[Congressional Record Volume 148, Number 136 (Wednesday, October 16, 2002)]
[House]
[Pages H7932-H7947]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HEALTH CARE SAFETY NET AMENDMENTS OF 2002
Mr. STEARNS. Mr. Speaker, I move to suspend the rules and pass the
Senate bill (S. 1533) to amend the Public Health Service Act to
reauthorize and strengthen the health centers program and the National
Health Service Corps, and to establish the Healthy Communities Access
Program, which will help coordinate services for the uninsured and
underinsured, and for other purposes, as amended.
The Clerk read as follows:
S. 1533
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 Amendments of 2002''.
(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. Telemedicine; incentive grants regarding coordination among
States.
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.
[[Page H7933]]
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.
Sec. 317. Demonstration project.
TITLE IV--HEALTHY COMMUNITIES ACCESS PROGRAM
Sec. 401. Purpose.
Sec. 402. Creation of Healthy Communities Access Program.
Sec. 403. Expanding availability of dental services.
Sec. 404. Study regarding barriers to participation of farmworkers in
health programs.
TITLE V--STUDY AND MISCELLANEOUS PROVISIONS
Sec. 501. Guarantee study.
Sec. 502. Graduate medical education.
TITLE VI--CONFORMING AMENDMENTS
Sec. 601. Conforming amendments.
TITLE I--CONSOLIDATED HEALTH CENTER PROGRAM AMENDMENTS
SEC. 101. HEALTH CENTERS.
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) in subparagraph (A)(i), by striking ``associated with
water supply;'' and inserting the following: ``associated
with--
``(I) water supply;
``(II) chemical and pesticide exposures;
``(III) air quality; or
``(IV) exposure to lead;'';
(B) by redesignating subparagraphs (A) and (B) as
subparagraphs (C) and (D), respectively; and
(C) by inserting before subparagraph (C) (as so
redesignated by subparagraph (B)) the following:
``(A) behavioral and mental health and substance abuse
services;
``(B) recuperative care services;'';
(D) in subparagraph (B)--
(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 ``up to 90 percent of 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).'';
(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 an existing loan (as of the date of
refinancing) to the center or centers, if the Secretary
determines--
``(I) that such refinancing will be beneficial to the
health center and the Federal Government;
``(II) that 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.
``(E) Federal credit reform.--The requirements of the
Federal Credit Reform Act of 1990 (2 U.S.C. 661 et seq.)
shall apply with respect to loans refinanced under
subparagraph (B)(iii).''; and
(C)(i) by striking paragraphs (6) and (7); and
(ii) by redesignating paragraph (8) as paragraph (6);
(4) in subsection (e)--
(A) in paragraph (1)--
(i) in subparagraph (B), by striking ``subsection (j)(3)''
and inserting ``subsection (k)(3)''; and
(ii) by adding at the end the following:
``(C) Operation of networks and plans.--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).'';
(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 or to a network or plan shall be determined by the
Secretary, but may not exceed 2 percent of the total amount
appropriated under this section for such fiscal year.''; and
(C) by redesignating paragraphs (4) and (5) as paragraphs
(3) and (4), respectively;
(5) in subsection (g)--
(A) in paragraph (2)--
(i) in subparagraph (A), by inserting ``and seasonal
agricultural worker'' after ``agricultural worker''; and
(ii) in subparagraph (B), by striking ``and members of
their families'' and inserting ``and seasonal agricultural
workers, and members of their families,''; and
(B) in paragraph (3)(A), by striking ``on a seasonal
basis'';
(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)'';
[[Page H7934]]
(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 (H), in the matter following clause
(iii), by striking ``or (p)'' and inserting ``or (q)'';
(D) in subparagraph (K)(ii), by striking ``and'' at the
end;
(E) in subparagraph (L), by striking the period and
inserting ``; and''; and
(F) by inserting after subparagraph (L), the following:
``(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, so long as the
center, in complying with this subparagraph, does not violate
the requirements of subparagraph (G)(iii)(I).'';
(8)(A) by redesignating subsection (l) as subsection (s)
and moving that subsection (s) to the end of the section;
(B) by redesignating subsections (j), (k), and (m) through
(q) as subsections (n), (o), and (p) through (s),
respectively; and
(C) by inserting after subsection (i) the following:
``(j) Access Grants.--
``(1) In general.--The Secretary may award grants to
eligible health centers with a substantial number of clients
with limited English speaking proficiency to provide
translation, interpretation, and other such services for such
clients with limited English speaking proficiency.
``(2) Eligible health center.--In this subsection, the term
`eligible health center' means an entity that--
``(A) is a health center as defined under subsection (a);
``(B) provides health care services for clients for whom
English is a second language; and
``(C) has exceptional needs with respect to linguistic
access or faces exceptional challenges with respect to
linguistic access.
``(3) Grant amount.--The amount of a grant awarded to a
center under this subsection shall be determined by the
Administrator. Such determination of such amount shall be
based on the number of clients for whom English is a second
language that is served by such center, and larger grant
amounts shall be awarded to centers serving larger numbers of
such clients.
``(4) Use of funds.--An eligible health center that
receives a grant under this subsection may use funds received
through such grant to--
``(A) provide translation, interpretation, and other such
services for clients for whom English is a second language,
including hiring professional translation and interpretation
services; and
``(B) compensate bilingual or multilingual staff for
language assistance services provided by the staff for such
clients.
