sec. 308. Authorization of appropriations.
Sec. 309. National Health Service Corps Scholarship Program.
Sec. 310. National Health Service Corps Loan Repayment Program.
Sec. 311. Obligated service.
Sec. 312. Private practice.
Sec. 313. Breach of scholarship contract or loan repayment contract.
Sec. 314. Authorization of appropriations.
Sec. 315. Grants to States for loan repayment programs.
Sec. 316. Demonstration grants to States for community scholarship 
              programs.

                    TITLE IV--ADDITIONAL PROVISIONS

Sec. 401. Community access demonstration program.
Sec. 402. Expanding availability of dental services.
Sec. 403. Study regarding barriers to participation of farmworkers in 
              health programs.
Sec. 404. Eligibility of certain entities for grants.
Sec. 405. Conforming amendments.

         TITLE I--CONSOLIDATED HEALTH CENTER PROGRAM AMENDMENTS

     SEC. 101. HEALTH CENTERS.

       (a) Increase of Authorization of Appropriations From 
     $802,124,000 for Fiscal Year

[[Page H6794]]

     1997  to $1,293,000,000 for Fiscal Year 2002.--Section 
     330(l)(1) of the Public Health Service Act (42 U.S.C. 
     254b(l(1))) is amended by striking ``$802,124,000'' and all 
     that follows and inserting ``$1,293,000,000 for fiscal year 
     2002, and such sums as may be necessary for each of the 
     fiscal years 2003 through 2006.''.
       (b) Additional Amendments.--Section 330 of the Public 
     Health Service Act (42 U.S.C. 254b) is amended--
       (1) in subsection (b)(1)(A)--
       (A) in clause (i)(III)(bb), by striking ``screening for 
     breast and cervical cancer'' and inserting ``appropriate 
     cancer screening'';
       (B) in clause (ii), by inserting ``(including specialty 
     referral when medically indicated)'' after ``medical 
     services''; and
       (C) in clause (iii), by inserting ``housing,'' after 
     ``social,'';
       (2) in subsection (b)(2)--
       (A) by redesignating subparagraphs (A) and (B) as 
     subparagraphs (B) and (C), respectively; and
       (B) by inserting before subparagraph (B) (as so 
     redesignated) the following:
       ``(A) behavioral and mental health and substance abuse 
     services;'';
       (3) in subsection (c)(1)--
       (A) in subparagraph (B)--
       (i) in the heading, by striking ``Comprehensive service 
     delivery'' and inserting ``Managed care'';
       (ii) in the matter preceding clause (i), by striking 
     ``network or plan'' and all that follows to the period and 
     inserting ``managed care network or plan.''; and
       (iii) in the matter following clause (ii), by striking 
     ``Any such grant may include'' and all that follows through 
     the period; and
       (B) by adding at the end the following:
       ``(C) Practice management networks.--The Secretary may make 
     grants to health centers that receive assistance under 
     this section to enable the centers to plan and develop 
     practice management networks that will enable the centers 
     to--
       ``(i) reduce costs associated with the provision of health 
     care services;
       ``(ii) improve access to, and availability of, health care 
     services provided to individuals served by the centers;
       ``(iii) enhance the quality and coordination of health care 
     services; or
       ``(iv) improve the health status of communities.
       ``(D) Use of funds.--The activities for which a grant may 
     be made under subparagraph (B) or (C) may include the 
     purchase or lease of equipment, which may include data and 
     information systems (including paying for the costs of 
     amortizing the principal of, and paying the interest on, 
     loans for equipment), the provision of training and technical 
     assistance related to the provision of health care services 
     on a prepaid basis or under another managed care arrangement, 
     and other activities that promote the development of practice 
     management or managed care networks and plans.'';
       (4) in subsection (d)--
       (A) by striking the subsection heading and inserting ``Loan 
     Guarantee Program.--'';
       (B) in paragraph (1)--
       (i) in subparagraph (A), by striking ``the principal and 
     interest on loans'' and all that follows through the period 
     and inserting ``the principal and interest on loans made by 
     non-Federal lenders to health centers, funded under this 
     section, for the costs of developing and operating managed 
     care networks or plans described in subsection (c)(1)(B), or 
     practice management networks described in subsection 
     (c)(1)(C), and for the costs of acquiring or leasing 
     buildings, or purchasing or leasing equipment.'';
       (ii) in subparagraph (B)--

       (I) in clause (i), by striking ``or'';
       (II) in clause (ii), by striking the period and inserting 
     ``; or''; and
       (III) by adding at the end the following:

       ``(iii) to refinance a loan to the center or centers, if 
     the Secretary determines that--

       ``(I) such refinancing will result in more favorable terms;
       ``(II) the savings resulting from the refinancing will be 
     beneficial to both the center (or centers) and the 
     Government; and
       ``(III) the center (or centers) can demonstrate an ability 
     to repay the refinanced loan equal to or greater than the 
     ability of the center (or centers) to repay the original loan 
     on the date the original loan was made.''; and

       (iii) by adding at the end the following:
       ``(D) Provision directly to networks or plans.--At the 
     request of health centers receiving assistance under this 
     section, loan guarantees provided under this paragraph may be 
     made directly to networks or plans that are at least majority 
     controlled and, as applicable, at least majority owned by 
     those health centers.''; and
       (C)(i) by striking paragraphs (6) and (7); and
       (ii) by redesignating paragraph (8) as paragraph (6);
       (5) in subsection (e)--
       (A) in paragraph (1), by adding at the end the following:
       ``(C) Operation of networks and plans.--
       ``(i) In general.--The Secretary may make grants to health 
     centers that receive assistance under this section, or at the 
     request of the health centers, directly to a network or plan 
     (as described in subparagraphs (B) and (C) of subsection 
     (c)(1)) that is at least majority controlled and, as 
     applicable, at least majority owned by such health centers 
     receiving assistance under this section, for the costs 
     associated with the operation of such network or plan, 
     including the purchase or lease of equipment (including the 
     costs of amortizing the principal of, and paying the interest 
     on, loans for equipment).
       ``(ii) Certain requirements.--Subsection (j) applies with 
     respect to grants under clause (i) to the same extent and in 
     the same manner as such subsection applies with respect to 
     grants under subparagraph (A) or (B), except to the extent 
     that as applied to clause (i) the Secretary waives any 
     requirement under subsection (j) on the basis that the 
     requirement is not necessary with respect to the purposes for 
     which grants under clause (i) are made.''; and
       (B) in paragraph (5)--
       (i) in subparagraph (A), by inserting ``subparagraphs (A) 
     and (B) of'' after ``any fiscal year under'';
       (ii) by redesignating subparagraphs (B) and (C) as 
     subparagraphs (C) and (D), respectively; and
       (iii) by inserting after subparagraph (A) the following:
       ``(B) Networks and plans.--The total amount of grant funds 
     made available for any fiscal year under paragraph (1)(C) and 
     subparagraphs (B) and (C) of subsection (c)(1) to a health 
     center shall be determined by the Secretary, but may not 
     exceed 2 percent of the total amount appropriated under 
     this section for such fiscal year.'';
       (6) in subsection (h)--
       (A) in paragraph (1), by striking ``homeless children and 
     children at risk of homelessness'' and inserting ``homeless 
     children and youth and children and youth at risk of 
     homelessness'';
       (B)(i) by redesignating paragraph (4) as paragraph (5); and
       (ii) by inserting after paragraph (3) the following:
       ``(4) Temporary continued provision of services to certain 
     former homeless individuals.--If any grantee under this 
     subsection has provided services described in this section 
     under the grant to a homeless individual, such grantee may, 
     notwithstanding that the individual is no longer homeless as 
     a result of becoming a resident in permanent housing, expend 
     the grant to continue to provide such services to the 
     individual for not more than 12 months.''; and
       (C) in paragraph (5)(C) (as redesignated by subparagraph 
     (B)), by striking ``and residential treatment'' and inserting 
     ``, risk reduction, outpatient treatment, residential 
     treatment, and rehabilitation'';
       (7) in subsection (j)(3)--
       (A) in subparagraph (E)--
       (i) in clause (i)--

       (I) by striking ``(i)'' and inserting ``(i)(I)'';
       (II) by striking ``plan; or'' and inserting ``plan; and''; 
     and
       (III) by adding at the end the following:
       ``(II) has or will have a contractual or other arrangement 
     with the State agency administering the program under title 
     XXI of such Act (42 U.S.C. 1397aa et seq.) with respect to 
     individuals who are State children's health insurance program 
     beneficiaries; or''; and

       (ii) by striking clause (ii) and inserting the following:
       ``(ii) has made or will make every reasonable effort to 
     enter into arrangements described in subclauses (I) and (II) 
     of clause (i);'';
       (B) in subparagraph (G)--
       (i) in clause (ii)(II), by striking ``; and'' and inserting 
     ``;'';
       (ii) by redesignating clause (iii) as clause (iv); and
       (iii) by inserting after clause (ii) the following:
       ``(iii)(I) will assure that no patient will be denied 
     health care services due to an individual's inability to pay 
     for such services; and
       ``(II) will assure that any fees or payments required by 
     the center for such services will be reduced or waived to 
     enable the center to fulfill the assurance described in 
     subclause (I); and'';
       (C) in subparagraph (K)(ii), by striking ``and'' after the 
     semicolon at the end;
       (D) in subparagraph (L), by striking the period at the end 
     and inserting ``; and''; and
       (E) by adding at the end the following subparagraph:
       ``(M) the center encourages persons receiving or seeking 
     health services from the center to participate in any public 
     or private (including employer-offered) health programs or 
     plans for which the persons are eligible.'';
       (8) by striking subsection (k) and inserting the following:
       ``(k) Technical Assistance.--The Secretary shall establish 
     a program through which the Secretary shall provide technical 
     and other assistance to eligible entities to assist such 
     entities to meet the requirements of paragraphs (2) and (3) 
     of subsection (j) and in developing plans for, and operating 
     health centers. Services provided through the program may 
     include necessary technical and nonfinancial assistance, 
     including fiscal and program management assistance, training 
     in program management, operational and administrative 
     support, and the provision of information to the entities of 
     the variety of resources available under this title and how 
     those resources can be best used to meet the health needs of 
     the communities served by the entities.'';
       (9)(A) in subsection (l) (as amended by subsection (a) of 
     this section), by striking ``(l) Authorization'';
       (B) by transferring such undesignated subsection to the end 
     of the section;
       (C) by redesignating subsections (m) through (q) as 
     subsections (l) through (p), respectively; and

[[Page H6795]]

       (D) in the subsection transferred by subparagraph (B), by 
     inserting ``(q) Authorization'' before ``of Appropriations.--
     ''; and
       (10) in subsection (q) (as transferred and redesignated by 
     paragraph (9)), in paragraph (2)--
       (A) in subparagraph (A), by striking ``(j)(3)(G)(ii)'' and 
     inserting ``(j)(3)(H)''; and
       (B) by striking subparagraph (B) and inserting the 
     following:
       ``(B) Distribution of grants.--For fiscal year 2002 and 
     each of the following fiscal years, the Secretary, in 
     awarding grants under this section, shall ensure that the 
     proportion of the amount made available under each of 
     subsections (g), (h), and (i), relative to the total amount 
     appropriated to carry out this section for that fiscal year, 
     is equal to the proportion of the amount made available under 
     that subsection for fiscal year 2001, relative to the total 
     amount appropriated to carry out this section for fiscal year 
     2001.''.
       (c) Telemedicine; Incentive Grants Regarding Coordination 
     Among States.--
       (1) In general.--The Secretary of Health and Human Services 
     may make grants to State professional licensing boards to 
     carry out programs under which such licensing boards of 
     various States cooperate to develop and implement State 
     policies that will reduce statutory and regulatory barriers 
     to telemedicine.
       (2) Authorization of appropriations.--For the purpose of 
     carrying out paragraph (1), there are authorized to be 
     appropriated $10,000,000 for fiscal year 2002, and such sums 
     as may be necessary for each of the fiscal years 2002 through 
     2006.

     SEC. 102. MIGRATORY AND SEASONAL AGRICULTURAL WORKERS.

       Section 330(g) of the Public Health Service Act (42 U.S.C. 
     254b(g)) is amended--
       (1) in paragraph (2)--
       (A) in subparagraph (A), by inserting ``and seasonal 
     agricultural worker'' after ``agricultural worker''; and
       (B) in subparagraph (B), by striking ``and members of their 
     families'' and inserting ``and seasonal agricultural workers, 
     and members of their families,''; and
       (2) in paragraph (3)(A), by striking ``on a seasonal 
     basis''.

                         TITLE II--RURAL HEALTH

 Subtitle A--Rural Health Care Services Outreach, Rural Health Network 
 Development, and Small Health Care Provider Quality Improvement Grant 
                                Programs

     SEC. 201. 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 CARE 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 care 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) Medically underserved community.--The term `medically 
     underserved community' has the meaning given the term in 
     section 799B.
       ``(5) 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 care 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 care 
     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 care 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 Care Services Outreach Grants.--
       ``(1) Grants.--The Director 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.
       ``(2) Eligibility.--To be eligible to receive a grant under 
     this subsection for a project, an entity--
       ``(A) shall be a rural public or private entity;
       ``(B) shall represent a consortium composed of members--
       ``(i) that include 3 or more health care providers; and
       ``(ii) that may be nonprofit or for-profit entities; and
       ``(C) 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.
       ``(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 eligible entity 
     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 sustaining 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 combined 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 care 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 network, if the 
     proposed participants in the network do not have a history of 
     collaborative efforts and a 3-year 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 private entity;
       ``(B) shall represent a network composed of participants--
       ``(i) that include 3 or more health care providers; and
       ``(ii) that may be nonprofit or for-profit entities; and
       ``(C) shall not previously have received a grant under this 
     subsection (other than a grant for planning activities) for 
     the same or a similar 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 eligible entity 
     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 
     care services across the continuum of care as a result of 
     the integration activities carried out by the network;
       ``(E) a plan for sustaining the project after Federal 
     support for the project has ended; and
       ``(F) a description of how the project will be evaluated.
       ``(g) Small Health Care Provider Quality Improvement 
     Grants.--

[[Page H6796]]

       ``(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.--To be eligible for a grant under this 
     subsection, an entity--
       ``(A)(i) shall be a rural public or rural nonprofit private 
     health care provider or provider of health care services, 
     such as a critical access hospital or a rural health clinic; 
     or
       ``(ii) shall be another rural provider or network of small 
     rural providers identified by the Secretary as a key source 
     of local care; and
       ``(B) shall not previously have received a grant under this 
     subsection for the same or a similar 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, another 
     appropriate State entity, or a hospital association, 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 eligible entity 
     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 
     care services across the continuum of care as a result of the 
     activities carried out by the entity;
       ``(E) a plan for sustaining the project after Federal 
     support for the project has ended; and
       ``(F) a description of how the project will be evaluated.
       ``(4) Expenditures for small health care provider quality 
     improvement grants.--In awarding a grant under this 
     subsection, the Director shall ensure that the funds made 
     available through the grant will be used to provide services 
     to residents of rural areas. The Director shall award not 
     less than 50 percent of the funds made available under this 
     subsection to providers located in and serving rural areas.
       ``(h) General Requirements.--
       ``(1) Prohibited uses of funds.--An entity that receives a 
     grant under this section may not use funds provided through 
     the grant--
       ``(A) to build or acquire real property; or
       ``(B) for construction, except that such funds may be 
     expended for minor renovations relating to the installation 
     of equipment.
       ``(2) 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.
       ``(3) Preference.--In awarding grants under this section, 
     the Secretary shall give preference to entities that--
       ``(A) are located in health professional shortage areas or 
     medically underserved communities, or serve medically 
     underserved populations; or
       ``(B) propose to develop projects with a focus on primary 
     care, and wellness and prevention strategies.
       ``(i) Report.--Not later than September 30, 2005, 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 (e), (f), and (g).
       ``(j) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section 
     $40,000,000 for fiscal year 2002, and such sums as may be 
     necessary for each of fiscal years 2003 through 2006.''.

