[Congressional Record Volume 164, Number 200 (Wednesday, December 19, 2018)]
[House]
[Pages H10286-H10288]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




       STATE OFFICES OF RURAL HEALTH REAUTHORIZATION ACT OF 2018

  Mr. WALDEN. Mr. Speaker, I move to suspend the rules and pass the 
bill (S. 2278) to amend the Public Health Service Act to provide grants 
to improve health care in rural areas.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                                S. 2278

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``State Offices of Rural 
     Health Reauthorization Act of 2018''.

     SEC. 2. STATE OFFICES OF RURAL HEALTH.

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

     ``SEC. 338J. GRANTS TO STATE OFFICES OF RURAL HEALTH.

       ``(a) In General.--The Secretary, acting through the 
     Director of the Federal Office of Rural Health Policy 
     (established under section 711 of the Social Security Act), 
     shall make grants to each State Office of Rural Health for 
     the purpose of improving health care in rural areas.
       ``(b) Requirement of Matching Funds.--
       ``(1) In general.--Subject to paragraph (2), the Secretary 
     may not make a grant under subsection (a) unless the State 
     office of rural health involved agrees, with respect to the 
     costs to be incurred in carrying out the purpose described in 
     such subsection, to provide non-Federal contributions toward 
     such costs in an amount equal to $3 for each $1 of Federal 
     funds provided in the grant.
       ``(2) Waiver or reduction.--The Secretary may waive or 
     reduce the non-Federal contribution if the Secretary 
     determines that requiring matching funds would limit the 
     State office of rural health's ability to carry out the 
     purpose described in subsection (a).
       ``(3) Determination of amount of non-federal 
     contribution.--Non-Federal contributions required in 
     paragraph (1) may be in cash or in kind, fairly evaluated, 
     including plant, equipment, or services. Amounts provided by 
     the Federal Government, or services assisted or subsidized to 
     any significant extent by the Federal Government, may not be 
     included in determining the amount of such non-Federal 
     contributions.
       ``(c) Certain Required Activities.--Recipients of a grant 
     under subsection (a) shall use the grant funds for purposes 
     of--
       ``(1) maintaining within the State office of rural health a 
     clearinghouse for collecting and disseminating information 
     on--
       ``(A) rural health care issues;
       ``(B) research findings relating to rural health care; and
       ``(C) innovative approaches to the delivery of health care 
     in rural areas;
       ``(2) coordinating the activities carried out in the State 
     that relate to rural health care, including providing 
     coordination for the purpose of avoiding redundancy in such 
     activities; and
       ``(3) identifying Federal and State programs regarding 
     rural health, and providing technical assistance to public 
     and nonprofit private entities regarding participation in 
     such programs.
       ``(d) Requirement Regarding Annual Budget for Office.--The 
     Secretary may not make a grant under subsection (a) unless 
     the State involved agrees that, for any fiscal year for which 
     the State office of rural health receives such a grant, the 
     office operated pursuant to subsection (a) of this section 
     will be provided with an annual budget of not less than 
     $150,000.
       ``(e) Certain Uses of Funds.--
       ``(1) Restrictions.--The Secretary may not make a grant 
     under subsection (a) unless the State office of rural health 
     involved agrees that the grant will not be expended--
       ``(A) to provide health care (including providing cash 
     payments regarding such care);
       ``(B) to conduct activities for which Federal funds are 
     expended--
       ``(i) within the State to provide technical and other 
     nonfinancial assistance under section 330A(f);
       ``(ii) under a memorandum of agreement entered into with 
     the State office of rural health under section 330A(h); or
       ``(iii) under a grant under section 338I;
       ``(C) to purchase medical equipment, to purchase 
     ambulances, aircraft, or other vehicles, or to purchase major 
     communications equipment;
       ``(D) to purchase or improve real property; or
       ``(E) to carry out any activity regarding a certificate of 
     need.
       ``(2) Authorities.--Activities for which a State office of 
     rural health may expend a grant under subsection (a) 
     include--
       ``(A) paying the costs of maintaining an office of rural 
     health for purposes of subsection (a);
       ``(B) subject to paragraph (1)(B)(iii), paying the costs of 
     any activity carried out with respect to recruiting and 
     retaining health professionals to serve in rural areas of the 
     State; and
       ``(C) providing grants and contracts to public and 
     nonprofit private entities to carry out activities authorized 
     in this section.
       ``(3) Limit on indirect costs.--The Secretary may impose a 
     limit of no more than 15 percent on indirect costs claimed by 
     the recipient of the grant.
       ``(f) Reports.--The Secretary may not make a grant under 
     subsection (a) unless the State office of rural health 
     involved agrees--
       ``(1) to submit to the Secretary reports or performance 
     data containing such information as the Secretary may require 
     regarding activities carried out under this section; and
       ``(2) to submit such a report or performance data not later 
     than September 30 of each fiscal year immediately following 
     any fiscal year for which the State office of rural health 
     has received such a grant.
       ``(g) Requirement of Application.--The Secretary may not 
     make a grant under subsection (a) unless an application for 
     the grant is submitted to the Secretary and the application 
     is in such form, is made in such manner, and contains such 
     agreements, assurances, and information as the Secretary 
     determines to be necessary to carry out such subsection.
       ``(h) Noncompliance.--The Secretary may not make payments 
     under subsection (a) to a State office of rural health for 
     any fiscal year subsequent to the first fiscal year of such 
     payments unless the Secretary determines that, for the 
     immediately preceding fiscal year, the State office of rural 
     health has complied with each of the agreements made by the 
     State office of rural health under this section.
       ``(i) Authorization of Appropriations.--