``(5) Application.--An eligible health center desiring a
grant under this subsection shall submit an application to
the Secretary at such time, in such manner, and containing
such information as the Secretary may reasonably require,
including--
``(A) an estimate of the number of clients that the center
serves for whom English is a second language;
``(B) the ratio of the number of clients for whom English
is a second language to the total number of clients served by
the center;
``(C) a description of any language assistance services
that the center proposes to provide to aid clients for whom
English is a second language; and
``(D) a description of the exceptional needs of such center
with respect to linguistic access or a description of the
exceptional challenges faced by such center with respect to
linguistic access.
``(6) Authorization of appropriations.--There are
authorized to be appropriated to carry out this subsection,
in addition to any funds authorized to be appropriated or
appropriated for health centers under any other subsection of
this section, such sums as may be necessary for each of
fiscal years 2002 through 2006.'';
(9) by striking subsection (m) (as redesignated by
paragraph (9)(B)) and inserting the following:
``(m) 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 subsection (l)(3).
Services provided through the program may include necessary
technical and nonfinancial assistance, including fiscal and
program management assistance, training in fiscal and program
management, operational and administrative support, and the
provision of information to 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.'';
(10) in subsection (q) (as redesignated by paragraph
(9)(B)), by striking ``(j)(3)(G)'' and inserting
``(l)(3)(G)''; and
(11) in subsection (s) (as redesignated by paragraph
(9)(A))--
(A) in paragraph (1), by striking ``$802,124,000'' and all
that follows through the period and inserting
``$1,340,000,000 for fiscal year 2002 and such sums as may be
necessary for each of the fiscal years 2003 through 2006.'';
(B) in paragraph (2)--
(i) in subparagraph (A)--
(I) by striking ``(j)(3))'' and inserting ``(l)(3))''; and
(II) by striking ``(j)(3)(G)(ii)'' and inserting
``(l)(3)(H)''; and
(ii) 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.''.
SEC. 102. TELEMEDICINE; INCENTIVE GRANTS REGARDING
COORDINATION AMONG STATES.
(a) 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.
(b) Authorization of Appropriations.--For the purpose of
carrying out subsection (a), there are authorized to be
appropriated such sums as may be necessary for each of the
fiscal years 2002 through 2006.
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);
[[Page H7935]]
``(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 rural nonprofit 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;
``(E) a description of how the project will be evaluated;
and
``(F) other such information as the Secretary determines to
be appropriate.
``(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 rural nonprofit 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;
``(F) a description of how the project will be evaluated;
and
``(G) other such information as the Secretary determines to
be appropriate.
``(g) Small Health Care Provider Quality Improvement
Grants.--
``(1) Grants.--The Director may award grants to provide for
the planning and implementation of small health care provider
quality improvement activities. The Director may award the
grants for periods of 1 to 3 years.
``(2) Eligibility.--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 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 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;
``(F) a description of how the project will be evaluated;
and
``(G) other such information as the Secretary determines to
be appropriate.
``(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.
``(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 2002''.
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'
shall have the meaning given the term in regulations issued
under subsection (r).
[[Page H7936]]
``(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;
``(6) information demonstrating the long-term viability of
the project, and other evidence of institutional commitment
of the entity to the project;
``(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; and
``(8) other such information as the Secretary determines to
be appropriate.
``(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 library;
``(II) an institution of higher education; or
``(III) 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 Amendments of 2002).
``(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
[[Page H7937]]
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; or
``(7) for expenditures for indirect costs (as determined by
the Secretary), to the extent that the expenditures would
exceed 15 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 to the appropriate
committees of Congress a report on the progress and
accomplishments of the grant programs described in subsection
(b).
``(r) Regulations.--The Secretary shall issue regulations
specifying, for purposes of this section, a definition of the
term `frontier area'. The definition shall be based on
factors that include population density, travel distance in
miles to the nearest medical facility, travel time in minutes
to the nearest medical facility, and such other factors as
the Secretary determines to be appropriate. The Secretary
shall develop the definition in consultation with the
Director of the Bureau of the Census and the Administrator of
the Economic Research Service of the Department of
Agriculture.
``(s) 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
[[Page H7938]]
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 or 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 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)(4)(A)--
``(i) to provide mental health services, including
diagnosis and treatment of mental illness, 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)(4)(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 cost 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.
``(f) Report.--Not later than 4 years after the date of
enactment of the Health Care Safety Net Amendments of 2002,
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 `behavioral 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 behavioral 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,
the individual's family, and the family's possessions 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;
[[Page H7939]]
``(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.
``(3) In evaluating a demonstration project described in
paragraph (1), the Secretary shall examine the effect of
multidisciplinary teams.''.
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 the Association of 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)--
(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
[[Page H7940]]
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--
(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
[[Page H7941]]
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 for New Participants.--Of the amounts
appropriated under subsection (a) for a fiscal year, the
Secretary shall obligate not less than 10 percent for the
purpose of providing contracts for--
``(1) scholarships under this subpart to individuals who
have not previously received such scholarships; or
``(2) scholarships or loan repayments under the Loan
Repayment Program under section 338B to individuals from
disadvantaged backgrounds.
``(c) 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.'';
(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.
SEC. 317. DEMONSTRATION PROJECT.
Subpart III of part D of title III of the Public Health
Service Act (42 U.S.C. 254l et seq.) is amended by adding at
the end the following:
``SEC. 338L. DEMONSTRATION PROJECT.
``(a) Program Authorized.--The Secretary shall establish a
demonstration project to provide for the participation of
individuals who are chiropractic doctors or pharmacists in
the Loan Repayment Program described in section 338B.
