[House Report 110-680]
[From the U.S. Government Publishing Office]



110th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     110-680

======================================================================



 
                   HEALTH CENTERS RENEWAL ACT OF 2008

                                _______
                                

  June 4, 2008.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

 Mr. Dingell, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 1343]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 1343) to amend the Public Health Service Act to 
provide additional authorizations of appropriations for the 
health centers program under section 330 of such Act, having 
considered the same, report favorably thereon with amendments 
and recommend that the bill as amended do pass.

                                CONTENTS

                                                                   Page
Amendments.......................................................     2
Purpose and Summary..............................................     6
Background and Need for Legislation..............................     6
Hearings.........................................................     9
Committee Consideration..........................................     9
Committee Votes..................................................     9
Committee Oversight Findings.....................................     9
Statement of General Performance Goals and Objectives............     9
New Budget Authority, Entitlement Authority, and Tax Expenditures    10
Earmarks and Tax and Tariff Benefits.............................    10
Committee Cost Estimate..........................................    10
Congressional Budget Office Estimate.............................    10
Federal Mandates Statement.......................................    12
Advisory Committee Statement.....................................    13
Constitutional Authority Statement...............................    13
Applicability to Legislative Branch..............................    13
Section-by-Section Analysis of the Legislation...................    13
Changes in Existing Law Made by the Bill, as Reported............    14

                               Amendments

  The amendments are as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Health Centers Renewal Act of 2008''.

SEC. 2. ADDITIONAL AUTHORIZATIONS OF APPROPRIATIONS FOR HEALTH CENTERS 
                    PROGRAM.

  Section 330(r)(1) of the Public Health Service Act (42 U.S.C. 
254b(r)(1)) is amended to read as follows:
          ``(1) In general.--For the purpose of carrying out this 
        section, in addition to the amounts authorized to be 
        appropriated under subsection (d), there are authorized to be 
        appropriated--
                  ``(A) for fiscal year 2008, $2,213,020,000;
                  ``(B) for fiscal year 2009, $2,451,394,400;
                  ``(C) for fiscal year 2010, $2,757,818,700;
                  ``(D) for fiscal year 2011, $3,116,335,131; and
                  ``(E) for fiscal year 2012, $3,537,040,374.''.

SEC. 3. RECOGNITION OF HIGH POVERTY AREAS.

  (a) In General.--Section 330(c) of the Public Health Service Act (42 
U.S.C. 254b(c)) is amended by adding at the end the following new 
paragraph:
          ``(3) Recognition of high poverty areas.--
                  ``(A) In general.--In making grants under this 
                subsection, the Secretary may recognize the unique 
                needs of high poverty areas.
                  ``(B) High poverty area defined.--For purposes of 
                subparagraph (A), the term `high poverty area' means a 
                catchment area which is established in a manner that is 
                consistent with the factors in subsection (k)(3)(J), 
                and the poverty rate of which is greater than the 
                national average poverty rate as determined by the 
                Bureau of the Census.''.
  (b) Effective Date.--The amendment made by subsection (a) shall apply 
to grants made on or after January 1, 2009.

SEC. 4. LIABILITY PROTECTIONS FOR HEALTH CENTER VOLUNTEER 
                    PRACTITIONERS.

  (a) In General.--Section 224 of the Public Health Service Act (42 
U.S.C. 233) is amended--
          (1) in subsection (g)(1)(A)--
                  (A) in the first sentence, by striking ``or 
                employee'' and inserting ``employee, or (subject to 
                subsection (k)(4)) volunteer practitioner''; and
                  (B) in the second sentence, by inserting ``and 
                subsection (k)(4)'' after ``subject to paragraph (5)''; 
                and
          (2) in each of subsections (g), (i), (j), (k), (l), and (m)--
                  (A) by striking the term ``employee, or contractor'' 
                each place such term appears and inserting ``employee, 
                volunteer practitioner, or contractor'';
                  (B) by striking the term ``employee, and contractor'' 
                each place such term appears and inserting ``employee, 
                volunteer practitioner, and contractor'';
                  (C) by striking the term ``employee, or any 
                contractor'' each place such term appears and inserting 
                ``employee, volunteer practitioner, or contractor''; 
                and
                  (D) by striking the term ``employees, or 
                contractors'' each place such term appears and 
                inserting ``employees, volunteer practitioners, or 
                contractors''.
  (b) Applicability; Definition.--Section 224(k) of the Public Health 
Service Act (42 U.S.C. 233(k)) is amended by adding at the end the 
following paragraph:
  ``(4)(A) Subsections (g) through (m) apply with respect to volunteer 
practitioners beginning with the first fiscal year for which an 
appropriations Act provides that amounts in the fund under paragraph 
(2) are available with respect to such practitioners.
  ``(B) For purposes of subsections (g) through (m), the term 
`volunteer practitioner' means a practitioner who, with respect to an 
entity described in subsection (g)(4), meets the following conditions:
          ``(i) In the State involved, the practitioner is a licensed 
        physician, a licensed clinical psychologist, or other licensed 
        or certified health care practitioner.
          ``(ii) At the request of such entity, the practitioner 
        provides services to patients of the entity, at a site at which 
        the entity operates or at a site designated by the entity. The 
        weekly number of hours of services provided to the patients by 
        the practitioner is not a factor with respect to meeting 
        conditions under this subparagraph.
          ``(iii) The practitioner does not for the provision of such 
        services receive any compensation from such patients, from the 
        entity, or from third-party payors (including reimbursement 
        under any insurance policy or health plan, or under any Federal 
        or State health benefits program).''.