               Subtitle B--Telehealth Grant Consolidation

     SEC. 211. SHORT TITLE.

       This subtitle may be cited as the ``Telehealth Grant 
     Consolidation Act of 2001''.

     SEC. 212. 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. TELEHEALTH NETWORK AND TELEHEALTH RESOURCE 
                   CENTERS GRANT PROGRAMS.

       ``(a) Definitions.--In this section:
       ``(1) Director; office.--The terms `Director' and `Office' 
     mean the Director and Office specified in subsection (c).
       ``(2) Federally qualified health center and rural health 
     clinic.--The term `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) Frontier community.--The term `frontier community' 
     means an area with fewer than 6 residents per square mile, 
     based on the latest population data published by the Bureau 
     of the Census.
       ``(4) Medically underserved area.--The term `medically 
     underserved area' has the meaning given the term `medically 
     underserved community' in section 799B.
       ``(5) Medically underserved population.--The term 
     `medically underserved population' has the meaning given the 
     term in section 330(b)(3).
       ``(6) Telehealth services.--The term `telehealth services' 
     means services provided through telehealth technologies.
       ``(7) Telehealth technologies.--The term `telehealth 
     technologies' means technologies relating to the use of 
     electronic information, and telecommunications technologies, 
     to support and promote, at a distance, health care, patient 
     and professional health-related education, health 
     administration, and public health.
       ``(b) Programs.--The Secretary shall establish, under 
     section 301, telehealth network and telehealth resource 
     centers grant programs.
       ``(c) Administration.--
       ``(1) Establishment.--There is established in the Health 
     and Resources and Services Administration an Office for the 
     Advancement of Telehealth. The Office shall be headed by a 
     Director.
       ``(2) Duties.--The telehealth network and telehealth 
     resource centers grant programs established under section 301 
     shall be administered by the Director, in consultation with 
     the State offices of rural health, State offices concerning 
     primary care, or other appropriate State government entities.
       ``(d) Grants.--
       ``(1) Telehealth network grants.--The Director may, in 
     carrying out the telehealth network grant program referred to 
     in subsection (b), award grants to eligible entities for 
     projects to demonstrate how telehealth technologies can be 
     used through telehealth networks in rural areas, frontier 
     communities, and medically underserved areas, and for 
     medically underserved populations, to--
       ``(A) expand access to, coordinate, and improve the quality 
     of health care services;
       ``(B) improve and expand the training of health care 
     providers; and
       ``(C) expand and improve the quality of health information 
     available to health care providers, and patients and their 
     families, for decisionmaking.
       ``(2) Telehealth resource centers grants.--The Director 
     may, in carrying out the telehealth resource centers grant 
     program referred to in subsection (b), award grants to 
     eligible entities for projects to demonstrate how telehealth 
     technologies can be used in the areas and communities, and 
     for the populations, described in paragraph (1), to establish 
     telehealth resource centers.
       ``(e) Grant Periods.--The Director may award grants under 
     this section for periods of not more than 4 years.
       ``(f) Eligible Entities.--
       ``(1) Telehealth network grants.--
       ``(A) Grant recipient.--To be eligible to receive a grant 
     under subsection (d)(1), an entity shall be a nonprofit 
     entity.
       ``(B) Telehealth networks.--
       ``(i) In general.--To be eligible to receive a grant under 
     subsection (d)(1), an entity shall demonstrate that the 
     entity will provide services through a telehealth network.
       ``(ii) Nature of entities.--Each entity participating in 
     the telehealth network may be a nonprofit or for-profit 
     entity.
       ``(iii) Composition of network.--The telehealth network 
     shall include at least 2 of the following entities (at least 
     1 of which shall be a community-based health care provider):

       ``(I) Community or migrant health centers or other 
     Federally qualified health centers.
       ``(II) Health care providers, including pharmacists, in 
     private practice.
       ``(III) Entities operating clinics, including rural health 
     clinics.
       ``(IV) Local health departments.
       ``(V) Nonprofit hospitals, including community access 
     hospitals.
       ``(VI) Other publicly funded health or social service 
     agencies.
       ``(VII) Long-term care providers.
       ``(VIII) Providers of health care services in the home.
       ``(IX) Providers of outpatient mental health services and 
     entities operating outpatient mental health facilities.
       ``(X) Local or regional emergency health care providers.
       ``(XI) Institutions of higher education.
       ``(XII) Entities operating dental clinics.

       ``(2) Telehealth resource centers grants.--To be eligible 
     to receive a grant under subsection (d)(2), an entity shall 
     be a nonprofit entity.
       ``(g) Applications.--To be eligible to receive a grant 
     under subsection (d), 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--
       ``(1) a description of the project that the eligible entity 
     will carry out using the funds provided under the grant;
       ``(2) a description of the manner in which the project 
     funded under the grant will meet the health care needs of 
     rural or other populations to be served through the project, 
     or improve the access to services of, and the quality of 
     the services received by, those populations;
       ``(3) evidence of local support for the project, and a 
     description of how the areas, communities, or populations to 
     be served will be involved in the development and ongoing 
     operations of the project;
       ``(4) a plan for sustaining the project after Federal 
     support for the project has ended;
       ``(5) information on the source and amount of non-Federal 
     funds that the entity will provide for the project;

[[Page H6797]]

       ``(6) information demonstrating the long-term viability of 
     the project, and other evidence of institutional commitment 
     of the entity to the project; and
       ``(7) in the case of an application for a project involving 
     a telehealth network, information demonstrating how the 
     project will promote the integration of telehealth 
     technologies into the operations of health care providers, to 
     avoid redundancy, and improve access to and the quality of 
     care.
       ``(h) Terms; Conditions; Maximum Amount of Assistance.--The 
     Secretary shall establish the terms and conditions of each 
     grant program described in subsection (b) and the maximum 
     amount of a grant to be awarded to an individual recipient 
     for each fiscal year under this section. The Secretary shall 
     publish, in a publication of the Health Resources and 
     Services Administration, notice of the application 
     requirements for each grant program described in subsection 
     (b) for each fiscal year.
       ``(i) Preferences.--
       ``(1) Telehealth networks.--In awarding grants under 
     subsection (d)(1) for projects involving telehealth networks, 
     the Secretary shall give preference to an eligible entity 
     that meets at least 1 of the following requirements:
       ``(A) Organization.--The eligible entity is a rural 
     community-based organization or another community-based 
     organization.
       ``(B) Services.--The eligible entity proposes to use 
     Federal funds made available through such a grant to develop 
     plans for, or to establish, telehealth networks that provide 
     mental health, public health, long-term care, home care, 
     preventive, or case management services.
       ``(C) Coordination.--The eligible entity demonstrates how 
     the project to be carried out under the grant will be 
     coordinated with other relevant federally funded projects in 
     the areas, communities, and populations to be served through 
     the grant.
       ``(D) Network.--The eligible entity demonstrates that the 
     project involves a telehealth network that includes an entity 
     that--
       ``(i) provides clinical health care services, or 
     educational services for health care providers and for 
     patients or their families; and
       ``(ii) is--

       ``(I) a public school;
       ``(II) a public library;
       ``(III) an institution of higher education; or
       ``(IV) a local government entity.

       ``(E) Connectivity.--The eligible entity proposes a project 
     that promotes local connectivity within areas, communities, 
     or populations to be served through the project.
       ``(F) Integration.--The eligible entity demonstrates that 
     health care information has been integrated into the project.
       ``(2) Telehealth resource centers.--In awarding grants 
     under subsection (d)(2) for projects involving telehealth 
     resource centers, the Secretary shall give preference to an 
     eligible entity that meets at least 1 of the following 
     requirements:
       ``(A) Provision of services.--The eligible entity has a 
     record of success in the provision of telehealth services to 
     medically underserved areas or medically underserved 
     populations.
       ``(B) Collaboration and sharing of expertise.--The eligible 
     entity has a demonstrated record of collaborating and sharing 
     expertise with providers of telehealth services at the 
     national, regional, State, and local levels.
       ``(C) Broad range of telehealth services.--The eligible 
     entity has a record of providing a broad range of telehealth 
     services, which may include--
       ``(i) a variety of clinical specialty services;
       ``(ii) patient or family education;
       ``(iii) health care professional education; and
       ``(iv) rural residency support programs.
       ``(j) Distribution of Funds.--
       ``(1) In general.--In awarding grants under this section, 
     the Director shall ensure, to the greatest extent possible, 
     that such grants are equitably distributed among the 
     geographical regions of the United States.
       ``(2) Telehealth networks.--In awarding grants under 
     subsection (d)(1) for a fiscal year, the Director shall 
     ensure that--
       ``(A) not less than 50 percent of the funds awarded shall 
     be awarded for projects in rural areas; and
       ``(B) the total amount of funds awarded for such projects 
     for that fiscal year shall be not less than the total amount 
     of funds awarded for such projects for fiscal year 2001 under 
     section 330A (as in effect on the day before the date of 
     enactment of the Health Care Safety Net Improvement Act).
       ``(k) Use of Funds.--
       ``(1) Telehealth network program.--The recipient of a grant 
     under subsection (d)(1) may use funds received through such 
     grant for salaries, equipment, and operating or other costs, 
     including the cost of--
       ``(A) developing and delivering clinical telehealth 
     services that enhance access to community-based health care 
     services in rural areas, frontier communities, or medically 
     underserved areas, or for medically underserved populations;
       ``(B) developing and acquiring, through lease or purchase, 
     computer hardware and software, audio and video equipment, 
     computer network equipment, interactive equipment, data 
     terminal equipment, and other equipment that furthers the 
     objectives of the telehealth network grant program;
       ``(C)(i) developing and providing distance education, in a 
     manner that enhances access to care in rural areas, frontier 
     communities, or medically underserved areas, or for medically 
     underserved populations; or
       ``(ii) mentoring, precepting, or supervising health care 
     providers and students seeking to become health care 
     providers, in a manner that enhances access to care in the 
     areas and communities, or for the populations, described in 
     clause (i);
       ``(D) developing and acquiring instructional programming;
       ``(E)(i) providing for transmission of medical data, and 
     maintenance of equipment; and
       ``(ii) providing for compensation (including travel 
     expenses) of specialists, and referring health care 
     providers, who are providing telehealth services through the 
     telehealth network, if no third party payment is available 
     for the telehealth services delivered through the telehealth 
     network;
       ``(F) developing projects to use telehealth technology to 
     facilitate collaboration between health care providers;
       ``(G) collecting and analyzing usage statistics and data to 
     document the cost-effectiveness of the telehealth services; 
     and
       ``(H) carrying out such other activities as are consistent 
     with achieving the objectives of this section, as determined 
     by the Secretary.
       ``(2) Telehealth resource centers.--The recipient of a 
     grant under subsection (d)(2) may use funds received through 
     such grant for salaries, equipment, and operating or other 
     costs for--
       ``(A) providing technical assistance, training, and 
     support, and providing for travel expenses, for health care 
     providers and a range of health care entities that provide or 
     will provide telehealth services;
       ``(B) disseminating information and research findings 
     related to telehealth services;
       ``(C) promoting effective collaboration among telehealth 
     resource centers and the Office;
       ``(D) conducting evaluations to determine the best 
     utilization of telehealth technologies to meet health care 
     needs;
       ``(E) promoting the integration of the technologies used in 
     clinical information systems with other telehealth 
     technologies;
       ``(F) fostering the use of telehealth technologies to 
     provide health care information and education for health care 
     providers and consumers in a more effective manner; and
       ``(G) implementing special projects or studies under the 
     direction of the Office.
       ``(l) Prohibited Uses of Funds.--An entity that receives a 
     grant under this section may not use funds made available 
     through the grant--
       ``(1) to acquire real property;
       ``(2) for expenditures to purchase or lease equipment, to 
     the extent that the expenditures would exceed 40 percent of 
     the total grant funds;
       ``(3) in the case of a project involving a telehealth 
     network, to purchase or install transmission equipment (such 
     as laying cable or telephone lines, or purchasing or 
     installing microwave towers, satellite dishes, amplifiers, or 
     digital switching equipment);
       ``(4) to pay for any equipment or transmission costs not 
     directly related to the purposes for which the grant is 
     awarded;
       ``(5) to purchase or install general purpose voice 
     telephone systems;
       ``(6) for construction, except that such funds may be 
     expended for minor renovations relating to the installation 
     of equipment; or
       ``(7) for expenditures for indirect costs (as determined by 
     the Secretary), to the extent that the expenditures would 
     exceed 10 percent of the total grant funds.
       ``(m) Collaboration.--In providing services under this 
     section, an eligible entity shall collaborate, if feasible, 
     with entities that--
       ``(1)(A) are private or public organizations, that receive 
     Federal or State assistance; or
       ``(B) are public or private entities that operate centers, 
     or carry out programs, that receive Federal or State 
     assistance; and
       ``(2) provide telehealth services or related activities.
       ``(n) Coordination With Other Agencies.--The Secretary 
     shall coordinate activities carried out under grant programs 
     described in subsection (b), to the extent practicable, with 
     Federal and State agencies and nonprofit organizations that 
     are operating similar programs, to maximize the effect of 
     public dollars in funding meritorious proposals.
       ``(o) Outreach Activities.--The Secretary shall establish 
     and implement procedures to carry out outreach activities to 
     advise potential end users of telehealth services in rural 
     areas, frontier communities, medically underserved areas, and 
     medically underserved populations in each State about the 
     grant programs described in subsection (b).
       ``(p) Telehealth.--It is the sense of Congress that, for 
     purposes of this section, States should develop reciprocity 
     agreements so that a provider of services under this section 
     who is a licensed or otherwise authorized health care 
     provider under the law of 1 or more States, and who, 
     through telehealth technology, consults with a licensed or 
     otherwise authorized health care provider in another 
     State, is exempt, with respect to such consultation, from 
     any State law of the other State that prohibits such 
     consultation on the basis that the first health care 
     provider is not a licensed or authorized health care 
     provider under the law of that State.
       ``(q) Report.--Not later than September 30, 2005, the 
     Secretary shall prepare and submit

[[Page H6798]]

     to the appropriate committees of Congress a report on the 
     progress and accomplishments of the grant programs described 
     in subsection (b).
       ``(r) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section--
       ``(1) for grants under subsection (d)(1), $40,000,000 for 
     fiscal year 2002, and such sums as may be necessary for each 
     of fiscal years 2003 through 2006; and
       ``(2) for grants under subsection (d)(2), $20,000,000 for 
     fiscal year 2002, and such sums as may be necessary for each 
     of fiscal years 2003 through 2006.''.