``(b) Procedure.--An individual that receives assistance
under this section with regard to the program described in
section 338B shall comply with all rules and requirements
described in such section (other than subparagraphs (A) and
(B) of section 338B(b)(1)) in order to receive assistance
under this section.
``(c) Limitations.--
``(1) In general.--The demonstration project described in
this section shall provide for the participation of
individuals who shall provide services in rural and urban
areas.
``(2) Availability of other health professionals.--The
Secretary may not assign an individual receiving assistance
under this section to provide obligated service at a site
unless--
``(A) the Secretary has assigned a physician (as defined in
section 1861(r) of the Social Security Act) or other health
professional licensed to prescribe drugs to provide obligated
service at such site under section 338C or 338D; and
``(B) such physician or other health professional will
provide obligated service at such site concurrently with the
individual receiving assistance under this section.
``(3) Rules of construction.--
``(A) Supervision of individuals.--Nothing in this section
shall be construed to require or imply that a physician or
other health professional licensed to prescribe drugs must
supervise an individual receiving assistance under the
demonstration project under this section, with respect to
such project.
``(B) Licensure of health professionals.--Nothing in this
section shall be construed to supersede State law regarding
licensure of health professionals.
``(d) Designations.--The demonstration project described in
this section, and any providers who are selected to
participate in such project, shall not be considered by the
Secretary in the designation of a health professional
shortage area under section 332 during fiscal years 2002
through 2004.
``(e) Rule of Construction.--This section shall not be
construed to require any State to participate in the project
described in this section.
``(f) Report.--
``(1) In general.--The Secretary shall evaluate the
participation of individuals in the demonstration projects
under this section and prepare and submit a report containing
the information described in paragraph (2) to--
``(A) the Committee on Health, Education, Labor, and
Pensions of the Senate;
``(B) the Subcommittee on Labor, Health and Human Services,
and Education of the Committee on Appropriations of the
Senate;
``(C) the Committee on Energy and Commerce of the House of
Representatives; and
[[Page H7942]]
``(D) the Subcommittee on Labor, Health and Human Services,
and Education of the Committee on Appropriations of the House
of Representatives.
``(2) Content.--The report described in paragraph (1) shall
detail--
``(A) the manner in which the demonstration project
described in this section has affected access to primary care
services, patient satisfaction, quality of care, and health
care services provided for traditionally underserved
populations;
``(B) how the participation of chiropractic doctors and
pharmacists in the Loan Repayment Program might affect the
designation of health professional shortage areas; and
``(C) whether adding chiropractic doctors and pharmacists
as permanent members of the National Health Service Corps
would be feasible and would enhance the effectiveness of the
National Health Service Corps.
``(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
fiscal years 2002 through 2004.
``(2) Fiscal year 2005.--If the Secretary determines and
certifies to Congress by not later than September 30, 2004,
that the number of individuals participating in the
demonstration project established under this section is
insufficient for purposes of performing the evaluation
described in subsection (f)(1), the authorization of
appropriations under paragraph (1) shall be extended to
include fiscal year 2005.''.
TITLE IV--HEALTHY COMMUNITIES ACCESS PROGRAM
SEC. 401. PURPOSE.
The purpose of this title is to provide assistance to
communities and consortia of health care providers and
others, to develop or strengthen integrated community health
care delivery systems that coordinate health care services
for individuals who are uninsured or underinsured and to
develop or strengthen activities related to providing
coordinated care for individuals with chronic conditions who
are uninsured or underinsured, through the--
(1) coordination of services to allow individuals to
receive efficient and higher quality care and to gain entry
into and receive services from a comprehensive system of
care;
(2) development of the infrastructure for a health care
delivery system characterized by effective collaboration,
information sharing, and clinical and financial coordination
among all providers of care in the community; and
(3) provision of new Federal resources that do not supplant
funding for existing Federal categorical programs that
support entities providing services to low-income
populations.
SEC. 402. CREATION OF HEALTHY COMMUNITIES ACCESS 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--Healthy Communities Access Program
``SEC. 340. GRANTS TO STRENGTHEN THE EFFECTIVENESS,
EFFICIENCY, AND COORDINATION OF SERVICES FOR
THE UNINSURED AND UNDERINSURED.
``(a) In General.--The Secretary may award grants to
eligible entities to assist in the development of integrated
health care delivery systems to serve communities of
individuals who are uninsured and individuals who are
underinsured--
``(1) to improve the efficiency of, and coordination among,
the providers providing services through such systems;
``(2) to assist communities in developing programs targeted
toward preventing and managing chronic diseases; and
``(3) to expand and enhance the services provided through
such systems.
``(b) Eligible Entities.--To be eligible to receive a grant
under this section, an entity shall be an entity that--
``(1) represents a consortium--
``(A) whose principal purpose is to provide a broad range
of coordinated health care services for a community defined
in the entity's grant application as described in paragraph
(2); and
``(B) that includes at least one of each of the following
providers that serve the community (unless such provider does
not exist within the community, declines or refuses to
participate, or places unreasonable conditions on their
participation):
``(i) a Federally qualified health center (as defined in
section 1861(aa) of the Social Security Act (42 U.S.C.