SEC. 5. LIABILITY PROTECTIONS FOR HEALTH CENTER PRACTITIONERS PROVIDING 
                    SERVICES IN EMERGENCY AREAS.

  Section 224(g) of the Public Health Service Act (42 U.S.C. 233(g)) is 
amended--
          (1) in paragraph (1)(B)(ii), by striking ``subparagraph (C)'' 
        and inserting ``subparagraph (C) and paragraph (6)''; and
          (2) by adding at the end the following paragraph:
  ``(6)(A) Subject to subparagraph (C), paragraph (1)(B)(ii) applies to 
health services provided to individuals who are not patients of the 
entity involved if, as determined under criteria issued by the 
Secretary, the following conditions are met:
          ``(i) The services are provided by a contractor, volunteer 
        practitioner (as defined in subsection (k)(4)(B)), or employee 
        of the entity who is a physician or other licensed or certified 
        health care practitioner and who is otherwise deemed to be an 
        employee for purposes of paragraph (1)(A) when providing 
        services with respect to the entity.
          ``(ii) The services are provided in an emergency area (as 
        defined in subparagraph (D)), with respect to a public health 
        emergency or major disaster described in subparagraph (D), and 
        during the period for which such emergency or disaster is 
        determined or declared, respectively.
          ``(iii) The services of the contractor, volunteer 
        practitioner, or employee (referred to in this paragraph as the 
        `out-of-area practitioner') are provided under an arrangement 
        with--
                  ``(I) an entity that is deemed to be an employee for 
                purposes of paragraph (1)(A) and that serves the 
                emergency area involved (referred to in this paragraph 
                as an `emergency-area entity'); or
                  ``(II) a Federal agency that has responsibilities 
                regarding the provision of health services in such area 
                during the emergency.
          ``(iv) The purposes of the arrangement are--
                  ``(I) to coordinate, to the extent practicable, the 
                provision of health services in the emergency area by 
                the out-of-area practitioner with the provision of 
                services by the emergency-area entity, or by the 
                Federal agency, as the case may be;
                  ``(II) to identify a location in the emergency area 
                to which such practitioner should report for purposes 
                of providing health services, and to identify an 
                individual or individuals in the area to whom the 
                practitioner should report for such purposes; and
                  ``(III) to verify the identity of the practitioner 
                and that the practitioner is licensed or certified by 
                one or more of the States.
          ``(v) With respect to the licensure or certification of 
        health care practitioners, the provision of services by the 
        out-of-area practitioner in the emergency area is not a 
        violation of the law of the State in which the area is located.
  ``(B) In issuing criteria under subparagraph (A), the Secretary shall 
take into account the need to rapidly enter into arrangements under 
such subparagraph in order to provide health services in emergency 
areas promptly after the emergency begins.
  ``(C) Subparagraph (A) applies with respect to an act or omission of 
an out-of-area practitioner only to the extent that the practitioner is 
not immune from liability for such act or omission under the Volunteer 
Protection Act of 1997.
  ``(D) For purposes of this paragraph, the term `emergency area' means 
a geographic area for which--
          ``(i) the Secretary has made a determination under section 
        319 that a public health emergency exists; or
          ``(ii) a presidential declaration of major disaster has been 
        issued under section 401 of the Robert T. Stafford Disaster 
        Relief and Emergency Assistance Act.''.

SEC. 6. DEMONSTRATION PROJECT FOR INTEGRATED HEALTH SYSTEMS TO EXPAND 
                    ACCESS TO PRIMARY AND PREVENTIVE SERVICES FOR THE 
                    MEDICALLY UNDERSERVED.

