[Congressional Record (Bound Edition), Volume 148 (2002), Part 15]
[Senate]
[Pages 21110-21122]
[From the U.S. Government Publishing Office, www.gpo.gov]




               HEALTH CARE SAFETY NET AMENDMENTS OF 2002

  Mr. REID. Mr. President, I ask the Chair lay before the Senate a 
message from the House of Representatives on the 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.
  The PRESIDING OFFICER laid before the Senate the following message 
from the House of Representatives:

       Amendment:
       Strike out all after the enacting clause and insert:

     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.

               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

[[Page 21111]]

     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)'';
       (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.

[[Page 21112]]



                         TITLE II--RURAL HEALTH

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

     SEC. 201. GRANT PROGRAMS.

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

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

       ``(a) Purpose.--The purpose of this section is to provide 
     grants for expanded delivery of health care services in rural 
     areas, for the planning and implementation of integrated 
     health care networks in rural areas, and for the planning and 
     implementation of small health care provider quality 
     improvement activities.
       ``(b) Definitions.--
       ``(1) Director.--The term `Director' means the Director 
     specified in subsection (d).
       ``(2) Federally qualified health center; rural health 
     clinic.--The terms `Federally qualified health center' and 
     `rural health clinic' have the meanings given the terms in 
     section 1861(aa) of the Social Security Act (42 U.S.C. 
     1395x(aa)).
       ``(3) Health professional shortage area.--The term `health 
     professional shortage area' means a health professional 
     shortage area designated under section 332.
       ``(4) Medically underserved community.--The term `medically 
     underserved community' has the meaning given the term in 
     section 799B.
       ``(5) Medically underserved population.--The term 
     `medically underserved population' has the meaning given the 
     term in section 330(b)(3).
       ``(c) Program.--The Secretary shall establish, under 
     section 301, a small health care provider quality improvement 
     grant program.
       ``(d) Administration.--
       ``(1) Programs.--The rural health care services outreach, 
     rural health network development, and small health care 
     provider quality improvement grant programs established under 
     section 301 shall be administered by the Director of the 
     Office of Rural Health Policy of the Health Resources and 
     Services Administration, in consultation with State offices 
     of rural health or other appropriate State government 
     entities.
       ``(2) Grants.--
       ``(A) In general.--In carrying out the programs described 
     in paragraph (1), the Director may award grants under 
     subsections (e), (f), and (g) to expand access to, 
     coordinate, and improve the quality of essential health care 
     services, and enhance the delivery of health care, in rural 
     areas.
       ``(B) Types of grants.--The Director may award the grants--
       ``(i) to promote expanded delivery of health care services 
     in rural areas under subsection (e);
       ``(ii) to provide for the planning and implementation of 
     integrated health care networks in rural areas under 
     subsection (f); and
       ``(iii) to provide for the planning and implementation of 
     small health care provider quality improvement activities 
     under subsection (g).
       ``(e) Rural Health Care Services Outreach Grants.--
       ``(1) Grants.--The Director may award grants to eligible 
     entities to promote rural health care services outreach by 
     expanding the delivery of health care services to include new 
     and enhanced services in rural areas. The Director may award 
     the grants for periods of not more than 3 years.
       ``(2) Eligibility.--To be eligible to receive a grant under 
     this subsection for a project, an entity--
       ``(A) shall be a rural public or 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.

[[Page 21113]]

       ``(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).
       ``(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.

[[Page 21114]]

       ``(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 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

[[Page 21115]]