1395x(aa)));
``(ii) a hospital with a low-income utilization rate (as
defined in section 1923(b)(3) of the Social Security Act (42
U.S.C. 1396r-4(b)(3)), that is greater than 25 percent;
``(iii) a public health department; and
``(iv) an interested public or private sector health care
provider or an organization that has traditionally served the
medically uninsured and underserved; and
``(2) submits to the Secretary an application, in such form
and manner as the Secretary shall prescribe, that--
``(A) defines a community or geographic area of uninsured
and underinsured individuals;
``(B) identifies the providers who will participate in the
consortium's program under the grant, and specifies each
provider's contribution to the care of uninsured and
underinsured individuals in the community, including the
volume of care the provider provides to beneficiaries under
the medicare, medicaid, and State child health insurance
programs and to patients who pay privately for services;
``(C) describes the activities that the applicant and the
consortium propose to perform under the grant to further the
objectives of this section;
``(D) demonstrates the consortium's ability to build on the
current system (as of the date of submission of the
application) for serving a community or geographic area of
uninsured and underinsured individuals by involving providers
who have traditionally provided a significant volume of care
for that community;
``(E) demonstrates 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 that assures
continuity of care in the community or geographic area;
``(F) provides evidence of community involvement in the
development, implementation, and direction of the program
that the entity proposes to operate;
``(G) demonstrates the consortium's ability to ensure that
individuals participating in the program are enrolled in
public insurance programs for which the individuals are
eligible or know of private insurance programs where
available;
``(H) presents 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
of the program;
``(I) describes a plan for evaluation of the activities
carried out under the grant, including measurement of
progress toward the goals and objectives of the program and
the use of evaluation findings to improve program
performance;
``(J) demonstrates fiscal responsibility through the use of
appropriate accounting procedures and appropriate management
systems;
``(K) demonstrates the consortium's commitment to serve the
community without regard to the ability of an individual or
family to pay by arranging for or providing free or reduced
charge care for the poor; and
``(L) includes such other information as the Secretary may
prescribe.
``(c) Limitations.--
``(1) Number of awards.--
``(A) In general.--For each of fiscal years 2003, 2004,
2005, and 2006, the Secretary may not make more than 35 new
awards under subsection (a) (excluding renewals of such
awards).
``(B) Rule of construction.--This paragraph shall not be
construed to affect awards made before fiscal year 2003.
``(2) In general.--An eligible entity may not receive a
grant under this section (including with respect to any such
grant made before fiscal year 2003) for more than 3
consecutive fiscal years, except that such entity may receive
such a grant award for not more than 1 additional fiscal year
if--
``(A) the eligible entity submits to the Secretary a
request for a grant for such an additional fiscal year;
``(B) the Secretary determines that extraordinary
circumstances (as defined in paragraph (3)) justify the
granting of such request; and
``(C) the Secretary determines that granting such request
is necessary to further the objectives described in
subsection (a).
``(3) Extraordinary circumstances.--
``(A) In general.--In paragraph (2), the term
`extraordinary circumstances' means an event (or events) that
is outside of the control of the eligible entity that has
prevented the eligible entity from fulfilling the objectives
described by such entity in the application submitted under
subsection (b)(2).
``(B) Examples.--Extraordinary circumstances include--
``(i) natural disasters or other major disruptions to the
security or health of the community or geographic area served
by the eligible entity; or
``(ii) a significant economic deterioration in the
community or geographic area served by such eligible entity,
that directly and adversely affects the entity receiving an
award under subsection (a).
``(d) Priorities.--In awarding grants under this section,
the Secretary--
``(1) shall accord priority to applicants that demonstrate
the extent of unmet need in the community involved for a more
coordinated system of care; and
``(2) may accord priority to applicants that best promote
the objectives of this section, taking into consideration the
extent to which the application involved--
``(A) identifies a community whose geographical area has a
high or increasing percentage of individuals who are
uninsured;
``(B) demonstrates that the applicant has included in its
consortium providers, support systems, and programs that have
a tradition of serving uninsured individuals and underinsured
individuals in the community;
``(C) shows evidence that the program would expand
utilization of preventive and primary care services for
uninsured and underinsured individuals and families in the
community, including behavioral and mental health services,
oral health services, or substance abuse services;
[[Page H7943]]
``(D) proposes a program that would improve coordination
between health care providers and appropriate social service
providers;
``(E) demonstrates collaboration with State and local
governments;
``(F) demonstrates that the applicant makes use of non-
Federal contributions to the greatest extent possible; or
``(G) demonstrates a 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 achieving the greater
integration of a health care delivery system so that the
system either directly provides or ensures the provision of a
broad range of culturally competent 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 under this
section, when such use meets the conditions stated in
subparagraph (A):
``(i) Increases in outreach activities and closing gaps in
health care service.
``(ii) Improvements to case management.
``(iii) Improvements to coordination of transportation to
health care facilities.
``(iv) Development of provider networks and other
innovative models to engage physicians in voluntary efforts
to serve the medically underserved within a community.
``(v) Recruitment, training, and compensation of necessary
personnel.
``(vi) Acquisition of technology for the purpose of
coordinating care.
``(vii) Improvements to provider communication, including
implementation of shared information systems or shared
clinical systems.
``(viii) Development of common processes for determining
eligibility for the programs provided through the system,
including creating common identification cards and single
sliding scale discounts.
``(ix) Development of specific prevention and disease
management tools and processes.
``(x) Translation services.
``(xi) Carrying out other activities that may be
appropriate to a community and that would increase access by
the uninsured to health care, such as access initiatives for
which private entities provide non-Federal contributions to
supplement the Federal funds provided through the grants for
the initiatives.
``(2) Direct patient care limitation.--Not more than 15
percent of the funds provided under a grant awarded under
this section may be used for providing direct patient care
and services.