    Subtitle C--Mental Health Services Telehealth Program and Rural 
  Emergency Medical Service Training and Equipment Assistance Program

     SEC. 221. PROGRAMS.

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

     ``SEC. 330J. RURAL EMERGENCY MEDICAL SERVICE TRAINING AND 
                   EQUIPMENT ASSISTANCE PROGRAM.

       ``(a) Grants.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration (referred to in this section as the 
     `Secretary') shall award grants to eligible entities to 
     enable such entities to provide for improved emergency 
     medical services in rural areas.
       ``(b) Eligibility.--To be eligible to receive a grant under 
     this section, an entity shall--
       ``(1) be--
       ``(A) a State emergency medical services office;
       ``(B) a State emergency medical services association;
       ``(C) a State office of rural health;
       ``(D) a local government entity;
       ``(E) a State or local ambulance provider; or
       ``(F) any other entity determined appropriate by the 
     Secretary; and
       ``(2) prepare and submit to the Secretary an application at 
     such time, in such manner, and containing such information as 
     the Secretary may require, that includes--
       ``(A) a description of the activities to be carried out 
     under the grant; and
       ``(B) an assurance that the eligible entity will comply 
     with the matching requirement of subsection (e).
       ``(c) Use of Funds.--An entity shall use amounts received 
     under a grant made under subsection (a), either directly or 
     through grants to emergency medical service squads that are 
     located in, or that serve residents of, a nonmetropolitan 
     statistical area, an area designated as a rural area by any 
     law or regulation of a State, or a rural census tract of a 
     metropolitan statistical area (as determined under the most 
     recent Goldsmith Modification, originally published in a 
     notice of availability of funds in the Federal Register on 
     February 27, 1992, 57 Fed. Reg. 6725), to--
       ``(1) recruit emergency medical service personnel;
       ``(2) recruit volunteer emergency medical service 
     personnel;
       ``(3) train emergency medical service personnel in 
     emergency response, injury prevention, safety awareness, and 
     other topics relevant to the delivery of emergency medical 
     services;
       ``(4) fund specific training to meet Federal or State 
     certification requirements;
       ``(5) develop new ways to educate emergency health care 
     providers through the use of technology-enhanced educational 
     methods (such as distance learning);
       ``(6) acquire emergency medical services equipment, 
     including cardiac defibrillators;
       ``(7) acquire personal protective equipment for emergency 
     medical services personnel as required by the Occupational 
     Safety and Health Administration; and
       ``(8) educate the public concerning cardiopulmonary 
     resuscitation, first aid, injury prevention, safety 
     awareness, illness prevention, and other related emergency 
     preparedness topics.
       ``(d) Preference.--In awarding grants under this section 
     the Secretary shall give preference to--
       ``(1) applications that reflect a collaborative effort by 2 
     or more of the entities described in subparagraphs (A) 
     through (F) of subsection (b)(1); and
       ``(2) applications submitted by entities that intend to use 
     amounts provided under the grant to fund activities described 
     in any of paragraphs (1) through (5) of subsection (c).
       ``(e) Matching Requirement.--The Secretary may not award a 
     grant under this section to an entity unless the entity 
     agrees that the entity will make available (directly or 
     through contributions from other public or private entities) 
     non-Federal contributions toward the activities to be carried 
     out under the grant in an amount equal to 25 percent of the 
     amount received under the grant.
       ``(f) Emergency Medical Services.--In this section, the 
     term `emergency medical services'--
       ``(1) means resources used by a qualified public or private 
     nonprofit entity, or by any other entity recognized as 
     qualified by the State involved, to deliver medical care 
     outside of a medical facility under emergency conditions that 
     occur--
       ``(A) as a result of the condition of the patient; or
       ``(B) as a result of a natural disaster or similar 
     situation; and
       ``(2) includes services delivered by an emergency medical 
     services provider (either compensated or volunteer) or other 
     provider recognized by the State involved that is licensed or 
     certified by the State as an emergency medical technician or 
     its equivalent (as determined by the State), a registered 
     nurse, a physician assistant, or a physician that provides 
     services similar to services provided by such an emergency 
     medical services provider.
       ``(g) Authorization of Appropriations.--
       ``(1) In general.--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.
       ``(2) Administrative costs.--The Secretary may use not more 
     than 10 percent of the amount appropriated under paragraph 
     (1) for a fiscal year for the administrative expenses of 
     carrying out this section.

     ``SEC. 330K. MENTAL HEALTH SERVICES DELIVERED VIA TELEHEALTH.

       ``(a) Definitions.--In this section:
       ``(1) Eligible entity.--The term `eligible entity' means a 
     public or nonprofit private telehealth provider network that 
     offers services that include mental health services provided 
     by qualified mental health providers.
       ``(2) Qualified mental health professionals.--The term 
     `qualified mental health professionals' refers to providers 
     of mental health services reimbursed under the medicare 
     program carried out under title XVIII of the Social Security 
     Act (42 U.S.C. 1395 et seq.) who have additional training in 
     the treatment of mental illness in children and adolescents 
     or who have additional training in the treatment of mental 
     illness in the elderly.
       ``(3) Special populations.--The term `special populations' 
     refers to the following 2 distinct groups:
       ``(A) Children and adolescents in mental health underserved 
     rural areas or in mental health underserved urban areas.
       ``(B) Elderly individuals located in long-term care 
     facilities in mental health underserved rural areas or in 
     mental health underserved urban areas.
       ``(4) Telehealth.--The term `telehealth' means the use of 
     electronic information and telecommunications technologies to 
     support long distance clinical health care, patient and 
     professional health-related education, public health, and 
     health administration.
       ``(b) Program Authorized.--
       ``(1) In general.--The Secretary, acting through the 
     Director of the Office for the Advancement of Telehealth of 
     the Health Resources and Services Administration, shall award 
     grants to eligible entities to establish demonstration 
     projects for the provision of mental health services to 
     special populations as delivered remotely by qualified mental 
     health professionals using telehealth and for the provision 
     of education regarding mental illness as delivered remotely 
     by qualified mental health professionals and qualified mental 
     health education professionals using telehealth.
       ``(2) Populations served.--The Secretary shall award the 
     grants under paragraph (1) in a manner that distributes the 
     grants so as to serve equitably the populations described in 
     subparagraphs (A) and (B) of subsection (a)(4).
       ``(c) Use of Funds.--
       ``(1) In general.--An eligible entity that receives a grant 
     under this section shall use the grant funds--
       ``(A) for the populations described in subsection 
     (a)(3)(A)--
       ``(i) to provide mental health services, including 
     diagnosis and treatment of mental illness, in public 
     elementary and public secondary schools as delivered remotely 
     by qualified mental health professionals using telehealth; 
     and
       ``(ii) to collaborate with local public health entities to 
     provide the mental health services; and
       ``(B) for the populations described in subsection 
     (a)(3)(B)--
       ``(i) to provide mental health services, including 
     diagnosis and treatment of mental illness, in long-term care 
     facilities as delivered remotely by qualified mental health 
     professionals using telehealth; and
       ``(ii) to collaborate with local public health entities to 
     provide the mental health services.
       ``(2) Other uses.--An eligible entity that receives a grant 
     under this section may also use the grant funds to--
       ``(A) pay telecommunications costs; and
       ``(B) pay qualified mental health professionals on a 
     reasonable basis as determined by the Secretary for services 
     rendered.
       ``(3) Prohibited uses.--An eligible entity that receives a 
     grant under this section shall not use the grant funds to--
       ``(A) purchase or install transmission equipment (other 
     than such equipment used by qualified mental health 
     professionals to deliver mental health services using 
     telehealth under the project involved); or
       ``(B) build upon or acquire real property.
       ``(d) Equitable Distribution.--In awarding grants under 
     this section, the Secretary shall ensure, to the greatest 
     extent possible, that such grants are equitably distributed 
     among geographical regions of the United States.
       ``(e) Application.--An entity that desires a grant under 
     this section shall submit an application to the Secretary at 
     such time, in such manner, and containing such information as 
     the Secretary determines to be reasonable.

[[Page H6799]]

       ``(f) Report.--Not later than 4 years after the date of 
     enactment of the Health Care Safety Net Improvement Act, the 
     Secretary shall prepare and submit to the appropriate 
     committees of Congress a report that shall evaluate 
     activities funded with grants under this section.
       ``(g) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section, 
     $20,000,000 for fiscal year 2002 and such sums as may be 
     necessary for fiscal years 2003 through 2006.''.

            TITLE III--NATIONAL HEALTH SERVICE CORPS PROGRAM

     SEC. 301. NATIONAL HEALTH SERVICE CORPS.

       (a) In General.--Section 331 of the Public Health Service 
     Act (42 U.S.C. 254d) is amended--
       (1) by adding at the end of subsection (a)(3) the 
     following:
       ``(E)(i) The term `behaviorial and mental health 
     professionals' means health service psychologists, licensed 
     clinical social workers, licensed professional counselors, 
     marriage and family therapists, psychiatric nurse 
     specialists, and psychiatrists.
       ``(ii) The term `graduate program of behavioral and mental 
     health' means a program that trains behavorial and mental 
     health professionals.'';
       (2) in subsection (b)--
       (A) in paragraph (1), by striking ``health professions'' 
     and inserting ``health professions, including schools at 
     which graduate programs of behavioral and mental health are 
     offered,''; and
       (B) in paragraph (2), by inserting ``behavioral and mental 
     health professionals,'' after ``dentists,''; and
       (3) by striking subsection (c) and inserting the following:
       ``(c)(1) The Secretary may reimburse an applicant for a 
     position in the Corps (including an individual considering 
     entering into a written agreement pursuant to section 338D) 
     for the actual and reasonable expenses incurred in traveling 
     to and from the applicant's place of residence to an eligible 
     site to which the applicant may be assigned under section 333 
     for the purpose of evaluating such site with regard to being 
     assigned at such site. The Secretary may establish a maximum 
     total amount that may be paid to an individual as 
     reimbursement for such expenses.
       ``(2) The Secretary may also reimburse the applicant for 
     the actual and reasonable expenses incurred for the travel of 
     1 family member to accompany the applicant to such site. The 
     Secretary may establish a maximum total amount that may be 
     paid to an individual as reimbursement for such expenses.
       ``(3) In the case of an individual who has entered into a 
     contract for obligated service under the Scholarship Program 
     or under the Loan Repayment Program, the Secretary may 
     reimburse such individual for all or part of the actual and 
     reasonable expenses incurred in transporting the individual 
     to the site of the individual's assignment under section 333. 
     The Secretary may establish a maximum total amount that may 
     be paid to an individual as reimbursement for such 
     expenses.''.
       (b) Demonstration Projects.--Section 331 of the Public 
     Health Service Act (42 U.S.C. 254d) is amended--
       (1) by redesignating subsection (i) as subsection (j); and
       (2) by inserting after subsection (h) the following:
       ``(i)(1) In carrying out subpart III, the Secretary may, in 
     accordance with this subsection, carry out demonstration 
     projects in which individuals who have entered into a 
     contract for obligated service under the Loan Repayment 
     Program receive waivers under which the individuals are 
     authorized to satisfy the requirement of obligated service 
     through providing clinical service that is not full-time.
       ``(2) A waiver described in paragraph (1) may be provided 
     by the Secretary only if--
       ``(A) the entity for which the service is to be performed--
       ``(i) has been approved under section 333A for assignment 
     of a Corps member; and
       ``(ii) has requested in writing assignment of a health 
     professional who would serve less than full time;
       ``(B) the Secretary has determined that assignment of a 
     health professional who would serve less than full time would 
     be appropriate for the area where the entity is located;
       ``(C) a Corps member who is required to perform obligated 
     service has agreed in writing to be assigned for less than 
     full-time service to an entity described in subparagraph (A);
       ``(D) the entity and the Corps member agree in writing that 
     the less than full-time service provided by the Corps member 
     will not be less than 16 hours of clinical service per week;
       ``(E) the Corps member agrees in writing that the period of 
     obligated service pursuant to section 338B will be extended 
     so that the aggregate amount of less than full-time service 
     performed will equal the amount of service that would be 
     performed through full-time service under section 338C; and
       ``(F) the Corps member agrees in writing that if the Corps 
     member begins providing less than full-time service but fails 
     to begin or complete the period of obligated service, the 
     method stated in 338E(c) for determining the damages for 
     breach of the individual's written contract will be used 
     after converting periods of obligated service or of service 
     performed into their full-time equivalents.''.

     SEC. 302. DESIGNATION OF HEALTH PROFESSIONAL SHORTAGE AREAS.