  Part D of title III of the Public Health Service Act (42 U.S.C. 259b 
et seq.) is amended by adding at the end the following new subpart:

 ``Subpart XI--Demonstration Project for Integrated Health Systems to 
  Expand Access to Primary and Preventive Services for the Medically 
                              Underserved

``SEC. 340H. DEMONSTRATION PROJECT FOR INTEGRATED HEALTH SYSTEMS TO 
                    EXPAND ACCESS TO PRIMARY AND PREVENTIVE CARE FOR 
                    THE MEDICALLY UNDERSERVED.

  ``(a) Establishment of Demonstration.--
          ``(1) In general.--Not later than January 1, 2009, the 
        Secretary shall establish a demonstration project (hereafter in 
        this section referred to as the `demonstration') under which up 
        to 30 qualifying integrated health systems receive grants for 
        the costs of their operations to expand access to primary and 
        preventive services for the medically underserved.
          ``(2) Rule of construction.--Nothing in this section shall be 
        construed as authorizing grants to be made or used for the 
        costs of specialty care or hospital care furnished by an 
        integrated health system.
  ``(b) Application.--Any integrated health system desiring to 
participate in the demonstration shall submit an application in such 
manner, at such time, and containing such information as the Secretary 
may require.
  ``(c) Criteria for Selection.--In selecting integrated health systems 
to participate in the demonstration (hereafter in this section referred 
to as `participating integrated health systems'), the Secretary shall 
ensure representation of integrated health systems that are located in 
a variety of States (including the District of Columbia and the 
territories and possessions of the United States) and locations within 
States, including rural areas, inner-city areas, and frontier areas.
  ``(d) Duration.--Subject to the availability of appropriations, the 
demonstration shall be conducted (and operating grants be made to each 
participating integrated health system) for a period of 3 years.
  ``(e) Reports.--
          ``(1) In general.--The Secretary shall submit to the 
        appropriate committees of the Congress interim and final 
        reports with respect to the demonstration, with an interim 
        report being submitted not later than 3 months after the 
        demonstration has been in operation for 24 months and a final 
        report being submitted not later than 3 months after the close 
        of the demonstration.
          ``(2) Content.--Such reports shall evaluate the effectiveness 
        of the demonstration in providing greater access to primary and 
        preventive care for medically underserved populations, and how 
        the coordinated approach offered by integrated health systems 
        contributes to improved patient outcomes.
  ``(f) Authorization of Appropriations.--
          ``(1) In general.--There is authorized to be appropriated 
        $25,000,000 for each of the fiscal years 2009, 2010, and 2011 
        to carry out this section.
          ``(2) Construction.--Nothing in this section shall be 
        construed as requiring or authorizing a reduction in the 
        amounts appropriated for grants to health centers under section 
        330 for the fiscal years referred to in paragraph (1).
  ``(g) Definitions.--For purposes of this section:
          ``(1) Frontier area.--The term `frontier area' has the 
        meaning given to such term in regulations promulgated pursuant 
        to section 330I(r).
          ``(2) Integrated health system.--The term `integrated health 
        system' means a health system that--
                  ``(A) has a demonstrated capacity and commitment to 
                provide a full range of primary care, specialty care, 
                and hospital care in both inpatient and outpatient 
                settings; and
                  ``(B) is organized to provide such care in a 
                coordinated fashion.
          ``(3) Qualifying integrated health system.--
                  ``(A) In general.--The term `qualifying integrated 
                health system' means a public or private nonprofit 
                entity that is an integrated health system that meets 
                the requirements of subparagraph (B) and serves a 
                medically underserved population (either through the 
                staff and supporting resources of the integrated health 
                system or through contracts or cooperative 
                arrangements) by providing--
                          ``(i) required primary and preventive health 
                        and related services (as defined in paragraph 
                        (4)); and
                          ``(ii) as may be appropriate for a population 
                        served by a particular integrated health 
                        system, integrative health services (as defined 
                        in paragraph (5)) that are necessary for the 
                        adequate support of the required primary and 
                        preventive health and related services and that 
                        improve care coordination.
                  ``(B) Other requirements.--The requirements of this 
                subparagraph are that the integrated health system--
                          ``(i) will make the required primary and 
                        preventive health and related services of the 
                        integrated health system available and 
                        accessible in the service area of the 
                        integrated health system promptly, as 
                        appropriate, and in a manner which assures 
                        continuity;
                          ``(ii) will demonstrate financial 
                        responsibility by the use of such accounting 
                        procedures and other requirements as may be 
                        prescribed by the Secretary;
                          ``(iii) provides or will provide services to 
                        individuals who are eligible for medical 
                        assistance under title XIX of the Social 
                        Security Act or for assistance under title XXI 
                        of such Act;
                          ``(iv) has prepared a schedule of fees or 
                        payments for the provision of its services 
                        consistent with locally prevailing rates or 
                        charges and designed to cover its reasonable 
                        costs of operation and has prepared a 
                        corresponding schedule of discounts to be 
                        applied to the payment of such fees or 
                        payments, which discounts are adjusted on the 