     subsection (a), either directly or through grants to 
     emergency medical service squads that are located in, or that 
     serve residents of, a nonmetropolitan statistical area, an 
     area designated as a rural area by any law or regulation of a 
     State, or a rural census tract of a metropolitan statistical 
     area (as determined under the most recent Goldsmith 
     Modification, originally published in a notice of 
     availability of funds in the Federal Register on February 27, 
     1992, 57 Fed. Reg. 6725), to--
       ``(1) recruit emergency medical service personnel;
       ``(2) recruit volunteer emergency medical service 
     personnel;
       ``(3) train emergency medical service personnel in 
     emergency response, injury prevention, safety awareness, and 
     other topics relevant to the delivery of emergency medical 
     services;
       ``(4) fund specific training to meet Federal or State 
     certification requirements;
       ``(5) develop new ways to educate emergency health care 
     providers through the use of technology-enhanced educational 
     methods (such as distance learning);
       ``(6) acquire emergency medical services equipment, 
     including cardiac defibrillators;
       ``(7) acquire personal protective equipment for emergency 
     medical services personnel as required by the Occupational 
     Safety and Health Administration; and
       ``(8) educate the public concerning cardiopulmonary 
     resuscitation, first aid, injury prevention, safety 
     awareness, illness prevention, and other related emergency 
     preparedness topics.
       ``(d) Preference.--In awarding grants under this section 
     the Secretary shall give preference to--
       ``(1) applications that reflect a collaborative effort by 2 
     or more of the entities described in subparagraphs (A) 
     through (F) of subsection (b)(1); and
       ``(2) applications submitted by entities that intend to use 
     amounts provided under the grant to fund activities described 
     in any of paragraphs (1) through (5) of subsection (c).
       ``(e) Matching Requirement.--The Secretary may not award a 
     grant under this section to an entity unless the entity 
     agrees that the entity will make available (directly or 
     through contributions from other public or private entities) 
     non-Federal contributions toward the activities to be carried 
     out under the grant in an amount equal to 25 percent of the 
     amount received under the grant.
       ``(f) Emergency Medical Services.--In this section, the 
     term `emergency medical services'--
       ``(1) means resources used by a qualified public or private 
     nonprofit entity, or by any other entity recognized as 
     qualified by the State involved, to deliver medical care 
     outside of a medical facility under emergency conditions that 
     occur--
       ``(A) as a result of the condition of the patient; or
       ``(B) as a result of a natural disaster or similar 
     situation; and
       ``(2) includes services delivered by an emergency medical 
     services provider (either compensated or volunteer) or other 
     provider recognized by the State involved that is licensed or 
     certified by the State as an emergency medical technician or 
     its equivalent (as determined by the State), a registered 
     nurse, a physician assistant, or a physician that provides 
     services similar to services provided by such an emergency 
     medical services provider.
       ``(g) Authorization of Appropriations.--
       ``(1) In general.--There are authorized to be appropriated 
     to carry out this section such sums as may be necessary for 
     each of fiscal years 2002 through 2006.
       ``(2) Administrative costs.--The Secretary may use not more 
     than 10 percent of the amount appropriated under paragraph 
     (1) for a fiscal year for the administrative expenses of 
     carrying out this section.

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

       ``(a) Definitions.--In this section:
       ``(1) Eligible entity.--The term `eligible entity' means a 
     public or nonprofit private telehealth provider network that 
     offers services that include mental health services provided 
     by qualified mental health providers.
       ``(2) Qualified mental health professionals.--The term 
     `qualified mental health professionals' refers to providers 
     of mental health services reimbursed under the medicare 
     program carried out under title XVIII of the Social Security 
     Act (42 U.S.C. 1395 et seq.) who have additional training in 
     the treatment of mental illness in children and adolescents 
     or who have additional training in the treatment of mental 
     illness in the elderly.
       ``(3) Special populations.--The term `special populations' 
     refers to the following 2 distinct groups:
       ``(A) Children and adolescents in mental health underserved 
     rural areas or in mental health underserved urban areas.
       ``(B) Elderly individuals located in long-term care 
     facilities in mental health underserved rural 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

[[Page 21116]]

     establish a maximum total amount that may be paid to an 
     individual as reimbursement for such expenses.''.
       (b) Demonstration Projects.--Section 331 of the Public 
     Health Service Act (42 U.S.C. 254d) is amended--
       (1) by redesignating subsection (i) as subsection (j); and
       (2) by inserting after subsection (h) the following:
       ``(i)(1) In carrying out subpart III, the Secretary may, in 
     accordance with this subsection, carry out demonstration 
     projects in which individuals who have entered into a 
     contract for obligated service under the Loan Repayment 
     Program receive waivers under which the individuals are 
     authorized to satisfy the requirement of obligated service 
     through providing clinical service that is not full-time.
       ``(2) A waiver described in paragraph (1) may be provided 
     by the Secretary only if--
       ``(A) the entity for which the service is to be performed--
       ``(i) has been approved under section 333A for assignment 
     of a Corps member; and
       ``(ii) has requested in writing assignment of a health 
     professional who would serve less than full time;
       ``(B) the Secretary has determined that assignment of a 
     health professional who would serve less than full time would 
     be appropriate for the area where the entity is located;
       ``(C) a Corps member who is required to perform obligated 
     service has agreed in writing to be assigned for less than 
     full-time service to an entity described in subparagraph (A);
       ``(D) the entity and the Corps member agree in writing that 
     the less than full-time service provided by the Corps member 
     will not be less than 16 hours of clinical service per week;
       ``(E) the Corps member agrees in writing that the period of 
     obligated service pursuant to section 338B will be extended 
     so that the aggregate amount of less than full-time service 
     performed will equal the amount of service that would be 
     performed through full-time service under section 338C; and
       ``(F) the Corps member agrees in writing that if the Corps 
     member begins providing less than full-time service but fails 
     to begin or complete the period of obligated service, the 
     method stated in 338E(c) for determining the damages for 
     breach of the individual's written contract will be used 
     after converting periods of obligated service or of service 
     performed into their full-time equivalents.
       ``(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)--