[[Page H10287]]

       ``(1) In general.--For the purpose of making grants under 
     subsection (a), there are authorized to be appropriated 
     $12,500,000 for each of fiscal years 2018 through 2022.
       ``(2) Availability.--Amounts appropriated under paragraph 
     (1) shall remain available until expended.''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Oregon (Mr. Walden) and the gentleman from New York (Mr. Tonko) each 
will control 20 minutes.
  The Chair recognizes the gentleman from Oregon.


                             General Leave

  Mr. WALDEN. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend their remarks and 
insert extraneous materials in the Record on the bill.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Oregon?
  There was no objection.
  Mr. WALDEN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise today in support of S. 2278, the State Offices of 
Rural Health Reauthorization Act led by Senator Pat Roberts and by my 
Energy and Commerce Committee colleagues Representative Markwayne 
Mullin of Oklahoma and my fellow Oregonian, Kurt Schrader, here in the 
House.
  This important legislation reauthorizes and enhances Federal grants 
to States for improving healthcare in rural areas through the operation 
of State Offices of Rural Health.
  Now, in my home State of Oregon, the Oregon Office of Rural Health 
has been the coordinating body for frontier health since the 1970s. 
This office partners with the Oregon Health & Sciences University to 
improve the delivery of statewide resources to rural areas, such as the 
Second District.
  Telehealth, rotational programs for medical students in rural 
communities, and recruitment of healthcare providers are just a few 
examples of the Oregon Office of Rural Health's work to help patients 
in Oregon's rural areas.
  I am proud of the great work that they do, and this bill will enhance 
their ability and those of all State Rural Health Offices to equip 
communities with the tools they need to strengthen the delivery of 
healthcare in rural and underserved areas.
  So, Mr. Speaker, I strongly support passage of this legislation. I 
urge my colleagues to vote ``yes,'' and I reserve the balance of my 
time.
  Mr. TONKO. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in support of S. 2278, the State Offices of Rural 
Health Reauthorization Act of 2018. I thank Chair Walden and incoming 
Chair Pallone, along with Congressman Schrader and Congressman Mullin, 
for their work on this important legislation.
  This legislation would reauthorize the Federal grant program that 
supports Offices of Rural Health in each State, including the Charles 
D. Cook Office of Rural Health with the New York State Department of 
Health for the first time.
  These offices assist States in strengthening rural health delivery 
systems and improving access to quality services in rural areas. This 
work is particularly important because patients and providers in rural 
communities can face obstacles that can: result in reduced access to 
care, increase health disparities, and inhibit individuals from 
experiencing optimal health.
  To ensure that States can continue to meet the requirements of this 
grant program, this reauthorization legislation provides new 
flexibility for State offices to meet their Federal match requirements, 
as well as to request a waiver that would allow the State office to 
continue to receive Federal funding if an office faces an extreme 
hardship in meeting that requirement.
  Mr. Speaker, I urge my colleagues to support S. 2278, and I reserve 
the balance of my time.
  Mr. WALDEN. Mr. Speaker, I yield 3 minutes to the gentleman from 
Oklahoma (Mr. Mullin), who is a cosponsor of this very important 
legislation.
  Mr. MULLIN. Mr. Speaker, I rise today in favor of my bill, the State 
Offices of Rural Health Reauthorization Act of 2018.
  There is a healthcare crisis right now going on in rural America. 
Rural hospitals are closing their doors at an alarming rate. Eighty-
five rural hospitals have closed since 2010, and 673 are vulnerable to 
close at any time. More closures are coming, and Congress needs to 
start making changes to ensure that rural Americans have the healthcare 
they need.
  My bill, the State Offices of Rural Health Reauthorization Act, will 
help Oklahoma's rural hospitals keep their doors open by reauthorizing 
the Oklahoma Office of Rural Health. This office provides a valuable 
resource to the hospitals of Oklahoma by helping hospitals explore 
innovative and collaborative ideas that can lead to improvements and 
savings.
  Mr. Speaker, I would be remiss not to mention that awesome sweater-
vest that you are wearing. So in the spirit of Christmas, I believe you 
just pull that off.
  Mr. TONKO. Mr. Speaker, I yield such time as he may consume to the 
gentleman from Oregon (Mr. Schrader), who represents Oregon's Fifth 
Congressional District.
  Mr. SCHRADER. Mr. Speaker, today I rise in support of the State 
Offices of Rural Health Reauthorization Act.
  Since 1979, as alluded to before, Oregon's Office of Rural Health has 
provided services critical to the folks in the rural portion of my 
State. Thirty-six percent of Oregonians live in rural communities, and 
as we know, these communities often face challenges not experienced in 
urban or suburban settings.