                        basis of the patient's ability to pay;
                          ``(v) will assure that no patient will be 
                        denied health care services due to an 
                        individual's inability to pay for such 
                        services;
                          ``(vi) will assure that any fees or payments 
                        required by the system for such services will 
                        be reduced or waived to enable the system to 
                        fulfill the assurance described in clause (v);
                          ``(vii) provides assurances that any grant 
                        funds will be expended to supplement, and not 
                        supplant, the expenditures of the integrated 
                        health system for primary and preventive health 
                        services for the medically underserved; and
                          ``(viii) submits to the Secretary such 
                        reports as the Secretary may require to 
                        determine compliance with this subparagraph.
                  ``(C) Treatment of certain entities.--The term 
                `qualifying integrated health system' may include a 
                nurse-managed health clinic if such clinic meets the 
                requirements of subparagraphs (A) and (B) (except those 
                requirements that have been waived under paragraph 
                (4)(B)).
          ``(4) Required primary and preventive health and related 
        services.--
                  ``(A) In general.--Except as provided in subparagraph 
                (B), the term `required primary and preventive health 
                and related services' means basic health services 
                consisting of--
                          ``(i) health services related to family 
                        medicine, internal medicine, pediatrics, 
                        obstetrics, or gynecology that are furnished by 
                        physicians where appropriate, physician 
                        assistants, nurse practitioners, and nurse 
                        midwives;
                          ``(ii) diagnostic laboratory services and 
                        radiologic services;
                          ``(iii) preventive health services, including 
                        prenatal and perinatal care; appropriate cancer 
                        screening; well-child services; immunizations 
                        against vaccine-preventable diseases; 
                        screenings for elevated blood lead levels, 
                        communicable diseases, and cholesterol; 
                        pediatric eye, ear, and dental screenings to 
                        determine the need for vision and hearing 
                        correction and dental care; and voluntary 
                        family planning services;
                          ``(iv) emergency medical services; and
                          ``(v) pharmaceutical services, behavioral, 
                        mental health, and substance abuse services, 
                        preventive dental services, and recuperative 
                        care, as may be appropriate.
                  ``(B) Exception.--In the case of an integrated health 
                system serving a targeted population, the Secretary 
                shall, upon a showing of good cause, waive the 
                requirement that the integrated health system provide 
                each required primary and preventive health and related 
                service under this paragraph if the Secretary 
                determines one or more such services are inappropriate 
                or unnecessary for such population.
          ``(5) Integrative health services.--The term `integrative 
        health services' means services that are not included as 
        required primary and preventive health and related services and 
        are associated with achieving the greater integration of a 
        health care delivery system to improve patient care 
        coordination so that the system either directly provides or 
        ensures the provision of a broad range of culturally competent 
        services. Integrative health services include but are not 
        limited to the following:
                  ``(A) Outreach activities.
                  ``(B) Case management and patient navigation 
                services.
                  ``(C) Chronic care management.
                  ``(D) Transportation to health care facilities.
                  ``(E) Development of provider networks and other 
                innovative models to engage local physicians and other 
                providers to serve the medically underserved within a 
                community.
                  ``(F) Recruitment, training, and compensation of 
                necessary personnel.
                  ``(G) Acquisition of technology for the purpose of 
                coordinating care.
                  ``(H) Improvements to provider communication, 
                including implementation of shared information systems 
                or shared clinical systems.
                  ``(I) Determination of eligibility for Federal, 
                State, and local programs that provide, or financially 
                support the provision of, medical, social, housing, 
                educational, or other related services.
                  ``(J) Development of prevention and disease 
                management tools and processes.
                  ``(K) Translation services.
                  ``(L) Development and implementation of evaluation 
                measures and processes to assess patient outcomes.
                  ``(M) Integration of primary care and mental health 
                services.
                  ``(N) 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.
          ``(6) Specialty care.--The term `specialty care' means care 
        that is provided through a referral and by a physician or 
        nonphysician practitioner, such as surgical consultative 
        services, radiology services requiring the immediate presence 
        of a physician, audiology, optometric services, cardiology 
        services, magnetic resonance imagery (MRI) services, 
        computerized axial tomography (CAT) scans, nuclear medicine 
        studies, and ambulatory surgical services.
          ``(7) Nurse-managed health clinic.--The term `nurse-managed 
        health clinic' means a nurse-practice arrangement, managed by 
        advanced practice nurses, that provides care for underserved 
        and vulnerable populations and is associated with a school, 
        college, or department of nursing or an independent nonprofit 
        health or social services agency.''.