       (a) In General.--Section 332 of the Public Health Service 
     Act (42 U.S.C. 254e) is amended--
       (1) in subsection (a)--
       (A) in paragraph (1), by inserting after the first sentence 
     the following: ``All Federally qualified health centers and 
     rural health clinics, as defined in section 1861(aa) of the 
     Social Security Act (42 U.S.C. 1395x(aa)), that meet the 
     requirements of section 334 shall be automatically designated 
     as having such a shortage. Not earlier than 6 years after 
     such date of enactment, and every 6 years thereafter, each 
     such center or clinic shall demonstrate that the center or 
     clinic meets the applicable requirements of the Federal 
     regulations, issued after the date of enactment of this Act, 
     that revise the definition of a health professional shortage 
     area for purposes of this section.''; and
       (B) in paragraph (3), by striking ``340(r)) may be a 
     population group'' and inserting ``330(h)(4)), seasonal 
     agricultural workers (as defined in section 330(g)(3)) and 
     migratory agricultural workers (as so defined)), and 
     residents of public housing (as defined in section 3(b)(1) of 
     the United States Housing Act of 1937 (42 U.S.C. 
     1437a(b)(1))) may be population groups'';
       (2) in subsection (b)(2), by striking ``with special 
     consideration to the indicators of'' and all that follows 
     through ``services.'' and inserting a period; and
       (3) in subsection (c)(2)(B), by striking ``XVIII or XIX'' 
     and inserting ``XVIII, XIX, or XXI''.
       (b) Regulations.--
       (1) Report.--
       (A) In general.--The Secretary shall submit the report 
     described in subparagraph (B) if the Secretary, acting 
     through the Administrator of the Health Resources and 
     Services Administration, issues--
       (i) a regulation that revises the definition of a health 
     professional shortage area for purposes of section 332 of the 
     Public Health Service Act (42 U.S.C. 254e); or
       (ii) a regulation that revises the standards concerning 
     priority of such an area under section 333A of that Act (42 
     U.S.C. 254f-1).
       (B) Report.--On issuing a regulation described in 
     subparagraph (A), the Secretary shall prepare and submit to 
     the Committee on Energy and Commerce of the House of 
     Representatives and the Committee on Health, Education, 
     Labor, and Pensions of the Senate a report that describes the 
     regulation.
       (2) Effective date.--Each regulation described in paragraph 
     (1)(A) shall take effect 180 days after the committees 
     described in paragraph (1)(B) receive a report referred to in 
     paragraph (1)(B) describing the regulation.
       (c) Scholarship and Loan Repayment Programs.--The Secretary 
     of Health and Human Services, in consultation with 
     organizations representing individuals in the dental field 
     and organizations representing publicly funded health care 
     providers, shall develop and implement a plan for increasing 
     the participation of dentists and dental hygienists in the 
     National Health Service Corps Scholarship Program under 
     section 338A of the Public Health Service Act (42 U.S.C. 
     254l) and the Loan Repayment Program under section 338B of 
     such Act (42 U.S.C. 254l-1).
       (d) Site Designation Process.--
       (1) Improvement of designation process.--The Administrator 
     of the Health Resources and Services Administration, in 
     consultation with appropriate State and territorial dental 
     directors, dental societies, and other interested parties, 
     shall revise the criteria on which the designations of dental 
     health professional shortage areas are based so that such 
     criteria provide a more accurate reflection of oral health 
     care need, particularly in rural areas.
       (2) Public health service act.--Section 332 of the Public 
     Health Service Act (42 U.S.C. 254e) is amended by adding at 
     the end the following:
       ``(i) Dissemination.--The Administrator of the Health 
     Resources and Services Administration shall disseminate 
     information concerning the designation criteria described in 
     subsection (b) to--
       ``(1) the Governor of each State;
       ``(2) the representative of any area, population group, or 
     facility selected by any such Governor to receive such 
     information;
       ``(3) the representative of any area, population group, or 
     facility that requests such information; and
       ``(4) the representative of any area, population group, or 
     facility determined by the Administrator to be likely to meet 
     the criteria described in subsection (b).''.
       (e) GAO Study.--Not later than February 1, 2005, the 
     Comptroller General of the United States shall submit to the 
     Congress a report on the appropriateness of the criteria, 
     including but not limited to infant mortality rates, access 
     to health services taking into account the distance to 
     primary health services, the rate of poverty and ability to 
     pay for health services, and low birth rates, established by 
     the Secretary of Health and Human Services for the 
     designation of health professional shortage areas and whether 
     the deeming of Federally qualified health centers and rural 
     health clinics as such areas is appropriate and necessary.

     SEC. 303. ASSIGNMENT OF CORPS PERSONNEL.

       Section 333 of the Public Health Service Act (42 U.S.C. 
     254f) is amended--
       (1) in subsection (a)--

[[Page H6800]]

       (A) in paragraph (1)--
       (i) in the matter before subparagraph (A), by striking 
     ``(specified in the agreement described in section 334)'';
       (ii) in subparagraph (A), by striking ``nonprofit''; and
       (iii) by striking subparagraph (C) and inserting the 
     following:
       ``(C) the entity agrees to comply with the requirements of 
     section 334; and''; and
       (B) in paragraph (3), by adding at the end ``In approving 
     such applications, the Secretary shall give preference to 
     applications in which a nonprofit entity or public entity 
     shall provide a site to which Corps members may be 
     assigned.''; and
       (2) in subsection (d)--
       (A) in paragraphs (1), (2), and (4), by striking 
     ``nonprofit'' each place it appears; and
       (B) in paragraph (1)--
       (i) in the second sentence--

       (I) in subparagraph (C), by striking ``and'' at the end; 
     and
       (II) by striking the period and inserting ``, and (E) 
     developing long-term plans for addressing health professional 
     shortages and improving access to health care.''; and

       (ii) by adding at the end the following: ``The Secretary 
     shall encourage entities that receive technical assistance 
     under this paragraph to communicate with other communities, 
     State Offices of Rural Health, State Primary Care 
     Associations and Offices, and other entities concerned with 
     site development and community needs assessment.''.

     SEC. 304. PRIORITIES IN ASSIGNMENT OF CORPS PERSONNEL.

       Section 333A of the Public Health Service Act (42 U.S.C. 
     254f-1) is amended--
       (1) in subsection (a)(1)(A), by striking ``, as determined 
     in accordance with subsection (b)'';
       (2) by striking subsection (b);
       (3) in subsection (c), by striking the second sentence;
       (4) in subsection (d)--
       (A) by redesignating paragraphs (1) through (3) as 
     paragraphs (2) through (4), respectively;
       (B) by inserting before paragraph (2) (as redesignated by 
     subparagraph (A)) the following:
       ``(1) Proposed list.--The Secretary shall prepare and 
     publish a proposed list of health professional shortage areas 
     and entities that would receive priority under subsection 
     (a)(1) in the assignment of Corps members. The list shall 
     contain the information described in paragraph (2), and the 
     relative scores and relative priorities of the entities 
     submitting applications under section 333, in a proposed 
     format. All such entities shall have 30 days after the date 
     of publication of the list to provide additional data and 
     information in support of inclusion on the list or in support 
     of a higher priority determination and the Secretary shall 
     reasonably consider such data and information in preparing 
     the final list under paragraph (2).'';
       (C) in paragraph (2) (as redesignated by subparagraph (A)), 
     in the matter before subparagraph (A)--
       (i) by striking ``paragraph (2)'' and inserting ``paragraph 
     (3)'';
       (ii) by striking ``prepare a list of health professional 
     shortage areas'' and inserting ``prepare and, as appropriate, 
     update a list of health professional shortage areas and 
     entities''; and
       (iii) by striking ``for the period applicable under 
     subsection (f)'';
       (D) by striking paragraph (3) (as redesignated by 
     subparagraph (A)) and inserting the following:
       ``(3) Notification of affected parties.--
       ``(A) Entities.--Not later than 30 days after the Secretary 
     has added to a list under paragraph (2) an entity specified 
     as described in subparagraph (A) of such paragraph, the 
     Secretary shall notify such entity that the entity has been 
     provided an authorization to receive assignments of Corps 
     members in the event that Corps members are available for the 
     assignments.
       ``(B) Individuals.--In the case of an individual obligated 
     to provide service under the Scholarship Program, not later 
     than 3 months before the date described in section 
     338C(b)(5), the Secretary shall provide to such individual 
     the names of each of the entities specified as described in 
     paragraph (2)(B)(i) that is appropriate for the individual's 
     medical specialty and discipline.''; and
       (E) by striking paragraph (4) (as redesignated by 
     subparagraph (A)) and inserting the following:
       ``(4) Revisions.--If the Secretary proposes to make a 
     revision in the list under paragraph (2), and the revision 
     would adversely alter the status of an entity with respect to 
     the list, the Secretary shall notify the entity of the 
     revision. Any entity adversely affected by such a revision 
     shall be notified in writing by the Secretary of the reasons 
     for the revision and shall have 30 days to file a written 
     appeal of the determination involved which shall be 
     reasonably considered by the Secretary before the revision to 
     the list becomes final. The revision to the list shall be 
     effective with respect to assignment of Corps members 
     beginning on the date that the revision becomes final.'';
       (5) by striking subsection (e) and inserting the following:
       ``(e) Limitation on Number of Entities Offered as 
     Assignment Choices in Scholarship Program.--
       ``(1) Determination of available corps members.--By April 1 
     of each calendar year, the Secretary shall determine the 
     number of participants in the Scholarship Program who will be 
     available for assignments under section 333 during the 
     program year beginning on July 1 of that calendar year.
       ``(2) Determination of number of entities.--At all times 
     during a program year, the number of entities specified under 
     subsection (c)(2)(B)(i) shall be--
       ``(A) not less than the number of participants determined 
     with respect to that program year under paragraph (1); and
       ``(B) not greater than twice the number of participants 
     determined with respect to that program year under paragraph 
     (1).'';
       (6) by striking subsection (f); and
       (7) by redesignating subsections (c), (d), and (e) as 
     subsections (b), (c), and (d) respectively.

     SEC. 305. COST-SHARING.

       Subpart II of part D of title III of the Public Health 
     Service Act (42 U.S.C. 254d et seq.) is amended by striking 
     section 334 and inserting the following:

     ``SEC. 334. CHARGES FOR SERVICES BY ENTITIES USING CORPS 
                   MEMBERS.

       ``(a) Availability of Services Regardless of Ability To Pay 
     or Payment Source.--An entity to which a Corps member is 
     assigned shall not deny requested health care services, and 
     shall not discriminate in the provision of services to an 
     individual--
       ``(1) because the individual is unable to pay for the 
     services; or
       ``(2) because payment for the services would be made 
     under--
       ``(A) the medicare program under title XVIII of the Social 
     Security Act (42 U.S.C. 1395 et seq.);
       ``(B) the medicaid program under title XIX of such Act (42 
     U.S.C. 1396 et seq.); or
       ``(C) the State children's health insurance program under 
     title XXI of such Act (42 U.S.C. 1397aa et seq.).
       ``(b) Charges for Services.--The following rules shall 
     apply to charges for health care services provided by an 
     entity to which a Corps member is assigned:
       ``(1) In general.--
       ``(A) Schedule of fees or payments.--Except as provided in 
     paragraph (2), the entity shall prepare a schedule of fees or 
     payments for the entity's services, consistent with locally 
     prevailing rates or charges and designed to cover the 
     entity's reasonable cost of operation.
       ``(B) Schedule of discounts.--Except as provided in 
     paragraph (2), the entity shall prepare a corresponding 
     schedule of discounts (including, in appropriate cases, 
     waivers) to be applied to such fees or payments. In preparing 
     the schedule, the entity shall adjust the discounts on the 
     basis of a patient's ability to pay.
       ``(C) Use of schedules.--The entity shall make every 
     reasonable effort to secure from patients fees and payments 
     for services in accordance with such schedules, and fees or 
     payments shall be sufficiently discounted in accordance with 
     the schedule described in subparagraph (B).
       ``(2) Services to beneficiaries of federal and federally 
     assisted programs.--In the case of health care services 
     furnished to an individual who is a beneficiary of a program 
     listed in subsection (a)(2), the entity--
       ``(A) shall accept an assignment pursuant to section 
     1842(b)(3)(B)(ii) of the Social Security Act (42 U.S.C. 
     1395u(b)(3)(B)(ii)) with respect to an individual who is a 
     beneficiary under the medicare program; and
       ``(B) shall enter into an appropriate agreement with--
       ``(i) the State agency administering the program under 
     title XIX of such Act with respect to an individual who is a 
     beneficiary under the medicaid program; and
       ``(ii) the State agency administering the program under 
     title XXI of such Act with respect to an individual who is a 
     beneficiary under the State children's health insurance 
     program.
       ``(3) Collection of payments.--The entity shall take 
     reasonable and appropriate steps to collect all payments due 
     for health care services provided by the entity, including 
     payments from any third party (including a Federal, State, or 
     local government agency and any other third party) that is 
     responsible for part or all of the charge for such 
     services.''.

     SEC. 306. ELIGIBILITY FOR FEDERAL FUNDS.

       Section 335(e)(1)(B) of the Public Health Service Act (42 
     U.S.C. 254h(e)(1)(B)) is amended by striking ``XVIII or XIX'' 
     and inserting ``XVIII, XIX, or XXI''.

     SEC. 307. FACILITATION OF EFFECTIVE PROVISION OF CORPS 
                   SERVICES.

       (a) Health Professional Shortage Areas.--Section 336 of the 
     Public Health Service Act (42 U.S.C. 254h-1) is amended--
       (1) in subsection (c), by striking ``health manpower'' and 
     inserting ``health professional''; and
       (2) in subsection (f)(1), by striking ``health manpower'' 
     and inserting ``health professional''.
       (b) Technical Amendment.--Section 336A(8) of the Public 
     Health Service Act (42 U.S.C. 254i(8)) is amended by striking 
     ``agreements under''.

     SEC. 308. AUTHORIZATION OF APPROPRIATIONS.

       Section 338(a) of the Public Health Service Act (42 U.S.C. 
     254k(a)) is amended--
       (1) by striking ``(1) For'' and inserting ``For'';
       (2) by striking ``1991 through 2000'' and inserting ``2002 
     through 2006''; and
       (3) by striking paragraph (2).

     SEC. 309. NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP PROGRAM.

       Section 338A of the Public Health Service Act (42 U.S.C. 
     254l) is amended--

[[Page H6801]]

       (1) in subsection (a)(1), by inserting ``behavioral and 
     mental health professionals,'' after ``dentists,'';
       (2) in subsection (b)(1)(B), by inserting ``, or an 
     appropriate degree from a graduate program of behavioral and 
     mental health'' after ``other health profession'';
       (3) in subsection (c)(1)--
       (A) in subparagraph (A), by striking ``338D'' and inserting 
     ``338E''; and
       (B) in subparagraph (B), by striking ``338C'' and inserting 
     ``338D'';
       (4) in subsection (d)(1)--
       (A) in subparagraph (A), by striking ``and'' at the end;
       (B) by redesignating subparagraph (B) as subparagraph (C); 
     and
       (C) by inserting after subparagraph (A) the following:
       ``(B) the Secretary, in considering applications from 
     individuals accepted for enrollment or enrolled in dental 
     school, shall consider applications from all individuals 
     accepted for enrollment or enrolled in any accredited dental 
     school in a State; and'';
       (5) in subsection (f)--
       (A) in paragraph (1)(B)--
       (i) in clause (iii), by striking ``and'' after the 
     semicolon;
       (ii) by redesignating clause (iv) as clause (v); and
       (iii) by inserting after clause (iii) the following new 
     clause:
       ``(iv) if pursuing a degree from a school of medicine or 
     osteopathic medicine, to complete a residency in a specialty 
     that the Secretary determines is consistent with the needs of 
     the Corps; and''; and
       (B) in paragraph (3), by striking ``338D'' and inserting 
     ``338E''; and
       (6) by striking subsection (i).

     SEC. 310. NATIONAL HEALTH SERVICE CORPS LOAN REPAYMENT 
                   PROGRAM.