                              {time}  1600

  People in rural areas might have long distances to travel over 
mountainous terrain just to see their doctor, or they might have issues 
even finding a primary care provider or specialist who can help them 
where and when they need it. That is why we need the Offices of Rural 
Health and why the House should pass this bill today.
  Oregonians have come to rely on the services and expertise of the 
Oregon Office of Rural Health to help build up the healthcare in rural 
areas so folks in these communities know they will be able to see a 
doctor, nurse practitioner, or other healthcare professional.
  The Office of Rural Health has worked with small hospitals and EMS 
providers to ensure that patients are safe, the ethics are up to code, 
and they can work through the often challenging patchwork of programs 
and regulation.
  My State's Office of Rural Health has also been instrumental in 
providing the data and policy expertise we have needed to ensure that 
all Oregonians receive the care that the Affordable Care Act and 
Oregon's healthcare transformation projects have promised.
  Everyone, including folks in our rural areas, should have access to 
quality healthcare. This bill provides the Federal support and 
resources necessary to ensure that all 50 States' Offices of Rural 
Health can be there for the patients who need them.
  I am proud to have led on this bill in the House with my good friend, 
Markwayne Mullin. I am grateful to Chairman Walden and Ranking Member 
Pallone for getting this to the floor before the end of a very 
interesting session. I thank them for their leadership on this issue 
and urge support for this bill.
  Mr. WALDEN. Mr. Speaker, I yield 3 minutes to the gentleman from 
Texas (Mr. Burgess), the chairman of the Subcommittee on Health.
  Mr. BURGESS. Mr. Speaker, I also want to rise in support of S. 2278, 
the State Offices of Rural Health Reauthorization Act of 2018.
  This bill, which was introduced by Senators Pat Roberts and Heidi 
Heitkamp, reauthorizes grants to State Offices of Rural Health.
  I also need to thank our House champion of this effort, 
Representative Markwayne Mullin, a valuable member of the Health 
Subcommittee.
  This legislation already passed the Senate, and today we have the 
opportunity to pass it on the floor of the House and send it down to 
the President for his signature.
  The majority of counties in the United States are rural. While urban 
and suburban counties are growing in population, certainly in my own 
community back in the 26th District of Texas, we have a significant 
percentage of the population living in rural areas.
  Citizens of rural America reap many benefits of their communities, 
but they

[[Page H10288]]

are also faced with unique challenges, particularly when it comes to 
healthcare. S. 2278 will enable States to maintain and improve upon 
healthcare in rural areas by reauthorizing grants to State Offices of 
Rural Health.
  Grantees will be required to maintain a clearinghouse for collecting 
and disseminating information on rural healthcare issues, research 
related to rural healthcare, as well as innovative approaches to rural 
healthcare delivery. The grantees will also be tasked with identifying 
both Federal and State programs to address rural health and to provide 
technical assistance to public and nonprofit private entities regarding 
participation in these programs.
  State Offices of Rural Health provide much value to the 57 million 
Americans that live in these areas around the country. Many of us 
represent towns and counties that are largely dependent upon the 
strength of rural Members of Congress. For these reasons, I ask Members 
to join me in supporting S. 2278.
  Mr. TONKO. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, I rise in support, again, of the legislation before us.
  I want to commend Congressmen Schrader and Mullin for their great 
work on this important legislation. It shows great sensitivity to the 
healthcare needs of rural America and to the corresponding health 
delivery systems. For that reason alone, this is worthy of our 
unanimous support.
  Mr. Speaker, I yield back the balance of my time.
  Mr. WALDEN. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, I, too, want to thank Members on both sides of the 
aisle, my colleagues who have worked so hard on this legislation, and, 
frankly, our friends in the Senate, as well, who worked with us on 
this. We are glad to bring this to a conclusion and another very 
important healthcare bill will make its way to the President's desk.
  Mr. Speaker, I ask my colleagues to support this legislation, and I 
yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Oregon (Mr. Walden) that the House suspend the rules and 
pass the bill, S. 2278.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. WALDEN. 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, further 
proceedings on this motion will be postponed.

                          ____________________