  Amend the title so as to read:

      A bill to amend the Public Health Service Act to provide 
additional authorizations of appropriations for the health 
centers program under section 330 of such Act, and for other 
purposes.

                          Purpose and Summary

    The purpose of H.R. 1343, the Health Centers Renewal Act of 
2008, is to reauthorize community health centers for fiscal 
years 2008 through 2012, authorize the Secretary to acknowledge 
the unique needs of high-poverty areas for planning grants, 
grant liability protection for practitioners who volunteer at 
the centers or travel to provide services in emergencies, and 
authorize a demonstration project for integrated health systems 
to expand access to primary and preventive care for the 
medically underserved.

                  Background and Need for Legislation

    For more than 40 years, community health centers have 
provided comprehensive, culturally competent, quality primary 
healthcare services--including preventive, diagnostic, 
treatment, emergency services, and referrals to specialty 
care--to medically underserved communities and vulnerable 
populations without access to such services. Where medically 
necessary, community health centers also provide enabling 
services, such as transportation and translation that help 
patients gain access to care. Patients are charged for services 
based on their ability to pay, on a sliding-fee scale.
    Reauthorization of the Health Centers Program. H.R. 1343 
reauthorizes community health centers for fiscal years 2008 
through 2012, under section 330 of the Public Health Service 
(PHS) Act, as amended (42 U.S.C. 254b).
    The Committee clarifies the authority of the Secretary, 
pursuant to subsection (e)(1)(B), to waive all or part of the 
statutory requirements set forth in subsection (k), including 
the governance requirement. Therefore, the Secretary may make 
grants, for a period not to exceed two years, for the costs of 
the operation of public and nonprofit private entities that 
provide health services to medically underserved populations, 
but with respect to which the Secretary is unable to make each 
of the determinations required by subsection (k)(3).
    The Committee notes that the determination made by the 
Committee with respect to the waiver authority of the Secretary 
is shared by the U.S. Department of Health and Human Services 
and is reflected in a letter addressed to the Committee dated 
April 22, 2008. The letter is provided here in its entirety.
        Department of Health & Human Services, Health 
            Resources and Services Administration, Bureau 
            of Primary Health Care,
                                     Rockville, MD, April 22, 2008.
Hon. Frank Pallone,
Chairman, Health Subcommittee, Energy and Commerce Committee,
House of Representatives, Washington, DC.
    Dear Chairman Pallone, This letter is in response to your 
request for information regarding the Health Resources and 
Services Administration's (HRSA) authority to waive the 
statutory governance requirements for health centers. Section 
330(e)(1)(B) of the Public Health Service Act permits HRSA to 
issue a waiver of the statutory requirements under subsection 
(k)(3) for up to 2 years. Additionally, under Section 
330(e)(4), this waiver may be extended for another 2 years, for 
a total waiver period of up to 4 years.
    Section 330(e) grantees may therefore be relieved of 
certain requirements including, but not limited to, the 
provisions related to the composition and authorities of the 
governing board under subsection (k)(3)(H). The statute gives 
the Secretary discretion as to whether he opts to grant such 
waivers.
    Thank you for your efforts to reauthorize the Health Center 
Program. I am sending the same letter to Congressman Nathan 
Deal.
            Sincerely,
                                              James Macrae,
                                           Associate Administrator.
    Furthermore, the Committee observes that ``look-alike'' 
centers, as outlined in the Social Security Act, must meet the 
same standards as Federally Qualified Health Centers (FQHCs) 
receiving grants under Section 330 of the PHS Act. The 
Committee clarifies that the waiver authority of the Secretary 
under subsection (e)(1)(B) is also available to the Secretary 
when making the determination that an entity applying for look-
alike status meets the requirements set forth under Section 
330. This observation does not expand the scope of the 
Secretary's waiver authority under existing law, but rather 
clarifies the current waiver authority of the Secretary.
    Recognition of High-Poverty Areas. Planning grants are 
considered useful aids to the development of viable proposals 
to establish new health center sites that will meet Federal 
requirements for governance, community involvement, quality of 
care, and financial feasibility under the Health Center 
Program. H.R. 1343 would grant the Secretary authority to 
recognize the unique needs of high-poverty areas when making 
grants under subsection (c).
    The Committee encourages the Secretary to use this 
authority to improve the geographic diversity and placement of 
new planning grants in the poorest areas with the highest 
capacity to support a comprehensive health center. The 
Committee encourages new grantees in high-poverty areas, 
including, but not limited to, pockets of high-poverty and 
medically underserved areas in otherwise affluent counties.
    Liability Protection for Health Center Volunteer 
Practitioner. Health practitioners may otherwise be willing to 
volunteer their services at a community health center, but may 
refrain from volunteering because of the fear of malpractice 
liability or the increasing cost of medical malpractice 
insurance. H.R. 1343 would amend section 224 of the PHS Act (42 
U.S.C. 233) to extend Federal medical malpractice protection to 
qualified healthcare practitioners who volunteer at community 
health centers within the scope of its approved Federal 
project. Currently, healthcare practitioners who volunteer at 
community health centers are not eligible for Federal Tort 
Claims Act (FTCA) coverage.
    Where a volunteer healthcare practitioner meets all the 
requirements under section 224, he or she may be sponsored by a 
community health center and ``deemed'' a Federal employee for 
the purpose of FTCA medical malpractice coverage. When making 
the determination to deem volunteer practitioners under this 
authority, the Secretary is encouraged to ensure such 
determination is consistent with the scope of the approved 
Federal project of the sponsoring community health center.
    Liability Protection for Health Center Practitioners 
Providing Services in Emergency Areas. In an effort to build 
upon the Federally Supported Health Centers Assistance Act of 
1992 (Public Law 102-501), H.R. 1343 would clarify that certain 
physicians or other licensed or certified healthcare 
practitioners have Federal liability protection for the 
purposes of any civil action that may arise due to services 
provided in an emergency area. Such services must be provided 
under an arrangement with a qualified health center or with a 
Federal agency with responsibility for providing health 
services in the emergency area.
    FTCA protection is also extended to qualified volunteer 
practitioners for services provided in an emergency area, as 
long as they are permitted to volunteer under State and Federal 
laws. The intent is to increase the numbers of qualified health 
care practitioners who are available to community health 
centers to work as part of the organized State or local 
response to natural disasters or man-made emergencies.
    Demonstration Project for Integrated Health Systems to 
Expand Access to Primary and Preventative Services for the 
Medically Underserved. H.R. 1343 would establish a 
demonstration project for qualifying integrated health systems 
to expand access to primary and preventive care for the 
medically underserved. The Committee strongly encourages the 
Secretary to select participants that represent a diverse 
assortment of rural, frontier, and urban communities, drawn 
from various locations within the States and/or a region/group 
of States. This representation is necessary to ensure that the 
demonstration project explores the capacity of (wide ranging 
needs of the) integrated health systems to expand access to 
primary and preventive care and improve patient outcomes in a 
variety of medically underserved communities.