       Section 338B of the Public Health Service Act (42 U.S.C. 
     254l-1) is amended--
       (1) in subsection (a)--
       (A) in paragraph (1), by inserting ``behavioral and mental 
     health professionals,'' after ``dentists,''; and
       (B) in paragraph (2), by striking ``(including mental 
     health professionals)'';
       (2) in subsection (b)(1), by striking subparagraph (A) and 
     inserting the following:
       ``(A) have a degree in medicine, osteopathic medicine, 
     dentistry, or another health profession, or an appropriate 
     degree from a graduate program of behavioral and mental 
     health, or be certified as a nurse midwife, nurse 
     practitioner, or physician assistant;'';
       (3) in subsection (e), by striking ``(1) In general.--''; 
     and
       (4) by striking subsection (i).

     SEC. 311. OBLIGATED SERVICE.

       Section 338C of the Public Health Service Act (42 U.S.C. 
     254m) is amended--
       (1) in subsection (b)--
       (A) in paragraph (1), in the matter preceding subparagraph 
     (A), by striking ``section 338A(f)(1)(B)(iv)'' and inserting 
     ``section 338A(f)(1)(B)(v)''; and
       (B) in paragraph (5)--
       (i) by striking all that precedes subparagraph (C) and 
     inserting the following:
       ``(5)(A) In the case of the Scholarship Program, the date 
     referred to in paragraphs (1) through (4) shall be the date 
     on which the individual completes the training required for 
     the degree for which the individual receives the scholarship, 
     except that--
       ``(i) for an individual receiving such a degree after 
     September 30, 2000, from a school of medicine or osteopathic 
     medicine, such date shall be the date the individual 
     completes a residency in a specialty that the Secretary 
     determines is consistent with the needs of the Corps; and
       ``(ii) at the request of an individual, the Secretary may, 
     consistent with the needs of the Corps, defer such date until 
     the end of a period of time required for the individual to 
     complete advanced training (including an internship or 
     residency).'';
       (ii) by striking subparagraph (D);
       (iii) by redesignating subparagraphs (C) and (E) as 
     subparagraphs (B) and (C), respectively; and
       (iv) in clause (i) of subparagraph (C) (as redesignated by 
     clause (iii)) by striking ``subparagraph (A), (B), or (D)'' 
     and inserting ``subparagraph (A)''; and
       (2) by striking subsection (e).

     SEC. 312. PRIVATE PRACTICE.

       Section 338D of the Public Health Service Act (42 U.S.C. 
     254n) is amended by striking subsection (b) and inserting the 
     following:
       ``(b)(1) The written agreement described in subsection (a) 
     shall--
       ``(A) provide that, during the period of private practice 
     by an individual pursuant to the agreement, the individual 
     shall comply with the requirements of section 334 that apply 
     to entities; and
       ``(B) contain such additional provisions as the Secretary 
     may require to carry out the objectives of this section.
       ``(2) The Secretary shall take such action as may be 
     appropriate to ensure that the conditions of the written 
     agreement prescribed by this subsection are adhered to.''.

     SEC. 313. BREACH OF SCHOLARSHIP CONTRACT OR LOAN REPAYMENT 
                   CONTRACT.

       (a) In General.--Section 338E of the Public Health Service 
     Act (42 U.S.C. 254o) is amended--
       (1) in subsection (a)(1)--
       (A) in subparagraph (A), by striking the comma and 
     inserting a semicolon;
       (B) in subparagraph (B), by striking the comma and 
     inserting ``; or'';
       (C) in subparagraph (C), by striking ``or'' at the end; and
       (D) by striking subparagraph (D);
       (2) in subsection (b)--
       (A) in paragraph (1)(A)--
       (i) by striking ``338F(d)'' and inserting ``338G(d)'';
       (ii) by striking ``either'';
       (iii) by striking ``338D or'' and inserting ``338D,''; and
       (iv) by inserting ``or to complete a required residency as 
     specified in section 338A(f)(1)(B)(iv),'' before ``the United 
     States''; and
       (B) by adding at the end the following new paragraph:
       ``(3) The Secretary may terminate a contract with an 
     individual under section 338A if, not later than 30 days 
     before the end of the school year to which the contract 
     pertains, the individual--
       ``(A) submits a written request for such termination; and
       ``(B) repays all amounts paid to, or on behalf of, the 
     individual under section 338A(g).'';
       (3) in subsection (c)--
       (A) in paragraph (1)--
       (i) in the matter preceding subparagraph (A), by striking 
     ``338F(d)'' and inserting ``338G(d)''; and
       (ii) by striking subparagraphs (A) through (C) and 
     inserting the following:
       ``(A) the total of the amounts paid by the United States 
     under section 338B(g) on behalf of the individual for any 
     period of obligated service not served;
       ``(B) an amount equal to the product of the number of 
     months of obligated service that were not completed by the 
     individual, multiplied by $7,500; and
       ``(C) the interest on the amounts described in 
     subparagraphs (A) and (B), at the maximum legal prevailing 
     rate, as determined by the Treasurer of the United States, 
     from the date of the breach;

     except that the amount the United States is entitled to 
     recover under this paragraph shall not be less than 
     $31,000.'';
       (B) by striking paragraphs (2) and (3) and inserting the 
     following:
       ``(2) The Secretary may terminate a contract with an 
     individual under section 338B if, not later than 45 days 
     before the end of the fiscal year in which the contract was 
     entered into, the individual--
       ``(A) submits a written request for such termination; and
       ``(B) repays all amounts paid on behalf of the individual 
     under section 338B(g).''; and
       (C) by redesignating paragraph (4) as paragraph (3);
       (4) in subsection (d)(3)(A), by striking ``only if such 
     discharge is granted after the expiration of the five-year 
     period'' and inserting ``only if such discharge is granted 
     after the expiration of the 7-year period''; and
       (5) by adding at the end the following new subsection:
       ``(e) Notwithstanding any other provision of Federal or 
     State law, there shall be no limitation on the period within 
     which suit may be filed, a judgment may be enforced, or an 
     action relating to an offset or garnishment, or other action, 
     may be initiated or taken by the Secretary, the Attorney 
     General, or the head of another Federal agency, as the case 
     may be, for the repayment of the amount due from an 
     individual under this section.''.
       (b) Effective Date.--The amendment made by subsection 
     (a)(4) shall apply to any obligation for which a discharge in 
     bankruptcy has not been granted before the date that is 31 
     days after the date of enactment of this Act.

     SEC. 314. AUTHORIZATION OF APPROPRIATIONS.

       Section 338H of the Public Health Service Act (42 U.S.C. 
     254q) is amended to read as follows:

     ``SEC. 338H. AUTHORIZATION OF APPROPRIATIONS.

       ``(a) Authorization of Appropriations.--For the purposes of 
     carrying out this subpart, there are authorized to be 
     appropriated $146,250,000 for fiscal year 2002, and such sums 
     as may be necessary for each of fiscal years 2003 through 
     2006.
       ``(b) Scholarships and Loan Repayments.--With respect to 
     certification as a nurse practitioner, nurse midwife, or 
     physician assistant, the Secretary shall, from amounts 
     appropriated under subsection (a) for a fiscal year, obligate 
     not less than a total of 10 percent for contracts for both 
     scholarships under the Scholarship Program under section 338A 
     and loan repayments under the Loan Repayment Program under 
     section 338B to individuals who are entering the first year 
     of a course of study or program described in section 
     338A(b)(1)(B) that leads to such a certification or 
     individuals who are eligible for the loan repayment program 
     as specified in section 338B(b) for a loan related to such 
     certification.''.

     SEC. 315. GRANTS TO STATES FOR LOAN REPAYMENT PROGRAMS.

       Section 338I of the Public Health Service Act (42 U.S.C. 
     254q-1) is amended--
       (1) in subsection (a), by striking paragraph (1) and 
     inserting the following:
       ``(1) Authority for grants.--The Secretary, acting through 
     the Administrator of the Health Resources and Services 
     Administration, may make grants to States for the purpose of 
     assisting the States in operating programs described in 
     paragraph (2) in order to provide for the increased 
     availability of primary health care services in health 
     professional shortage areas. The National Advisory Council 
     established under section 337 shall advise the Administrator 
     regarding the program under this section.'';

[[Page H6802]]

       (2) in subsection (e), by striking paragraph (1) and 
     inserting the following:
       ``(1) to submit to the Secretary such reports regarding the 
     States loan repayment program, as are determined to be 
     appropriate by the Secretary; and''; and
       (3) in subsection (i), by striking paragraph (1) and 
     inserting the following:
       ``(1) In general.--For the purpose of making grants under 
     subsection (a), there are authorized to be appropriated 
     $12,000,000 for fiscal year 2002 and such sums as may be 
     necessary for each of fiscal years 2003 through 2006.''.

     SEC. 316. DEMONSTRATION GRANTS TO STATES FOR COMMUNITY 
                   SCHOLARSHIP PROGRAMS.

       Section 338L of the Public Health Service Act (42 U.S.C. 
     254t) is repealed.

                    TITLE IV--ADDITIONAL PROVISIONS

     SEC. 401. COMMUNITY ACCESS DEMONSTRATION PROGRAM.

       Part D of title III of the Public Health Service Act (42 
     U.S.C. 254b et seq.) is amended by inserting after subpart IV 
     the following new subpart:

          ``Subpart V--Community Access Demonstration Program

     ``SEC. 340. GRANTS TO STRENGTHEN EFFECTIVENESS, EFFICIENCY, 
                   AND COORDINATION OF SERVICES FOR THE UNINSURED 
                   AND UNDERINSURED.

       ``(a) In General.--
       ``(1) Grants.--The Secretary may make not more than 35 
     grants for the purpose of carrying out demonstration projects 
     to improve the effectiveness, efficiency, and coordination of 
     services for uninsured and underinsured individuals.
       ``(2) Project period.--A demonstration project under this 
     section may not receive funding under this section for more 
     than three fiscal years.
       ``(b) Eligible Entities.--To be eligible to receive a grant 
     under this section, an entity must--
       ``(1) be an entity that is a public or private entity such 
     as--
       ``(A) a Federally qualified health center (as defined under 
     section 1861(aa)(4) of the Social Security Act);
       ``(B) a hospital that meets the requirements of section 
     340B(a)(4)(L) (or, if none are available in the area, a 
     hospital that is a provider of a substantial volume of non-
     emergency health services to uninsured individuals and 
     families without regard to their ability to pay) without 
     regard to 340B (a)(4)(L)(iii); or
       ``(C) a public health department; or
       ``(2) represent a consortium of providers and, as 
     appropriate, related agencies or entities--
       ``(A) whose principal purpose is to provide a broad range 
     of coordinated health care services in a geographic area 
     defined in the entity's grant application;
       ``(B) that includes health care providers that serve such 
     geographic area and that have traditionally provided care 
     (beyond emergency services) to uninsured and underinsured 
     individuals without regard to the individuals' ability to 
     pay; and
       ``(C) that may include other health care providers and 
     related agencies and organizations;

     except that preference may be given to applicants that are 
     health care providers identified in paragraph (1).
       ``(c) Applications.--To be eligible to receive a grant 
     under this section, an eligible entity shall submit to the 
     Secretary an application, in such form and manner as the 
     Secretary shall prescribe, that shall--
       ``(1) define a geographic area of uninsured and 
     underinsured individuals;
       ``(2) identify the providers who will participate in the 
     consortium's program under the grant, and specify each one's 
     contribution to the care of uninsured and underinsured 
     individuals in such geographic area, including the volume of 
     care it provides to medicare and medicaid beneficiaries, to 
     individuals served by the program under title XXI of the 
     Social Security Act (relating to SCHIP), and to privately 
     paid patients;
       ``(3) describe the activities that the applicant and the 
     consortium propose to perform under the grant to further the 
     purposes of this section;
       ``(4) demonstrate the consortium's ability to build on the 
     current system for serving uninsured and underinsured 
     individuals by involving providers who have traditionally 
     provided a significant volume of care for that community;
       ``(5) demonstrate the consortium's ability to develop 
     coordinated systems of care that either directly provide or 
     ensure the prompt provision of a broad range of high-quality, 
     accessible services, including, as appropriate, primary, 
     secondary, and tertiary services, as well as substance abuse 
     treatment and mental health services in a manner which 
     assures continuity of care in the community;
       ``(6) provide evidence of community involvement in the 
     development, implementation, and direction of the program 
     that it proposes to operate;
       ``(7) demonstrate the consortium's ability to ensure that 
     individuals participating in the program are enrolled in 
     public insurance programs for which they are eligible (or 
     know of private insurance options available to them, if any);
       ``(8) present a plan for leveraging other sources of 
     revenue, which may include State and local sources and 
     private grant funds, and integrating current and proposed new 
     funding sources in a way to assure long-term sustainability;
       ``(9) describe a plan for evaluation of the activities 
     carried out under the grant, including measurement of 
     progress toward the goals and objectives of the program;
       ``(10) demonstrate fiscal responsibility through the use of 
     appropriate accounting procedures and appropriate management 
     systems;
       ``(11) include such other information as the Secretary may 
     prescribe; and
       ``(12) demonstrate the commitment to serve individuals in 
     the geographic area without regard to the ability of the 
     individual or family to pay by arranging for or providing 
     free or reduced charge care for the poor.
       ``(d) Priorities.--In awarding grants under this section, 
     the Secretary may accord priority to applicants--
       ``(1) whose consortium includes public hospitals, Federally 
     qualified health centers (as defined in section 1905(l)(2)(B) 
     of the Social Security Act), and other providers that are 
     covered entities as defined by section 340B(a)(4) of this Act 
     (or that would be covered entities as so defined but for 
     subparagraph (L)(iii) of such section);
       ``(2) that identify a geographic area has a high or 
     increasing percentage of individuals who are uninsured;
       ``(3) whose consortium includes other health care providers 
     that have a tradition of serving uninsured individuals and 
     underinsured individuals in the community;
       ``(4) who show evidence that the program would expand 
     utilization of preventive and primary care services for 
     uninsured and underinsured individuals and families in the 
     community, including mental health services or substance 
     abuse services;
       ``(5) whose proposed program would improve coordination 
     between health care providers and appropriate social service 
     providers, including local and regional human services 
     agencies, school systems, and agencies on aging;
       ``(6) that demonstrate collaboration with State and local 
     governments;
       ``(7) that make use of non-Federal contributions to the 
     greatest extent possible; or
       ``(8) that demonstrate a significant likelihood that the 
     proposed program will continue after support under this 
     section ceases.
       ``(e) Use of Funds.--
       ``(1) Use by grantees.--
       ``(A) In general.--Except as provided in paragraphs (2) and 
     (3), a grantee may use amounts provided under this section 
     only for--
       ``(i) direct expenses associated with operating the greater 
     integration of a health care delivery system so that it 
     either directly provides or ensures the provision of a broad 
     range of services, as appropriate, including primary, 
     secondary, and tertiary services, as well as substance abuse 
     treatment and mental health services; and
       ``(ii) direct patient care and service expansions to fill 
     identified or documented gaps within an integrated delivery 
     system.
       ``(B) Specific uses.--The following are examples of 
     purposes for which a grantee may use grant funds, when such 
     use meets the conditions stated in subparagraph (A):
       ``(i) Increase in outreach activities.
       ``(ii) Improvements to case management.
       ``(iii) Development of provider networks.
       ``(iv) Recruitment, training, and compensation of necessary 
     personnel.
       ``(v) Acquisition of technology for the purpose of 
     coordinating health care.
       ``(vi) Identifying and closing gaps in health care services 
     being provided.
       ``(vii) Improvements to provider communication, including 
     implementation of shared information systems or shared 
     clinical systems.
       ``(viii) Other activities that may be appropriate to a 
     community that would increase access to the uninsured.
       ``(2) Reservation of funds for national program purposes.--
     The Secretary may use not more than 3 percent of funds 
     appropriated to carry out this section for technical 
     assistance to grantees, obtaining assistance of experts and 
     consultants, meetings, dissemination of information, 
     evaluation, and activities that will extend the benefits of 
     funded programs to communities other than the one funded.
       ``(f) Maintenance of Effort.--With respect to activities 
     for which a grant under this section is authorized, the 
     Secretary may award such a grant only if the recipient of the 
     grant and each of the participating providers agree that each 
     one will maintain its expenditures of non-Federal funds for 
     such activities at a level that is not less than the level of 
     such expenditures during the year immediately preceding the 
     fiscal year for which the applicant is applying to receive 
     such grant.
       ``(g) Reports to the Secretary.--The recipient of a grant 
     under this section shall report to the Secretary annually 
     regarding--
       ``(1) progress in meeting the goals stated in its grant 
     application; and
       ``(2) such additional information as the Secretary may 
     require.
     The Secretary may not renew an annual grant under this 
     section unless the Secretary is satisfied that the consortium 
     has made reasonable and demonstrable progress in meeting the 
     goals set forth in its grant application for the preceding 
     year.
       ``(h) Audits.--Each entity which receives a grant under 
     this section shall provide for an independent annual 
     financial audit of all records that relate to the disposition 
     of funds received through this grant.
       ``(i) Technical Assistance.--The Secretary may, either 
     directly or by grant or