``(3) 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 providing
technical assistance to grantees, obtaining assistance of
experts and consultants, holding meetings, developing of
tools, disseminating of information, evaluation, and carrying
out activities that will extend the benefits of programs
funded under this section to communities other than the
community served by the program funded.
``(f) Grantee Requirements.--
``(1) Evaluation of effectiveness.--A grantee under this
section shall--
``(A) report to the Secretary annually regarding--
``(i) progress in meeting the goals and measurable
objectives set forth in the grant application submitted by
the grantee under subsection (b); and
``(ii) the extent to which activities conducted by such
grantee have--
``(I) improved the effectiveness, efficiency, and
coordination of services for uninsured and underinsured
individuals in the communities or geographic areas served by
such grantee;
``(II) resulted in the provision of better quality health
care for such individuals; and
``(III) resulted in the provision of health care to such
individuals at lower cost than would have been possible in
the absence of the activities conducted by such grantee; and
``(B) provide for an independent annual financial audit of
all records that relate to the disposition of funds received
through the grant.
``(2) Progress.--The Secretary may not renew an annual
grant under this section for an entity for a fiscal year
unless the Secretary is satisfied that the consortium
represented by the entity has made reasonable and
demonstrable progress in meeting the goals and measurable
objectives set forth in the entity's grant application for
the preceding fiscal year.
``(g) 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 applicant for
the grant, and each of the participating providers, agree
that the grantee and each such provider 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 fiscal year immediately preceding the fiscal year
for which the applicant is applying to receive such grant.
``(h) Technical Assistance.--The Secretary may, either
directly or by grant or contract, provide any entity that
receives a grant under this section with technical and other
nonfinancial assistance necessary to meet the requirements of
this section.
``(i) Evaluation of Program.--Not later than September 30,
2005, the Secretary shall prepare and submit to the
appropriate committees of Congress a report that describes
the extent to which projects funded under this section have
been successful in improving the effectiveness, efficiency,
and coordination of services for uninsured and underinsured
individuals in the communities or geographic areas served by
such projects, including whether the projects resulted in the
provision of better quality health care for such individuals,
and whether such care was provided at lower costs, than would
have been provided in the absence of such projects.
``(j) Demonstration Authority.--The Secretary may make
demonstration awards under this section to historically black
health professions schools for the purposes of--
``(1) developing patient-based research infrastructure at
historically black health professions schools, which have an
affiliation, or affiliations, with any of the providers
identified in section (b)(1)(B);
``(2) establishment of joint and collaborative programs of
medical research and data collection between historically
black health professions schools and such providers, whose
goal is to improve the health status of medically underserved
populations; or
``(3) supporting the research-related costs of patient
care, data collection, and academic training resulting from
such affiliations.
``(k) Authorization of Appropriations.--There are
authorized to be appropriated to carry out this section such
sums as may be necessary for each of fiscal years 2002
through 2006.
``(l) Date Certain for Termination of Program.--Funds may
not be appropriated to carry out this section after September
30, 2006.''.
SEC. 403. 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;
[[Page H7944]]
``(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 Amendments of 2002,
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. 404. 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.
(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.
TITLE V--STUDY AND MISCELLANEOUS PROVISIONS
SEC. 501. GUARANTEE STUDY.
The Secretary of Health and Human Services shall conduct a
study regarding the ability of the Department of Health and
Human Services to provide for solvency for managed care
networks involving health centers receiving funding under
section 330 of the Public Health Service Act. The Secretary
shall prepare and submit a report to the appropriate
Committees of Congress regarding such ability not later than
2 years after the date of enactment of the Health Care Safety
Net Amendments of 2002.
SEC. 502. GRADUATE MEDICAL EDUCATION.
Section 762(k) of the Public Health Service Act (42 U.S.C.
294o(k)) is amended by striking ``2002'' and inserting
``2003''.
TITLE VI--CONFORMING AMENDMENTS
SEC. 601. 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. Stearns) and the gentlewoman from California (Ms. Solis)
each will control 20 minutes.
The Chair recognizes the gentleman from Florida (Mr. Stearns).
General Leave
Mr. STEARNS. Mr. Speaker, I ask unanimous consent that all Members
may have 5 legislative days within which to revise and extend their
remarks and include extraneous matter on this legislation.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Florida?
There was no objection.
Mr. STEARNS. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I rise today in support of the Senate bill, S. 1533, the
Health Care Safety Net Amendments of 2002. This legislation strengthens
the country's key safety net programs through the reauthorization of
the community health centers, CHC, and National Health Service Corps,
NHSC, programs.
{time} 1215
Mr. Speaker, it represents Congress's strong commitment to provide
safety net providers' ability to offer health care services to millions
of underserved and uninsured people.
One of the most pressing health care issues facing our country today
is the problem of the uninsured. By some statistics over 40 million
Americans currently do not possess health care insurance, a number that
is expected to rise without health insurance reform. Many individuals
lack the ability to receive even basic primary health care services.
And, of course, during this time of
[[Page H7945]]
economic uncertainty, our safety net is being stretched to its capacity
simply to ensure that all Americans have access to quality health care.
Fortunately, there is something we can do about this problem.
This legislation, while not a panacea to the problem of the
uninsured, will significantly increase the authorization of resources
for community health centers, thereby ensuring that low-income
Americans' basic health care needs are being met today.
Each year community, migrant, public housing and homeless health
centers serve more than 12 million citizens at over 3,300 delivery
sites throughout the urban and rural community in all 50 States.
Community health centers are making a difference in providing health
care service to those who are in need. That is why it is critical we
strengthen the role of community health centers, the role they play in
guaranteeing patients have access to high-quality health care.