                                Hearings

    On Tuesday, December 4, 2007, the Subcommittee on Health 
held a hearing on H.R. 1343 and two other bills. The hearing 
included testimony from Dennis P. Williams, Ph.D., Deputy 
Administrator, Health Resources and Services Administration; 
Mr. Wilbert Jones, Chief Executive Officer, Greater Meridian 
Health Clinic; Stephen Miracle, M.B.A., Executive Director, 
Georgia Mountain Health Services, Inc.; Ricardo Guzman, M.S.W., 
M.P.H., Chief Executive Officer, Community Health and Social 
Services, Inc.; and Michael Ehlert, M.D., President, American 
Student Medical Association.

                        Committee Consideration

    On Wednesday, April 23, 2008, the Subcommittee on Health 
met in open markup session and favorably forwarded H.R. 1343, 
amended, to the full Committee for consideration by a voice 
vote. On Wednesday, May 7, 2008, the full Committee met in open 
markup session and ordered H.R. 1343 favorably reported to the 
House, amended, by a voice vote.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report legislation and amendments thereto. No 
record votes were taken on amendments or in connection with 
ordering H.R. 1343 reported to the House. A motion by Mr. 
Dingell to order H.R. 1343 favorably reported to the House, 
amended, was agreed to by a voice vote.

                      Committee Oversight Findings

    Regarding clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Subcommittee on Health held a 
legislative hearing on H.R. 1343, and the oversight findings of 
the Committee regarding the bill are reflected in this report.

         Statement of General Performance Goals and Objectives

    The purpose of H.R. 1343 is to expand access to primary and 
preventive care by ensuring that community health centers can 
continue to offer health care services to millions of medically 
underserved and uninsured people.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    Regarding compliance with clause 3(c)(2) of rule XIII of 
the Rules of the House of Representatives, the Committee finds 
that H.R. 1343 would result in no new or increased budget 
authority, entitlement authority, or tax expenditures or 
revenues.

                  Earmarks and Tax and Tariff Benefits

    Regarding compliance with clause 9 of rule XXI of the Rules 
of the House of Representatives, H.R. 1343 does not contain any 
Congressional earmarks, limited tax benefits, or limited tariff 
benefits as defined in clause 9(d), 9(e), or 9(f) of rule XXI.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate on H.R. 
1343 prepared by the Director of the Congressional Budget 
Office pursuant to section 402 of the Congressional Budget Act 
of 1974.