[[Page H6803]]

     contract, provide any funded entity with technical and other 
     non-financial assistance necessary to meet the requirements 
     of this section.
       ``(j) Report.--Not later than September 30, 2005, the 
     Secretary shall submit to the Congress a report describing 
     the extent to which demonstration projects under this section 
     have been successful in improving the effectiveness, 
     efficiency, and coordination of services for uninsured and 
     underinsured individuals in the geographic areas served by 
     such projects, including providing better quality health care 
     for such individuals, and at lower costs, than would have 
     been the case in the absence of such projects.
       ``(k) Authorization of Appropriations.--For the purpose of 
     carrying out this section, there are authorized to be 
     appropriated $40,000,000 for fiscal year 2002, and such sums 
     as may be necessary for each of fiscal years 2003 through 
     2006.''.

     SEC. 402. EXPANDING AVAILABILITY OF DENTAL SERVICES.

       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:

                  ``Subpart X--Primary Dental Programs

     ``SEC. 340F. DESIGNATED DENTAL HEALTH PROFESSIONAL SHORTAGE 
                   AREA.

       ``In this subpart, the term `designated dental health 
     professional shortage area' means an area, population group, 
     or facility that is designated by the Secretary as a dental 
     health professional shortage area under section 332 or 
     designated by the applicable State as having a dental health 
     professional shortage.

     ``SEC. 340G. GRANTS FOR INNOVATIVE PROGRAMS.

       ``(a) Grant Program Authorized.--The Secretary, acting 
     through the Administrator of the Health Resources and 
     Services Administration, is authorized to award grants to 
     States for the purpose of helping States develop and 
     implement innovative programs to address the dental workforce 
     needs of designated dental health professional shortage areas 
     in a manner that is appropriate to the States' individual 
     needs.
       ``(b) State Activities.--A State receiving a grant under 
     subsection (a) may use funds received under the grant for--
       ``(1) loan forgiveness and repayment programs for dentists 
     who--
       ``(A) agree to practice in designated dental health 
     professional shortage areas;
       ``(B) are dental school graduates who agree to serve as 
     public health dentists for the Federal, State, or local 
     government; and
       ``(C) agree to--
       ``(i) provide services to patients regardless of such 
     patients' ability to pay; and
       ``(ii) use a sliding payment scale for patients who are 
     unable to pay the total cost of services;
       ``(2) dental recruitment and retention efforts;
       ``(3) grants and low-interest or no-interest loans to help 
     dentists who participate in the medicaid program under title 
     XIX of the Social Security Act (42 U.S.C. 1396 et seq.) to 
     establish or expand practices in designated dental health 
     professional shortage areas by equipping dental offices or 
     sharing in the overhead costs of such practices;
       ``(4) the establishment or expansion of dental residency 
     programs in coordination with accredited dental training 
     institutions in States without dental schools;
       ``(5) programs developed in consultation with State and 
     local dental societies to expand or establish oral health 
     services and facilities in designated dental health 
     professional shortage areas, including services and 
     facilities for children with special needs, such as--
       ``(A) the expansion or establishment of a community-based 
     dental facility, free-standing dental clinic, consolidated 
     health center dental facility, school-linked dental facility, 
     or United States dental school-based facility;
       ``(B) the establishment of a mobile or portable dental 
     clinic; and
       ``(C) the establishment or expansion of private dental 
     services to enhance capacity through additional equipment or 
     additional hours of operation;
       ``(6) placement and support of dental students, dental 
     residents, and advanced dentistry trainees;
       ``(7) continuing dental education, including distance-based 
     education;
       ``(8) practice support through teledentistry conducted in 
     accordance with State laws;
       ``(9) community-based prevention services such as water 
     fluoridation and dental sealant programs;
       ``(10) coordination with local educational agencies within 
     the State to foster programs that promote children going into 
     oral health or science professions;
       ``(11) the establishment of faculty recruitment programs at 
     accredited dental training institutions whose mission 
     includes community outreach and service and that have a 
     demonstrated record of serving underserved States;
       ``(12) the development of a State dental officer position 
     or the augmentation of a State dental office to coordinate 
     oral health and access issues in the State; and
       ``(13) any other activities determined to be appropriate by 
     the Secretary.
       ``(c) Application.--
       ``(1) In general.--Each State desiring a grant under this 
     section shall submit an application to the Secretary at such 
     time, in such manner, and containing such information as the 
     Secretary may reasonably require.
       ``(2) Assurances.--The application shall include assurances 
     that the State will meet the requirements of subsection (d) 
     and that the State possesses sufficient infrastructure to 
     manage the activities to be funded through the grant and to 
     evaluate and report on the outcomes resulting from such 
     activities.
       ``(d) Matching Requirement.--The Secretary may not make a 
     grant to a State under this section unless that State agrees 
     that, with respect to the costs to be incurred by the State 
     in carrying out the activities for which the grant was 
     awarded, the State will provide non-Federal contributions 
     in an amount equal to not less than 40 percent of Federal 
     funds provided under the grant. The State may provide the 
     contributions in cash or in kind, fairly evaluated, 
     including plant, equipment, and services and may provide 
     the contributions from State, local, or private sources.
       ``(e) Report.--Not later than 5 years after the date of 
     enactment of the Health Care Safety Net Improvement Act, the 
     Secretary shall prepare and submit to the appropriate 
     committees of Congress a report containing data relating to 
     whether grants provided under this section have increased 
     access to dental services in designated dental health 
     professional shortage areas.
       ``(f) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $50,000,000 for 
     the 5-fiscal year period beginning with fiscal year 2002.''.

     SEC. 403. STUDY REGARDING BARRIERS TO PARTICIPATION OF 
                   FARMWORKERS IN HEALTH PROGRAMS.

       (a) In General.--The Secretary shall conduct a study of the 
     problems experienced by farmworkers (including their 
     families) under Medicaid and SCHIP. Specifically, the 
     Secretary shall examine the following:
       (1) Barriers to enrollment.--Barriers to their enrollment, 
     including a lack of outreach and outstationed eligibility 
     workers, complicated applications and eligibility 
     determination procedures, and linguistic and cultural 
     barriers.
       (2) Lack of portability.--The lack of portability of 
     Medicaid and SCHIP coverage for farmworkers who are 
     determined eligible in one State but who move to other States 
     on a seasonal or other periodic basis.
       (3) Possible solutions.--The development of possible 
     solutions to increase enrollment and access to benefits for 
     farmworkers, because, in part, of the problems identified in 
     paragraphs (1) and (2), and the associated costs of each of 
     the possible solution described in subsection (b).
       (b) Possible Solutions.--Possible solutions to be examined 
     shall include each of the following:
       (1) Interstate compacts.--The use of interstate compacts 
     among States that establish portability and reciprocity for 
     eligibility for farmworkers under the Medicaid and SCHIP and 
     potential financial incentives for States to enter into such 
     compacts.
       (2) Demonstration projects.--The use of multi-state 
     demonstration waiver projects under section 1115 of the 
     Social Security Act (42 U.S.C. 1315) to develop comprehensive 
     migrant coverage demonstration projects.
       (3) Use of current law flexibility.--Use of current law 
     Medicaid and SCHIP State plan provisions relating to coverage 
     of residents and out-of-State coverage.
       (4) National migrant family coverage.--The development of 
     programs of national migrant family coverage in which States 
     could participate.
       (5) Public-private partnerships.--The provision of 
     incentives for development of public-private partnerships to 
     develop private coverage alternatives for farmworkers.
       (6) Other possible solutions.--Such other solutions as the 
     Secretary deems appropriate.
       (c) Consultations.--In conducting the study, the Secretary 
     shall consult with the following:
       (1) Farmworkers affected by the lack of portability of 
     coverage under the Medicaid program or the State children's 
     health insurance program (under titles XIX and XXI of the 
     Social Security Act).
       (2) Individuals with expertise in providing health care to 
     farmworkers, including designees of national and local 
     organizations representing migrant health centers and other 
     providers.
       (3) Resources with expertise in health care financing.
       (4) Representatives of foundations and other nonprofit 
     entities that have conducted or supported research on 
     farmworker health care financial issues.
       (5) Representatives of Federal agencies which are involved 
     in the provision or financing of health care to farmworkers, 
     including the Health Care Financing Administration and the 
     Health Research and Services Administration.
       (6) Representatives of State governments.
       (7) Representatives from the farm and agricultural 
     industries.
       (8) Designees of labor organizations representing 
     farmworkers.
       (d) Definitions.--For purposes of this section:
       (1) Farmworker.--The term ``farmworker'' means a migratory 
     agricultural worker or seasonal agricultural worker, as such 
     terms are defined in section 330(g)(3) of the Public Health 
     Service Act (42 U.S.C. 254c(g)(3)), and includes a family 
     member of such a worker.
       (2) Medicaid.--The term ``Medicaid'' means the program 
     under title XIX of the Social Security Act.

[[Page H6804]]

       (3) SCHIP.--The term ``SCHIP'' means the State children's 
     health insurance program under title XXI of the Social 
     Security Act.
       (e) Report.--Not later than one year after the date of the 
     enactment of this Act, the Secretary shall transmit a report 
     to the President and the Congress on the study conducted 
     under this section. The report shall contain a detailed 
     statement of findings and conclusions of the study, together 
     with its recommendations for such legislation and 
     administrative actions as the Secretary considers 
     appropriate.

     SEC. 404. ELIGIBILITY OF CERTAIN ENTITIES FOR GRANTS.

       If under a program established in this Act (other than 
     section 401), or if pursuant to an amendment made by this 
     Act, a private entity that is not a nonprofit entity is 
     eligible for an award of a grant, contract, or cooperative 
     agreement, such an award may not be made to such private 
     entity unless the entity is the only available provider of 
     quality health services in the geographic area involved.

     SEC. 405. CONFORMING AMENDMENTS.

       (a) Homeless Programs.--Subsections (g)(1)(G)(ii), (k)(2), 
     and (n)(1)(C) of section 224, and sections 317A(a)(2), 
     317E(c), 318A(e), 332(a)(2)(C), 340D(c)(5), 799B(6)(B), 1313, 
     and 2652(2) of the Public Health Service Act (42 U.S.C. 233, 
     247b-1(a)(2), 247b-6(c), 247c-1(e), 254e(a)(2)(C), 
     256d(c)(5), 295p(6)(B), 300e-12, and 300ff-52(2)) are amended 
     by striking ``340'' and inserting ``330(h)''.
       (b) Homeless Individual.--Section 534(2) of the Public 
     Health Service Act (42 U.S.C. 290cc-34(2)) is amended by 
     striking ``340(r)'' and inserting ``330(h)(5)''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Florida (Mr. Bilirakis) and the gentleman from Texas (Mr. Green) each 
will control 20 minutes.
  The Chair recognizes the gentleman from Florida (Mr. Bilirakis).