[[Page 21117]]

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

     SEC. 305. COST-SHARING.

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

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

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

     SEC. 306. ELIGIBILITY FOR FEDERAL FUNDS.

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

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

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

     SEC. 308. AUTHORIZATION OF APPROPRIATIONS.

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

     SEC. 309. NATIONAL HEALTH SERVICE CORPS SCHOLARSHIP PROGRAM.

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

[[Page 21118]]

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

     SEC. 312. PRIVATE PRACTICE.

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

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

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

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

     SEC. 314. AUTHORIZATION OF APPROPRIATIONS.

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

     ``SEC. 338H. AUTHORIZATION OF APPROPRIATIONS.

       ``(a) Authorization of Appropriations.--For the purposes of 
     carrying out this subpart, there are authorized to be 
     appropriated $146,250,000 for fiscal year 2002, and such sums 
     as may be necessary for each of fiscal years 2003 through 
     2006.
       ``(b) Scholarships 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

[[Page 21119]]

     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
       ``(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

[[Page 21120]]

     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;
       ``(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

[[Page 21121]]

       ``(C) the establishment or expansion of private dental 
     services to enhance capacity through additional equipment or 
     additional hours of operation;
       ``(6) placement and support of dental students, dental 
     residents, and advanced dentistry trainees;
       ``(7) continuing dental education, including distance-based 
     education;
       ``(8) practice support through teledentistry conducted in 
     accordance with State laws;
       ``(9) community-based prevention services such as water 
     fluoridation and dental sealant programs;
       ``(10) coordination with local educational agencies within 
     the State to foster programs that promote children going into 
     oral health or science professions;
       ``(11) the establishment of faculty recruitment programs at 
     accredited dental training institutions whose mission 
     includes community outreach and service and that have a 
     demonstrated record of serving underserved States;
       ``(12) the development of a State dental officer position 
     or the augmentation of a State dental office to coordinate 
     oral health and access issues in the State; and
       ``(13) any other activities determined to be appropriate by 
     the Secretary.
       ``(c) Application.--
       ``(1) In general.--Each State desiring a grant under this 
     section shall submit an application to the Secretary at such 
     time, in such manner, and containing such information as the 
     Secretary may reasonably require.
       ``(2) Assurances.--The application shall include assurances 
     that the State will meet the requirements of subsection (d) 
     and that the State possesses sufficient infrastructure to 
     manage the activities to be funded through the grant and to 
     evaluate and report on the outcomes resulting from such 
     activities.
       ``(d) Matching Requirement.--The Secretary may not make a 
     grant to a State under this section unless that State agrees 
     that, with respect to the costs to be incurred by the State 
     in carrying out the activities for which the grant was 
     awarded, the State will provide non-Federal contributions in 
     an amount equal to not less than 40 percent of Federal funds 
     provided under the grant. The State may provide the 
     contributions in cash or in kind, fairly evaluated, including 
     plant, equipment, and services and may provide the 
     contributions from State, local, or private sources.
       ``(e) Report.--Not later than 5 years after the date of 
     enactment of the Health Care Safety Net 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)''.