                  Congressional Budget Office Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate on 
H.R. 1343 provided by the Congressional Budget Office pursuant 
to section 402 of the Congressional Budget Act of 1974:

                                                      June 3, 2008.
Hon. John D. Dingell, 
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 1343, the Health 
Centers Renewal Act of 2008.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Lara 
Robillard.
            Sincerely,
                                                   Peter R. Orszag.
    Enclosure.

H.R. 1343--Health Centers Renewal Act of 2008

    Summary: H.R. 1343 would amend the Public Health Service 
Act to authorize a program that provides funding for community 
health centers. It would also expand the pool of individuals 
covered by the Federal Tort Claims Act (FTCA) and authorize a 
three-year demonstration project for integrated health systems.
    CBO estimates that the bill would authorize the 
appropriation for those activities of $2.2 billion for 2008 and 
$14.2 billion over the 2008-2013 period. However, $2.0 billion 
has already been appropriated for 2008 for health centers. 
Thus, H.R. 1343 would authorize the appropriation of an 
additional $0.2 billion for fiscal year 2008 and $12.1 billion 
over the 2008-2013 period. Assuming the appropriation of 
authorized amounts, CBO estimates that the bill would cost $77 
million in 2008 and $11.8 billion over the 2008-2013 period.
    Enacting H.R. 1343 would not affect direct spending or 
revenues. H.R. 1343 contains no intergovernmental or private-
sector mandates as defined in the Unfunded Mandates Reform Act 
(UMRA) and would impose no costs on state, local, or tribal 
governments.
    Estimated cost to the Federal Government: The estimated 
budgetary impact of H.R. 1343 is shown in the following table. 
The costs of this legislation fall within budget function 550 
(health).

----------------------------------------------------------------------------------------------------------------
                                                             By fiscal year, in millions of dollars--
                                                ----------------------------------------------------------------
                                                   2008     2009     2010     2011     2012     2013   2008-2013
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Health Centers:
    Authorization Level........................      191    2,451    2,758    3,116    3,537        0     12,053
    Estimated Outlays..........................       77    1,397    2,505    2,883    3,266    1,579     11,707
FTCA Expansion:
    Estimated Authorization Level..............        0        2        2        2        2        2         10
    Estimated Outlays..........................        0        0        1        1        2        2          6
Integrated Health System Demonstration:
    Authorization Level........................        0       25       25       25        0        0         75
    Estimated Outlays..........................        0        5       20       25       20        5         75
    Total:
        Estimated Authorization Level..........      191    2,478    2,785    3,143    3,539        2     12,138
        Estimated Outlays......................       77    1,402    2,526    2,909    3,288    1,586     11,788
----------------------------------------------------------------------------------------------------------------