                             General Leave

  Mr. BILIRAKIS. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days within which to revise and extend their 
remarks on this legislation, and to insert extraneous material on the 
bill.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Florida?
  There was no objection.
  Mr. BILIRAKIS. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I rise in strong support of H.R. 3450, the Health Care 
Safety Net Improvement Act. This bill reauthorizes our Nation's key 
health care delivery systems and creates additional efficiencies. 
Specifically, this bill reauthorizes the Community Health Center 
program, the National Health Service Corps and rural outreach grants. 
Each of these programs ensures that both the uninsured and the 
underinsured have access to quality health care services.
  Since 1965, America's health centers have delivered comprehensive 
services to people who otherwise would face major barriers to obtaining 
quality, affordable health care. Health centers serve those who are 
hardest to reach and are required by law to make their services 
accessible to everyone, regardless of their ability to pay.
  Our legislation increases the funding authorization for health 
centers to $1.293 billion. We have included language allowing health 
centers to provide behavioral, mental health, and substance abuse 
services if they choose. The legislation also creates a new program for 
practice management networks. These networks will improve access to 
care and reduce costs of delivering the high-quality care that health 
centers provide.
  Many community health centers are located in America's inner cities, 
isolated rural areas, and migrant farm worker communities, which often 
lack adequate numbers of health professionals. H.R. 3450 ensures that 
health centers will have an easier process for becoming designated as a 
health professional shortage area. The HPSA designation is important 
because it will help health centers access health professionals through 
other Federal programs.
  One of the most important programs for ensuring an adequate supply of 
health professionals is the National Health Service Corps. The National 
Health Service Corps recruits, trains, and places primary care 
providers in both urban and rural health care shortage areas. Program 
participants are health professionals who receive educational 
assistance in return for a period of obligated service.
  Our legislation reauthorizes this vital program, which serves as a 
pipeline for health care facilities that have trouble attracting health 
professionals. The bill strengthens the service obligation requirements 
of the National Health Service Corps. By strengthening this provision, 
health care facilities using program graduates can be certain that 
health corps personnel will fulfill their entire service contract, 
something I have been concerned with for years and years.
  H.R. 3450 also recognizes the importance of oral health care and 
authorizes the inclusion of primary dental care education. The bill 
creates flexibility for the HHS Secretary in administering the program 
to ensure that resources are maximized between the loan repayment and 
the scholarship programs.
  Another area of focus in the Safety Net Improvement Act is in the 
rural health arena. Often rural communities have trouble developing 
capacity and maintaining health care facilities. Our bill includes 
programs that will help rural providers develop new service capacity 
and integrated health delivery networks. It will help rural facilities 
implement quality improvement initiatives.
  A concern for many rural communities is the delivery of adequate 
specialty care and mental health services. Our bill consolidates 
programs within the Office of Telehealth to build on them to deliver 
services via teletechnologies. We authorize funding for the creation of 
programs that will expand access to, coordinate, and improve the 
quality of health services. These programs will also improve and expand 
the training of health care providers and the quality of health 
information available to underserved communities.
  Mr. Speaker, I believe using telehealth technologies is an effective 
and efficient way to expand access to care for those in the most remote 
locations of our country. H.R. 3450 authorizes for the first time a 
demonstration program to coordinate the care that individuals receive 
in a particular geographic area. I believe that programs like this may 
help reduce duplicative services and lead to greater efficiencies 
within our systems, and I anxiously await the GAO study on this program 
so we may better evaluate its overall effectiveness.
  As health care delivery becomes more complex, we must be sure that we 
have the trained professionals and the necessary infrastructure to 
address the increasing demand for health care services.
  Mr. Speaker, given recent events and news of increasing numbers of 
uninsured, it is vitally important that we keep our safety net strong. 
I believe this bill is a good start, and I am certain it will improve 
services for our most vulnerable populations. I urge Members to support 
H.R. 3450, the Health Care Safety Net Improvement Act.
  Mr. Speaker, I reserve the balance of my time.
  Mr. GREEN of Texas. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I rise today in support of H.R. 3450, the Health Care 
Safety Net Improvement Act, and I thank the gentleman from Florida (Mr. 
Bilirakis) and the gentleman from Ohio (Mr. Brown) for bringing this 
important legislation to the floor today. I would also like to thank 
the gentleman from Louisiana (Chairman Tauzin) and the ranking member, 
the gentleman from Michigan (Mr. Dingell), for their efforts to improve 
access to quality preventive and primary health care for the millions 
of medically underserved Americans who rely on these programs.
  This important legislation strengthens our health care safety net by 
reauthorizing the Consolidated Health Centers program, the National 
Health Services Corps, certain rural health programs, and creating a 
new Community Access Demonstration Program.
  This legislation could not come at a better time. The U.S. Census 
Bureau announced on Sunday that the number of uninsured people in the 
United States increased by 1.4 million in 2001 to more than 41 million 
Americans.
  With the decline in the economy and escalating health care costs, the 
ranks of the uninsured will continue to grow. We must act now to ensure 
that our health care safety net is prepared for the flood of newly 
uninsured individuals. These programs ensure that all Americans have 
access to health care, regardless of their ability to pay.
  I would like to take a moment to talk about the Community Access 
Program, or CAP program, as this is an

[[Page H6805]]

issue I have been working on for a number of years. The CAP program was 
launched as a demonstration project in fiscal year 2000, providing 
grants to 23 communities across the country. This program has expanded 
in fiscal year 2001 to 77 communities, and again in fiscal year 2002 to 
a total of 136 communities.
  The CAP program provides grants to help agencies coordinate 
preventive and primary care for that 41 million Americans without 
insurance. The uninsured and underinsured tend to be more expensive to 
treat, often because they fall through the cracks in our health care 
system. Instead of getting checkups and having small problems looked 
at, the uninsured often ignore the symptoms of what might be larger 
problems because they simply cannot afford to go to the doctor. CAP can 
help fill the gaps in our health care safety net by improving 
infrastructure and communication among the agencies to ensure that care 
is continuous.
  With better information, agencies can provide preventive, primary, 
and emergency clinical health services in an integrated and coordinated 
manner.
  I am particularly proud of the CAP program in Houston, Texas, which 
has been operating for the past 2 years. Using Federal CAP funds, the 
Harris County Community Access Collaborative was able to grow into an 
organization consisting of 78 member and affiliate groups working 
together to coordinate and improve access to health care. In just the 
last year, over 9,000 persons have been assisted during the 15,000 
interventions to procure access to care through navigation services.
  And after-hours telephone service called Ask Your Nurse has been 
opened that is designed to provide health care information to 20,000 
callers per year as an alternative to emergency rooms. The 
collaborative is also supporting the redesign of existing safety net 
services in order to assist them to use their resources more 
efficiently resulting in the increase of services to 18,000 to 24,000 
additional persons. This kind of program not only helps ease some of 
the burdens on our health care system, but makes a tremendous 
difference in the quality of life for many of these patients. That is 
why I am pleased to support H.R. 3450, including a 3-year demonstration 
program for the CAP program.
  However, I am concerned that H.R. 3450 limits the number of grants 
nationally to 35 and that the initial authorization level in the bill 
will not adequately support the program or provide for its growth.
  Given that there are currently 136 grantees and many more prospective 
CAP participants, I support efforts to achieve the strongest CAP 
provisions possible as the bill moves forward. It is my hope in the 
closing days of the 107th Congress, we are able to work out the 
differences and produce a strong and effective CAP program.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BILIRAKIS. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I want to acknowledge the work of the gentleman from 
Texas (Mr. Green) on the entire issue of the Safety Net Community 
Health Centers, and particularly the CAP program. It sounds like a 
terrific concept, and we are continuing to talk on it and hopefully 
improve on what we have in this legislation insofar as that area is 
concerned. But it is important also that we have oversight, and take a 
look at how it is working and is it working, as we hope and dream that 
it is working.
  Mr. Speaker, I yield such time as he may consume to the gentleman 
from Illinois (Mr. Shimkus).
  (Mr. SHIMKUS asked and was given permission to revise and extend his 
remarks.)

                              {time}  1245

  Mr. SHIMKUS. Mr. Speaker, as a cosponsor of the bill and as a proud 
member of the Committee on Energy and Commerce, I would like to commend 
the distinguished gentleman from Florida (Mr. Bilirakis), the Commerce 
Subcommittee on Health and all those who have worked to bring this 
legislation to the floor. This bill will improve access to quality 
preventative and primary health care for the medically underserved, 
including the millions of Americans, many who reside in Illinois, 
without health insurance coverage.
  First and foremost, H.R. 3450 would reauthorize the critically 
important Community Health Centers Program for another 5 years, 
including reaffirmation that health centers be located in high-need 
areas; provide comprehensive preventive and primary health care 
services; governed by community boards made up of a majority of current 
health care center patients to assure responsiveness to local needs; 
and open to everyone in the communities they serve, regardless of 
ability to pay.
  I have been in love with community health centers since I have been 
involved here in Washington. They are meeting a great need. That is why 
I wholeheartedly support what we are doing here.
  This legislation also authorizes for the very first time the 
Community Access Program, the CAP program as has been talked about 
earlier before me, which supports the development of communitywide 
networks to organize and improve access to health care in low-income 
and uninsured populations. The CAP program has proven successful in 
improving health care access, reducing emergency room use and saving 
money through shared resources and economies of scale.
  I have had the opportunity to observe the benefits of this important 
program up close when I visited Macoupin County Health Department and 
the Springfield and Sangamon County Comprehensive Community Health 
Initiative, two innovative CAP projects in my district. I am proud to 
report that these two projects have helped tremendously to both expand 
and strengthen the health care safety net in the communities I 
represent.
  I am pleased that H.R. 3450 includes a 5-year authorization for the 
CAP program. However, as has been stated by the chairman and the 
gentleman from Texas, H.R. 3450 limits the number of grants nationally 
to 35. Given that there are currently 136 grantees and many more 
prospective CAP participants, I strongly support efforts to achieve the 
strongest CAP provisions possible as the bill moves forward, most 
importantly the elimination of the bill's limit on the number of CAP 
grantees.
  Again, I am pleased to support passage of H.R. 3450, and I stand 
ready to work with my esteemed colleagues to ensure that the Health 
Care Safety Net Improvement Act is enacted into law. I look forward to 
working with the gentleman from Florida (Mr. Bilirakis) and the 
gentleman from Texas (Mr. Green) in the future.
  Mr. GREEN of Texas. Mr. Speaker, I yield 4 minutes to the gentleman 
from Illinois (Mr. Davis).
  Mr. DAVIS of Illinois. I thank the gentleman from Texas for yielding 
me this time and also for his outstanding work on this legislation.
  Mr. Speaker, as a cosponsor of the bill, former president of the 
National Association of Community Health Centers, cochair of the Health 
Center Caucus, former employee of two community health centers, and 
with 26 community health centers in my district, I rise to add my 
strong support for H.R. 3450, the Health Care Safety Net Improvement 
Act. I would like to commend the distinguished gentleman from Florida 
(Mr. Bilirakis), chairman of the House Energy and Commerce Subcommittee 
on Health, and the distinguished gentleman from Ohio (Mr. Brown), 
ranking member of the House Energy and Commerce Subcommittee on Health, 
for bringing this important legislation to the floor today. I would 
also like to commend the distinguished gentleman from Louisiana (Mr. 
Tauzin), chairman of the Committee on Energy and Commerce and the 
distinguished gentleman from Michigan (Mr. Dingell), the ranking 
member, for their efforts to improve access to quality preventative and 
primary health care for the medically underserved, including the 
millions of Americans without health insurance coverage.
  The Federal Health Centers Program was designed as a unique public-
private partnership, with Federal resources provided directly to 
community organizations for the development and operation of local 
health care systems. Under program rules, a majority of the membership 
on the policy boards of the local health centers must consist of 
individuals who receive their health care at the local center and who 
represent the community being served. In this way communities in need 
are given the

[[Page H6806]]

resources to address their most pressing health problems, and they are 
held responsible for doing so.
  Mr. Speaker, community health centers are truly integral threads of 
America's health care safety net. That is why I am pleased to support 
reauthorization of this critically important program for another 5 
years.
  Most importantly, H.R. 3450 strongly reaffirms the four foundations 
of the health centers programs that, one, health centers be located in 
high-need areas; two, provide comprehensive preventive and primary 
health care services; three, be governed by community boards made up of 
a majority of current health center patients to assure responsiveness 
to local needs; and, four, be open to everyone in the communities they 
serve, regardless of ability to pay. It is these requirements of the 
Health Centers Program that have made it a model of health care 
delivery for more than 30 years, providing high-quality, cost-effective 
primary and preventive health care to all who need it.
  I am pleased, Mr. Speaker, that H.R. 3450 reauthorizes the Health 
Centers Program so that these centers can continue their proven record 
of attacking some of the most challenging health problems that exist. 
One example of this program's effectiveness is the tenacity with which 
health centers have addressed the racial and ethnic disparities in 
health care, a growing issue highlighted by the Institute of Medicine's 
March 2002 report entitled ``Unequal Treatment: Confronting Racial and 
Ethnic Disparities in Health Care.'' This report found overwhelming 
evidence that minorities in America generally receive poor health care 
even when income, insurance and medical conditions are similar. The 
report identified a number of causes for racial health disparities, 
including language barriers, inadequate coverage, provider bias, and 
lack of minority doctors. For most of us, this is not new.
  This bill also expands the availability of dental health services at 
community health centers, which is so greatly and vitally needed even 
for senior citizens who have Medicare and still cannot get dental 
services.
  Mr. Speaker, this is an outstanding program. I commend all of those 
who continue to make it happen.
  Mr. BILIRAKIS. Mr. Speaker, I, too, thank the gentleman for his kind 
remarks and endorse his remarks.
  Mr. Speaker, I yield such time as he may consume to the gentleman 
from Florida (Mr. Foley).
  Mr. FOLEY. Mr. Speaker, let me thank, first of all, the gentleman 
from Florida (Mr. Bilirakis), who is known as Mr. Health in the Florida 
delegation for his timely passage of H.R. 3450, and urge adoption. 
Coming from Florida, many people think of us as a very large urban 
regional center. They think of Palm Beach, they think of Tampa, they 
think of St. Petersburg, Jacksonville. They do not recognize the small 
agrarian rural counties that are contained in 67 counties in the great 
State of Florida.
  I happen to represent communities that go from the east coast to the 
west coast, and they include such impoverished communities as Glades 
and Henry, where average, hard-working families have absolutely no 
access to quality health care. Fortunately, due to the work of the 
gentleman from Florida (Mr. Bilirakis) and the Committee on Energy and 
Commerce, we have seen an outpouring and a growth, if you will, of 
community health centers throughout these areas.
  Five years ago most of these families would have had to travel to Lee 
County to gain any type of health care at all. Oftentimes doctors were 
not even available in the communities. You could not attract or recruit 
them. This bill goes a long way to ensuring not only do we have a 
quality work force of doctors, but trained professionals to assist.
  The gentleman from Illinois just mentioned another important 
provision in this bill, which is dental health. Dental health is part 
of the physical being. If we do not adequately care for the dentures, 
the teeth, the jaws and gums of the individuals we serve, they will 
have a decline, if you will, of quality of life.
  The mental health coverage provided in this bill is expanded, and it 
brings about new innovations.
  We mentioned again about providing help to migratory and seasonal 
agricultural workers. Oftentimes if we can catch their illnesses early, 
we can actually save society a great deal of money. The sicker a person 
becomes, whether it is pneumonia or some other disease, the more 
expensive it is and typically will be treated in an emergency room 
where the cost is that much greater for Medicaid and some of the other 
delivery services. Some of the hospitals in my district are going 
uncompensated for the care of some of these individuals.
  This is the underpinnings of this very well-crafted legislation, that 
it reaches out and not only provides a safety net for our communities, 
but actually strengthens the communities through a delivery system of 
quality health care. Every citizen in this country is entitled to 
quality health care regardless of their ability to pay and regardless 
of their ability to speak English, because oftentimes they are the 
hardest working among us.
  Again, I commend and salute the chairman, the ranking member, and the 
gentleman from Texas for his hard work on this issue. I urge all 
colleagues to strongly support H.R. 3450.
  Mr. BARR of Georgia. Mr. Speaker, since its creation in 1972, the 
National Health Service Corps (NHSC) has made a significant impact both 
in improving the distribution of health care providers (physicians, 
physician assistants, nurse practitioners and dentists) in the 
underserved areas of our country and increasing primary care access for 
at-risk populations.
  The NHSC operates two programs to help meet the needs of underserved 
communities: the scholarship program and the loan repayment program. 
The scholarship program provides funds to students for educational 
living expenses during health care practitioner training. The loan 
repayment program provides financial assistance to help newly graduated 
practitioners repay their educational loans. For each year of NHSC 
scholarship or loan repayment support, participants are obligated to 
provide one year of medical care in underserved communities.
  Noteworthy research comparing the effectiveness of the NHSC 
scholarship and loan repayment programs was conducted by The Cecil G. 
Sheps Center at UNC Chapel Hill, NC and Mathematica Policy Research--
``Evaluation of the Effectiveness of the National Health Service 
Corps'' HRSA Contract No. 240-95-0038, May 31, 2000. This research 
confirmed that only 20.7 percent of NHSC scholarship recipients stayed 
at least one month beyond their service obligation, compared to 57.2 
percent of NHSC loan repayment recipients.
  In addition, the General Accounting Office (GAO), in a 1995 report 
entitled, ``National Health Service Corp: Opportunities to Stretch 
Scarce Dollars and Improve Provider Placement,'' concluded that the 
NHSC scholarship program was significantly more expensive than the NHSC 
loan repayment program. The report stated that ``loan repayment 
recipients cost the federal government one-half to one-third less than 
scholarship recipients and . . . the loan repayment program offers a 
better long term investment of limited federal dollars.''
  Given this information from both the Sheps Center/Mathematica study 
and the GAO report, I am a strong advocate for removing the current 30 
percent set aside for NHSC scholarships. The legislation before us 
today, H.R. 3450, does not include a 30 percent set aside for NHSC 
scholarships. Instead, the legislation leaves the division of resources 
between the scholarship and loan repayment programs up to the experts 
at the Health Resources Services Administration (HRSA). This way HRSA 
officials can look at all of the data collected on these programs and 
determine the best use of taxpayer money.
  We all want to see America's safety net of community health care 
centers, rural health care clinics, and providers for underserved areas 
grow stronger and more stable. The NHSC loan repayment program has 
proven its effectiveness in this area and I am proud to say that the 
House-version of this legislation will enable the fullest possible 
support of that program.
  Mr. BROWN of Ohio. Mr. Speaker, I want to thank the Chairman of the 
Energy and Commerce Health Subcommittee, Mr. Bilirakis, for his hard 
work on this bill. And a special thanks to staff members Steve Tilton, 
Erin Okunzzi, and Pat Morissey, on the Republican side, and David 
Nelson and John Ford on ours.
  Community Health Centers and the National Health Service Corps 
provide health care to an underserved and uninsured population. A 
population that faces poverty, hunger, poor living conditions--all of 
which exacerbate the need for health care and all but guarantee 
disenfranchisement from the private health insurance system so many of 
us take for granted.
  Community Health Centers and the National Health Service Corps serve 
populations that otherwise would fall through the cracks of our