This bill also accomplishes other important goals that I know are
important to several Members of this body. This legislation
reauthorizes the National Health Service Corps, a program designed to
improve the delivery of health care services by providing scholarships
and loan repayments to eligible clinicians. The National Health Service
Corps strives to address the growing demand for health care
professionals. It does so in underserved areas.
Moreover, the legislation includes revised grant programs for rural
health services outreach, rural health network planning, and small
health care provider quality improvement, as well as the consolidation
of telehealth grants which will increase the efficient and effective
use of resources at the Department of Health and Human Services. The
Bush administration asked us to place additional resources into this
program earlier this year, and we have done that in this bill.
Mr. Speaker, I want to talk just briefly about the Office for the
Advancement of Telehealth at the Health Resources and Service
Administration, an innovative and very important program. This service
will promote telehealth technologies in rural areas and frontier
communities in medically underserved areas for medically underserved
populations to expand high-quality health care services, using today's
technology to provide more efficient delivery of health care services.
It also improves the training of health care providers, improves the
sharing of health information, most importantly, expresses the sense of
Congress that States should develop reciprocity agreements so that
licensed telehealth providers can conduct consultations under differing
State laws.
So truly, across this country with 50 States having reciprocity
agreements whereby telehealth can be implemented will provide access to
information.
Mr. Speaker, I would like to thank the gentleman from Louisiana (Mr.
Tauzin), the subcommittee chairman, the gentleman from Florida (Mr.
Bilirakis), the gentleman from Ohio (Mr. Brown), and the ranking
member, the gentleman from Michigan (Mr. Dingell), for their efforts in
producing this legislation. I am pleased we were ability to work out on
a bipartisan basis with our Senate counterparts to provide legislation
in this Congress that can strengthen the community health care centers
program in America. Mr. Speaker, these program are vital to our efforts
to provide care for those who would otherwise not have access to
primary health care services.
Mr. Speaker, I urge all of us to join in full support of this
legislation. Mr. Speaker, I urge my colleagues to support the bill.
Mr. Speaker, I reserve the balance of my time.
Ms. SOLIS. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I also rise in strong support of Senate 1533, the Health
Care Safety Net Amendments of 2002. This is an important piece of
legislation which will provide the 5-year reauthorization of community
health centers as well as the National Health Service Corps and grants
for rural health care programs. Community health centers provide health
care services to over 12 million people annually, 5 million of whom
have no health insurance coverage at all, and currently there are over
41 million uninsured Americans and untold numbers of underinsured.
Due to the slowing economy, this number keeps increasing. And as a
result, the demand for health care services has increased dramatically,
forcing risky delays for important primary and preventive health care
services. Community health care services are effective and efficient
providers of care to millions of our country's most vulnerable people
who are located in more than 3,400 communities in every single State.
This legislation authorizes $1.34 billion for fiscal year 2002 and
such sums as may be necessary through 2006. Senate 1533 also authorizes
grants for a new category of networks so that health centers may work
to reduce costs, improve access to health care services, and enhance
the quality of coordination of health care services and improve the
health status of communities.
In addition to reauthorizing the community health centers program,
the bill also provides for the inclusion of behavioral and mental
health professionals in the NHSC scholarship and loan repayment
programs. The NHSC provides loan forgiveness and scholarship dollars to
nurses, doctors, and for the first time, dentists, in return for
services in underserved communities, both urban and rural, throughout
this country. This legislation moves the Community Health Center Rural
Program far along the road to telemedicine services and includes
numerous other important improvements.
The Health Care Safety Net Improvement Act of 2002 also provides for
5-year reauthorization of the Community Access Program. This program is
designed to provide assistance to communities and consortia of health
care providers to develop and strengthen health care delivery systems
that coordinate health care services for individuals who are uninsured
and underinsured.
In this increasingly difficult economy, community health centers are
having a hard time expanding their health care services to an
increasing number of uninsured who seek health services. I urge all of
my colleagues to join me today to support Senate 1533 so that we may
continue to aid the organizations and people who work so diligently to
provide this aid to the uninsured.
Mr. Speaker, I would also at this time like to recognize and commend
the committee's ranking member, the gentleman from Michigan (Mr.
Dingell), and the Subcommittee on Health's ranking member, the
gentleman from Ohio (Mr. Brown), as well as the gentleman from
Louisiana (Mr. Tauzin) and the gentleman from Florida (Mr. Bilirakis).
Mr. Speaker, I reserve the balance of my time.
Mr. STEARNS. Mr. Speaker, I yield 5 minutes to the gentleman from
Georgia (Mr. Norwood).
Mr. NORWOOD. Mr. Speaker, I thank the chairman very much for yielding
me time. I congratulate the gentleman from Louisiana (Mr. Tauzin) from
the Committee on Commerce and the ranking member, the gentleman from
Michigan (Mr. Dingell), for bringing this legislation to the floor; but
maybe most of all I want to thank and congratulate the gentleman from
Florida (Mr. Bilirakis), who has been working on rural health community
health centers for years. In fact, as long as I have been in this body,
he has been a mover and shaker of improvement of rural health.
Mr. Speaker, I rise today in support of the House amendment, S. 1533,
the Health Care Safety Net Improvement Act of 2002. This legislation is
critically important and goes a long way to ensuring that Americans
living in our Nation's rural areas receive the same access to
dependable and quality health care that the rest of us enjoy. It is
vital that our national health care safety net programs be as strong as
possible.
