[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
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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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