[[Page H6807]]

patch-work public/private healthcare system. In Ohio, over 217,000 
patients receive services through Community Health Centers. Life-saving 
services like treatment for dehydration and for exposure to extreme 
heat and cold. Services as fundamental--and fundamentally important--as 
immunizations, child health exams, and breast and cervical cancer 
screening. And services as sophisticated as treatment for heart 
disease, diabetes, asthma and mental illness.
  Since 1972, the National Health Service Act has reach millions of 
Americans living in areas where health care is scarce. The Corps has 
encouraged health professionals to go where other health professionals 
would not, providing access to health care and working to eliminate 
health disparities in underserved areas. Reauthorization of the Corps 
will only make this public program stronger.
  Health centers and the National Health Service Corps continue to 
improve the quality of life for so many uninsured families. I urge my 
colleagues to support this popular bill.
  While the committee did not report the bill, I have discussed 
interpretation of certain provisions with the Chairman, and the 
explanation follows.
  We recognize the critically important role that translation and 
interpretation services, as well as health care services provided in a 
culturally competent manner, play in ensuring the delivery of 
appropriate health care services to patients who have limited ability 
to speak English, and applaud the efforts of health centers to deliver 
linguistically and culturally appropriate care.
  We recognize that health centers serve increasing numbers of patients 
speaking a variety of languages and representing a variety of racial 
and ethnic backgrounds.
  We also recognize that the particular community health centers that 
serve limited English proficient populations bear a disproportionate 
financial, administrative and clinical burden above and beyond costs 
associated with providing health services and other general enabling 
services.
  It is our expectation that the Secretary will work with health 
centers to enable them to provide, to the maximum extent feasible, 
appropriate translation and interpretation services for all of the 
patients they serve.
  Mr. CAPUANO. Mr. Speaker, I rise today in support of H.R. 3450, the 
Health Care Safety Net Improvement Act. As a cosponsor of this bill and 
Co-Chair of the Community Health Center Caucus I'd like to thank Mr. 
Bilirakis and Mr. Brown for their leadership in bringing this 
legislation to the floor today.
  As you know, health centers were established over 35 years ago to 
provide access to quality preventive and primary health care for the 
medically underserved--including the millions of Americans without 
health insurance, low income working families, members of minority 
groups, residents of rural areas, homeless persons, and agricultural 
farmworkers. Since their inception, health centers have served as a 
prototype for effective public-private partnerships, demonstrating an 
ability to meet pressing local health needs while being held 
accountable for meeting national performance standards.
  H.R. 3450 would reauthorize the National Health Service Corps program 
and authorize the Community Access Program. According to the Department 
of Health and Human Services, over 50 million people do not have a 
regular health care provider, including millions with public or private 
health insurance coverage. This legislation is vital in light of this 
data, including yesterday's Census Bureau study reporting the number of 
Americans who lack health coverage has increased again after a two-year 
decline. Specifically, one-third of Latinos lack coverage, far more 
than any other racial or ethnic group. More than 4 in 10 residents who 
are not citizens are uninsured, and more than one-quarter of high 
school dropouts have no insurance.
  Health Centers focus their efforts on these underserved and uninsured 
populations. H.R. 3450 continues to reaffirm the principles of health 
centers, by focusing on high-need areas while ensuring care to all, 
regardless of their ability to pay. Health centers across the nation 
have begun a five-year effort to expand services to millions more 
underserved patients. My District has over twenty-five health centers 
and my constituents rely on the dedicated staff to provide health care 
services to them and their families. We cannot jeopardize the 
extraordinary work of the health centers because of a lack of federal 
authorization.
  Mr. Speaker, I urge all Members of the House to support this bill and 
to ensure its passage and enactment this year. The House must move 
quickly to ensure that health centers can continue to provide high 
quality health care services to vulnerable populations in underserved 
communities across America.
  Ms. PELOSI. Mr. Speaker, I rise in strong support of H.R. 3450, the 
Health Care Safety Net Improvement Act. By reauthorizing the Community 
Health Centers program and the National Health Service Corps, this 
important legislation will preserve and expand access to culturally and 
linguistically appropriate primary health care services for the 
millions of uninsured and underinsured Americans who rely on these 
programs.
  Just this week, the Census Bureau released figures showing that the 
number of uninsured Americans increased by 1.4 million last year to a 
total of 41.2 million, or 14.6 percent of the total population. 
Community Health Centers create a cost-effective alternative to the 
emergency room for those without adequate access to health care by 
providing comprehensive primary and preventive care to 12 million 
people each year, including 5 million uninsured Americans, in more than 
3400 urban and rural communities. H.R. 3450 will expand the 
availability of cancer screening and housing service at Health Centers, 
and create new grants to increase access to health services in rural 
areas.
  Existing shortages in the health professions, especially in nursing, 
have strained all aspects of the health care system. The National 
Health Services Corps helps increase the number of trained health 
professionals available to meet the personnel needs of safety net 
providers by providing scholarship and loan repayment support to 2500 
health professionals, who then agree to serve in Community Health 
Centers and other locations in underserved communities.
  H.R. 3450 also authorizes the Healthy Communities Access Program, 
which has demonstrated ability to strengthen our health care safety net 
through improved information systems, telecommunication, integrated 
networks, and better care management. Coordination of care is an issue 
that is consistently raised as one of the challenges associated with 
reducing the number of uninsured Americans. The Healthy Communities 
Access Program is the only federal program designed to address this 
need, and today's legislation will ensure that it is preserved.
  In my district, the San Francisco Community Clinics Consortium has 
used these funds to build a system that will link community health 
centers to each other and to family planning clinics, Ryan White 
grantees, and all of our city's providers that serve uninsured San 
Franciscans. The result is a cohesive system of care that includes a 
common registration system, installation of electronic medical record 
software, standardization of referral systems, and integration of 
behavioral health care with primary care.
  Expanding access to quality health care is one of our most important 
responsibilities in Congress. I urge my colleagues to vote in support 
of H.R. 3450.
  Mr. DINGELL. Mr. Speaker, I support H.R. 3450, the ``Health Care 
Safety Net Improvement Act,'' an important piece of legislation. Its 
progress has been delayed for nearly a year by a Republican leadership 
that was willing to jeopardize a bill of vital importance to millions 
of Americans by attempting to attach an extremely controversial, yet 
completely non-related, amendment to this bill. Thankfully we now have 
an opportunity, though long overdue, to pass this legislation.
  H.R. 3450 will reauthorize the National Health Service Corps (NHSC), 
the Community Health Centers program, and will establish a Community 
Access demonstration program (CAP). H.R. 3450 is vital to providing 
health care services to the uninsured and under-insured. Health centers 
are located in more than 3,400 communities in all 50 states and often 
are the only available source of care for uninsured and medically under 
served individuals.
  Health centers provide primary health care services to more than 12 
million people per year--nearly five million of whom have no health 
insurance coverage. Currently, there are over 41 million uninsured 
Americans and untold numbers of under-insured. Due to the slowing 
economy, this number is increasing rapidly. As a result, demand for 
health care services has increased drastically, forcing risky delays 
for important primary and preventive health care services.
  Health centers are effective and efficient providers of care to 
millions of our country's most vulnerable people. Ensuring access to 
primary and preventive care, regardless of insurance status or income, 
is an important component of H.R. 3450.
  While health centers provide quality care to the uninsured for nearly 
one dollar per patient per day, they cannot continue to expand care to 
the growing number of uninsured who seek their care without a 
significant increase in their appropriations. This legislation is 
valuable because it authorizes such appropriations as may be necessary 
for community health centers for FY 2003 through FY 2006 so that these 
centers may continue to serve the public and the communities that 
depend on them for reliable, quality health care services. We should be 
passing legislation that would double these programs now, but this bill 
authorizes needed funding to community health centers and we should 
therefore support its passage.
  This bill, however, has two noteworthy shortcomings. The 
Administration has chosen

[[Page H6808]]

to minimize the CAP program that permits local communities to 
coordinate the use of scarce healthcare dollars, event though where 
implemented that program that has been praised by local officials. 
Secondly, all authorizations for construction of the physical 
facilities have been struck from the bill, because the Republican 
leadership has refused to allow vote on a bill that provides the basic 
labor protections found in the Davis-Bacon Act for all direct Federal 
construction projects. Such protections would pass if a vote were 
allowed, and needed construction could begin.
  Though this bill is far from perfect, I urge all of my colleagues to 
join me in support of H.R. 3450, the ``Health Care Safety Net 
Improvement Act.'' This is an important piece of legislation and its 
passage is long overdue.
  Mr. BEREUTER. Mr. Speaker, as a cosponsor of the bill, this Member 
wishes to add his strong support for H.R. 3450, the Health Care Safety 
Net Improvement Act. Furthermore, this Member would like to commend the 
distinguished gentleman from Florida [Mr. Bilirakis], the Chairman of 
the House Energy and Commerce Subcommittee on Health, and the 
distinguished gentleman from Ohio [Mr. Brown], the ranking member of 
the House Energy and Commerce Subcommittee on Health, for bringing this 
important legislation to the House Floor today. This Member would also 
like to commend the distinguished gentleman from Louisiana [Mr. 
Tauzin], Chairman of the House Energy and Commerce Committee, and the 
distinguished gentleman from Michigan [Mr. Dingell], the ranking member 
of the House Energy and Commerce Committee, for their efforts to 
improve access to quality preventive and primary health care for the 
medically underserved--including the millions of Americans without 
health insurance coverage.
  The Health Care Safety Net Improvement Act would:
  (1) reauthorize the critically important Community Health Centers 
program for another five years, including reaffirmation that Health 
Centers should be: located in high-need areas; provide comprehensive 
preventive and primary health care services; governed by community 
boards made up of a majority of current health center patients to 
assure responsiveness to local needs; and, open to everyone in the 
communities they serve, regardless of ability to pay; and
  (2) reauthorize the important Telehealth Programs, as well as the 
Rural Health Outreach and the Rural Health Network Development. In 
addition, H.R. 3450 would authorize a new Small Health Care Provider 
Quality Improvement Program. These programs would go a long way to 
facilitate the provision of care to vulnerable populations living in 
rural areas all across the country.
  This Member is particularly pleased that language is included in H.R. 
3450 that would provide automatic designation to Federally Qualified 
Health Centers (FQHC) and Federally Certified Rural Health Clinics as 
Health Professional Shortage Areas (HPSA) facilities for a period of 
six years. This Member recognizes that the National Health Service 
Corps plays a critical role in providing care for underserved 
populations by placing clinicians in urban and rural areas. However, it 
has come to this Member's attention that health centers and rural 
clinics must obtain Health Professional Shortage Area designation to 
become eligible for the placement of Nation Health Service Corps 
personnel. While this Member is pleased to see that H.R. 3450 would 
improve on the current HPSA designation process, he would have 
preferred that the bill include permanent automatic designation, which 
would have guaranteed that FQHCs and rural health clinics would not 
have to return to the current, cumbersome HPSA designation process. 
This is a process that certainly seems unnecessary and duplicative, and 
which in some cases may result in delays in the placement of needed 
practitioners at high-need health centers and rural health clinics. 
Last year, this Member sent a letter, along with several colleagues, to 
the Chairman of the Energy and Commerce Subcommittee on Health 
requesting this change on a permanent basis and greatly appreciates the 
inclusion of the provision--even in the short term.
  In closing, Mr. Speaker, this Member looks forward to working with 
the Committee and Subcommittee leadership, as earlier noted, on this 
important issue and this important bill as H.R. 3450 moves foward.
  Mr. GREEN of Texas. Mr. Speaker, I have no further requests for time, 
and I yield back the balance of my time.
  Mr. BILIRAKIS. Mr. Speaker, I have no further requests for time, and 
I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Boozman). The question is on the motion 
offered by the gentleman from Florida (Mr. Bilirakis) that the House 
suspend the rules and pass the bill, H.R. 3450.
  The question was taken; and (two-thirds having voted in favor 
thereof) the rules were suspended and the bill was passed.
  A motion to reconsider was laid on the table.

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