  Mr. KENNEDY. Mr. President, I am pleased to join my colleagues in 
support of the Senate passage of the Health Care Safety Net Amendment 
of 2002--a bill that could not have been realized without the strong 
support received from both sides of the aisle. I want to commend 
Senator Frist and Senator Gregg for their unfailing dedication to the 
goals of this legislation. Senator Reed and Senator Harkin contributed 
to this bill in important ways by expanding access in underserved areas 
to pharmacists and chiropractic doctors. I also must express my 
appreciation to Congressmen Bill Tauzin, Mike Bilirakis, Sherrod Brown, 
and John Dingell for all their hard work in reaching agreement. Most of 
all, I would like to recognize the unfaltering efforts of Senator Dodd, 
who as always, was determined to improve the delivery and quality of 
health care to poor and vulnerable populations.
  Thirty years ago, Congress created the health centers program in 
response to an urgent need. At that time, there were growing numbers of 
Americans who lived in medically underserved areas and lacked access to 
basic primary care. And for the past three decades, the health centers 
program fulfilled the crucial role of a safety net for our nation's 
most vulnerable and underserved populations.
  I am proud of the hard work and dedication of our community health 
centers. In 2000, health centers provided more than 9.6 million people 
with cost-effective, high quality, preventive and primary care at more 
than 3,000 sites across the country. Of those served, 500,000 people 
were homeless, 600,000 were migrant and seasonal farm

[[Page 21122]]

workers and 55,000 were residents of public housing. Clearly, this 
program has been successful in meeting the goals of its creators.
  That is why I urge the Senate to approve the Safety Net Amendments of 
2002--critical legislation that includes the reauthorization of the 
community health center program. Today, the need for a robust safety 
net is more pressing than ever before. The Census Bureau recently 
reported an increase in the numbers of uninsured to 41.2 million, an 
astounding 14.6% of the population.
  This increase resulted from a drop in the number of people covered by 
employment-based health insurance. With the economy in its weakened 
state, the Congress cannot sit idly by as more and more Americans see 
their access to health care slip from their grasp. Once more, Congress 
must recognize a responsibility to ensure adequate health care to all 
Americans and strengthen the programs that have been proven effective 
in delivering care to the uninsured.
  Passage of the Safety Net Amendments is the first step to closing the 
dangerous gaps in our health care system. Not only does it strengthen 
the community health center program, it also reauthorizes and improves 
the National Health Service Corps, a program that enables health care 
providers to serve in medically underserved areas. The bill enhances 
the delivery and integration of rural health care services. It 
encourages the development of innovative telehealth technologies that 
can connect remote areas with providers. It addresses the serious 
shortages in dental care in many communities across the country. 
Finally, it authorizes the Healthy Communities Access Program (HCAP), 
an existing initiative that has been successful in integrating and 
improving care to needy populations. This program brings together 
public and private providers and encourages them to work collectively 
to enhance the health care of the uninsured. HCAP has spurred the 
development of creative and effective solutions to health care delivery 
problems that are models of innovation and collaboration for us all.
  In approving, the Safety Net bill, we will not only offer hope to 
millions of struggling families, but we will provide them with the 
security that even without health insurance, there is someone they can 
turn to for help.
  Mr. GREGG. Mr. President, I am proud to support the Health Care 
Safety Net conference agreement passed today. This legislation re-
authorizes and strengthens several programs that provide critical 
services to the uninsured and medically underserved. With the recent 
announcement by the U.S. Census Bureau that there are now 41.5 million 
uninsured Americans, this legislation comes at a crucial time. The 
safety net legislation will ensure that millions of Americans who are 
uninsured or who lack adequate health insurance coverage will at least 
have access to preventive and basic primary health care services in 
their communities.
  The legislation reauthorizes the community health centers program, 
which provides needed health care services, including outpatient 
dental, diagnostic, treatment, preventive, and primary care--in under-
served rural and inner-city areas. These services are provided through 
community health centers, migrants health centers, farm-workers, health 
centers for the homeless, health centers for residents of public 
housing, and healthy schools programs. It also re-authorizes the 
National Health Service Crops, a program that trains and places health 
professionals in areas where there are shortages of qualified 
professionals. Finally, the legislation establishes the Healthy 
Communities Access Program, which will help coordinate community 
services for the uninsured.
  I believe this legislation represents what can be achieved when good 
policy and bipartisanship overcome politics. A priority for President 
Bush, this legislation is an important piece of his agenda to ensure 
that all Americans have access to health care services. As a next step, 
I look forward to working with the President, and my colleagues in the 
Senate and House, to ensure that all Americans have access to 
affordable health insurance.
  Mr. REID. Mr. President, I ask unanimous consent that the Senate 
concur in the House amendment to the bill, and that the motion to 
reconsider be laid on the table.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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