I represent a rural area of Georgia. I have 26 rural hospitals. I
have a part of the State where it is not that there is not health care,
there is just not enough. And I am happy to be able to be part of this
effort to strengthen that up. This bill accomplishes that. And it also
provides the needed flexibility to effectively improve health care
services for the underserved, as well as provide a 5-year
reauthorization of our Nation's Community Health Centers, the National
Health Service Corps, and grants for rural health care programs.
[[Page H7946]]
Beyond the funding alone, this legislation takes major steps towards
improving the efficiency of the programs that we already have out
there. With the community health centers, the Health Care Safety Net
Improvement Act of 2002 consolidates and streamlines the program while
also empowering the Secretary to make grants available where
appropriate and also authorizes a loan guarantee program with
safeguards.
With our National Health Service Corps program, again, beyond just
the funding, this legislation delivers a host of provisions that
improve patient access to high-quality health care in health
professional shortage areas. Among these, this provides for the
inclusion of behavioral and mental health professionals and the
National Health Service Corps scholarship and loan repayment programs.
In the area of Rural Health Care Services Outreach, Rural Health Care
Network Development, and Small Health Care Provider Quality Improvement
grant programs, this legislation also provides adequate funding. And I
will state what is really important in this bill in my opinion, Mr.
Speaker. It establishes an Office for the Advancement of Telehealth,
which is telemedicine and teledentistry at the Health Resources and
Services Administration.
This office will promote telehealth medicine and dentistry
technologies in rural area, frontier communities, and medically
underserved areas and for medically underserved populations to expand
access to high-quality health care service, improve the training of the
health care providers and improve the sharing of health care
information. It expressly says in this bill that it is only, and this
to me is important, it is only the sense of Congress that States should
develop reciprocal agreements so that licensed telehealth providers can
conduct consultations under differing State laws. I am delighted that
we at the Federal level decided to leave that to the health
professionals at home in the States to determine how they will work
that out.
Finally, the Health Care Safety Net Improvement Act of 2002 provides
the necessary funding for the community access program which is
designed to provide assistance to communities and groups of health care
providers, to develop or strengthen health care delivery systems that
coordinate health care services for individuals who are uninsured or
underinsured, which is the typical problem in rural areas. It also
authorizes the award of grants to States for the development and
implementation of innovative programs to address the dental workforce
needs of dental health professional shortage areas.
As a dentist, obviously, this is an issue near and dear to my heart;
and this legislation goes a long way in addressing this problem.
Mr. Speaker, I would urge my colleagues to vote for this measure
today and send a strong and positive message to our Nation's rural
health care patients. I urge all of us to be consistently aware that in
the rural parts of the Nation, there are health care providers there in
private practice and we want to make sure that we do not do anything in
legislation like this to put those people out of business who are out
there struggling today to deal with the underserved.
Mr. STEARNS. Mr. Speaker, I yield 2 minutes to the gentleman from
Minnesota (Mr. Kennedy).
Mr. KENNEDY of Minnesota. Mr. Speaker, when I entered Congress, I was
made aware of the need for better emergency medical services in rural
areas. And when I sponsored my EMS legislation, I was responding to
concerns that we would lose important emergency medical services in
rural Minnesota and that providers would not have the resources they
needed to make sure that when we dialed 911 we could be assured that
help would be on the way.
For this reason, I am happy to support Senate 1533 today, the Health
Care Safety Net Amendments of 2002.
Among other things included in this bill, it authorizes grants to
provide improved emergency medical services in rural areas. This grant
was first introduced to this House as part of my bill, H.R. 1353,
Sustaining Access To Vital Emergency Medical Services Act of 2001. And
I am happy to say that my legislation today now has over 80 cosponsors
from the House from both sides of the aisle. I am excited that a
portion of my legislation is becoming law because it fills a need. And
along with the original reason for the provision for rural America, it
has taken on a new importance after September 11 with the need to make
sure that we can respond to emergency crises.
{time} 1230
I urge my colleagues to support this bill. I thank those that have
done such great work in putting it forward.
Mr. STEARNS. Mr. Speaker, I yield myself such time as I may consume.
I am especially pleased to highlight that the bill authorizes the
Secretary to make grants to State professional licensing boards towards
developing and implementing State policies that will reduce statutory
and regulatory barriers in telehealth or telemedicine.
In the past week, I have kicked off a workshop at the Federal Trade
Commission with Chairman Muris on just this topic, statutory and
regulatory barriers to e-commerce. Furthermore, my Subcommittee on
Commerce, Consumer Trade and Protection has held hearings just on this
subject.
It is often the case that well-intentioned laws have unintended
consequences to commerce and, in this case, to the practice of
medicine. I am pleased also to recognize that the University of Florida
in my home State has a CHC telehealth project so they are actually
implementing a telemedicine program out to the rural areas, and I want
to commend them this afternoon for their efforts.
Mr. Speaker, I reserve the balance of my time.
Mr. BEREUTER. Mr. Speaker, as a cosponsor of H.R. 3450, the Health
Care Safety Net Improvement Act, this Member wishes to add his strong
support for S. 1533, the Health Care Safety Net Amendments of 2001, as
amended. 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.
This Member currently does not have a Federally Qualified Health
Center (FQHC) in his Congressional District, but believes one is
greatly needed. This Member is very pleased that the Lincoln-Lancaster
County Health Department has taken the initiative to develop a
Community Health Center planning committee. This Member would like to
commend this committee for its dedication and commitment to improving
health care in Nebraska. It is this member's understanding that the
group intends to submit an application for the Community Health Center
Federal Grant program in January 2003. This Member hopes this
application will be given full and fair consideration.
This Member is particularly pleased that language is included in S.
1533, as amended, that would provide automatic designation to Federally
Qualified Health Centers (FQHC) and Federally Certified Rural Health
Clinics as Health Professional Shortage Area (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 National Health
Service Corps personnel. While this member is pleased to see that S.
1533, as amended, 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
[[Page H7947]]
change on a permanent basis and greatly appreciates the inclusion of
the provision--even in the short term.
As amended, S. 1533, 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 Care Outreach Program and the Rural Health Network
Development Program. In addition, S. 1533, as amended, would authorize
a new Small Health Care Provider Quality Improvement Program. These
programs will go a long way to facilitate the provision of care to
vulnerable populations living in rural areas all across the county.
In closing, Mr. Speaker, this Member urges his colleagues to support
S. 1533, as amended.
Mr. SHAYS. Mr. Speaker, I strongly support S. 1533, a bill which will
reauthorize the Community Health Center program. This legislation
ensures that community health centers will continue providing high-
quality care to the medically underserved and neediest populations.
I have always been impressed with community health centers and have
supported increasing the resources available to them. These centers
have made wonderful contributions to the urban areas in the Fourth
Congressional District, and the care they provide is as good or better
than the care many patients with more comprehensive coverage receive.
Last year, these clinics served over 12 million people, 66 percent of
whom live below the poverty level. Community health centers are located
in 3,000 rural and urban communities throughout the country and provide
quality cost-effective primary and preventive care for low-income,
uninsured and underinsured patients.
By preventing costly hospitalizations and reducing the use of
emergency care for routine services, it is estimated community clinics
save the health care system over $6 billion annually.
Mr. Speaker, I strongly support passage of this legislation so
community health centers can continue providing high-quality, cost-
effective care. I urge my colleagues to vote for this bill.
Mr. BALDACCI. Mr. Speaker, today we will take another step toward
promoting access to quality health care in Rural America. As a member
of the House Rural Health Care Coalition, I am pleased with the
overwhelming bipartisan support in both the House and Senate for the
legislation we will pass today. Earlier this month we passed similar
legislation by voice vote.
This bill supports a number of critical programs and grants leading
to direct benefits to thousands of Maine citizens. There are 31
community health centers in the State of Maine, most of which are
located in my district, the largest district in area east of the
Mississippi River. Rural health care delivery has been one of the top
concerns of my constituents.
This bill reauthorizes the Community Health Centers Program, the
National Health Service Corps, Rural Health Outreach and telehealth
services. Significant improvements will be made to these programs. In
particular, NHSC scholarship and loan expansions will enable rural
areas to attract more mental health and dental providers. A focus on
coordination and integration of telehealth networks through targeted
grants will enable facilities across regions to improve direct, patient
and training of providers. In addition, outreach grants, technical
assistance grants, rural health network development grants, and small
health care provider quality improvement grants will significantly
expand access to quality health care services and enhance the delivery
of health care in rural areas.
Mr. Speaker, I thank the Leadership for bringing this important bill
to the Floor and encourage its speedy passage.
Mr. BILIRAKIS. Mr. Speaker, I rise in strong support of S. 1533, the
Health Care Safety Net Improvement Act. As you know, the House recently
approved the Health Care Safety Net Improvement Act by voice vote.
Today we are considering a solid bipartisan compromise between the
House and Senate on this important legislation. I urge all of my
colleagues to support the bipartisan compromise we are considering
today.
This legislation reauthorizes our nation's key health care safety net
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.
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.
S. 1533 also recognizes the importance of oral health care and
authorizes the inclusion of primary dental care education. Improving
rural health is another area of focus in this legislation. 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.
Mr. Speaker, given recent events and news of increasing numbers of
uninsured, it is vitally important that we keep our safety net strong.
This bill will allow critical programs to continue. I am certain it
will improve services for our most vulnerable populations. I urge
Members to support this bipartisan agreement.
Mr. DINGELL. Mr. Speaker, I support S. 1533, the ``Health Care Safety
Net Amendments of 2002,'' an important piece of legislation. It
reauthorizes the National Health Service Corps, the Community Health
Centers program, and will establish a limited Community Access Program.
S. 1533 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.
We passed H.R. 3450, a very similar bill, two weeks ago, and are back
with S. 1533 which incorporates changes to H.R. 3450 needed to assure
speedy enactment. The most significant change is an improved Community
Access Program, which helps local communities coordinate the use of
scarce healthcare dollars. Other changes increase access to community
healthcare programs. And the bill now authorizes demonstration projects
for chiropractors and pharmacists within the National Health Service
Corps, as well as provides a ten percent set-aside for loans and
scholarships for disadvantaged individuals.
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 our efforts here today. I urge adoption of
this important legislation.
Ms. SOLIS. Mr. Speaker, I have no further speakers, and I yield back
the balance of my time.
Mr. STEARNS. Mr. Speaker I have no further requests for time, and I
yield back the balance of my time.
The SPEAKER pro tempore (Mr. Gutknecht). The question is on the
motion offered by the gentleman from Florida (Mr. Stearns) that the
House suspend the rules and pass the Senate bill, S. 1533, as amended.
The question was taken.
The SPEAKER pro tempore. In the opinion of the Chair, two-thirds of
those present have voted in the affirmative.
Mr. STEARNS. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the
Chair's prior announcement, further proceedings on this motion will be
postponed.
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