    Basis of estimate: H.R. 1343 would authorize the health 
centers program, which funds community-based and patient-
directed organizations that serve populations with limited 
access to primary health care services. In total, CBO estimates 
that the bill would authorize the appropriation of $2.2 billion 
for 2008 and $14.1 billion over the 2008-2013 period. The 
Omnibus Appropriations Act (Public Law 110-161) appropriated 
$2.2 billion in 2008 for health centers. Thus, H.R. 1343 would 
authorize the appropriation of an additional $191 million for 
fiscal year 2008 and $12.1 billion over the 2008-2013 period 
for health centers.
    Assuming the appropriation of the additional funds for 2008 
in the early summer, and the appropriation of the authorized 
amounts in subsequent years, CBO estimates that spending for 
the community health center program from the funds that would 
be authorized by this bill would total $77 million in 2008 and 
$11.7 billion over the 2008-2013 period.
    Under current law, liability protections under the Federal 
Tort Claims Act (FTCA) are granted to employees and contractors 
of participating health centers, because those individuals are 
considered employees of the federal government. Therefore, the 
government defends all medical liability claims against health 
center employees and pays any claims arising from liability. 
H.R. 1343 would grant that protection to health care 
professionals who volunteer at health centers.
    Under H.R. 1343, the liability protection for volunteers 
would be conditional upon the appropriation of funds, in 
addition to existing FTCA resources, for the purposes of 
covering volunteers.\1\ CBO assumes that funds would be 
appropriated beginning in fiscal year 2009 and each year 
thereafter. Based on historical program expenditures for 
existing liability protections and the potential role of 
volunteer staff at health centers, CBO estimates that covering 
volunteers under the FTCA would require the appropriation of $2 
million for 2009 and $ 10 million over the 2010-2013 period. 
CBO estimates that implementing the FTCA expansion would cost 
less than $500,000 in 2009 and $6 million over the 2009-2013 
period, assuming appropriation of the necessary amounts.
---------------------------------------------------------------------------
    \1\ The Omnibus Appropriations Act of 2007 appropriated $43 million 
for FTCA coverage of health center employees.
---------------------------------------------------------------------------
    H.R. 1343 also would extend liability protection to health 
center practitioners who provide services in emergency areas. 
Under current law, FTCA liability protection applies when 
health center practitioners treat patients of the health center 
where they work, except in limited circumstances. H.R. 1343 
would broaden the application of the FTCA so that health center 
practitioners would be covered when treating people at a health 
center in an area that has been declared a public health 
emergency or major disaster area. Because this provision would 
not add new practitioners to the FTCA coverage, but rather 
would allow practitioners to carry the liability protection 
with them to new sites, CBO expects that this expansion of 
coverage under the FTCA would not have a significant budgetary 
impact.
    H.R. 1343 would authorize a grant program to allow 
integrated health systems to expand access to primary and 
preventive care for the medically underserved. The legislation 
defines eligible integrated health systems as public or non-
profit entities that serve a medically underserved population 
and deliver specific primary and preventive care services. The 
legislation would authorize the appropriation of $25 million a 
year for fiscal years 2009 through 2011. Based on information 
provided by the Health Resources and Services Administration, 
CBO estimates that implementing the grant program would cost $5 
million in 2009 and $75 million over the 2009-2013 period, 
assuming the appropriation of authorized amounts.
    Intergovernmental and private-sector impact: H.R. 1343 
contains no intergovernmental or private-sector mandates as 
defined in UMRA. Funds authorized in the bill would benefit 
local governments that participate in community health 
programs.
    Previous CBO estimate: On March 20, CBO released a cost 
estimate for S. 901, the Health Care Safety Net Act of 2007. 
Like H.R. 1343, S. 901 would authorize funding for health 
centers; however, S. 901 does not include the liability 
protection and demonstration provisions included in H.R. 1343. 
In addition, S. 901 would authorize funding for two other HRSA 
programs: the National Health Service Corps and Rural Health 
Outreach Grants.
    Estimate prepared by: Federal Costs: Lara Robillard; Impact 
on State, Local, and Tribal Governments: Lisa Ramirez-Branum; 
Impact on the Private Sector: Keisuke Nakagawa.
    Estimate approved by: Keith J. Fontenot, Deputy Assistant 
Director for Health and Human Resources, Budget Analysis 
Division.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 1343 prepared by the Director of the 
Congressional Budget Office pursuant to section 423 of the 
Unfunded Mandates Reform Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act would be created by H.R. 
1343.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that the 
Constitutional authority for H.R. 1343 is provided in Article 
I, section 8, clause 3, which grants Congress the power to 
regulate commerce with foreign nations, among the several 
States, and with the Indian Tribes, and in the provisions of 
Article I, section 8, clause 1, that relate to expending funds 
to provide for the general welfare of the United States.

                  Applicability to Legislative Branch

    The Committee finds that H.R. 1343 does not relate to the 
terms and conditions of employment or access to public services 
or accommodations within the meaning of section 102(b)(3) of 
the Congressional Accountability Act of 1995.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 specifies the short title of the legislation as 
the ``Health Centers Renewal Act of 2008.''

Section 2. Additional authorizations of appropriations for health 
        centers programs

    Section 2 sets forth the authorizations of appropriations 
for fiscal years 2008 through 2012.

Section 3. Recognition of high-poverty areas

    Section 3 authorizes the Secretary to acknowledge the 
unique needs of high-poverty areas for planning grants.

Section 4. Liability protections for health center volunteer 
        practitioners

    Section 4 grants liability protection for practitioners who 
volunteer at the centers. This provision would apply in the 
first fiscal year for which an appropriations Act made such 
funds available.

Section 5. Liability protections for health center practitioners 
        providing services in emergency areas

    Section 5 grants liability protection for practitioners 
who, under an arrangement with a qualified health center or 
with a Federal agency with responsibility for providing health 
services in the emergency area, travel to provide services in 
emergencies to individuals who are not patients of the 
community health center involved.

Section 6. Recognition of high-poverty areas

    Section 6 authorizes a demonstration project for integrated 
health systems to expand access to primary and preventive care 
for the medically underserved.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, existing law in which no change 
is proposed is shown in roman):

PUBLIC HEALTH SERVICE ACT

           *       *       *       *       *       *       *



         TITLE II--ADMINISTRATION AND MISCELLANEOUS PROVISIONS


Part A--Administration

           *       *       *       *       *       *       *



          defense of certain malpractice and negligence suits

  Sec. 224. (a) * * *

           *       *       *       *       *       *       *

  (g)(1)(A) For purposes of this section and subject to the 
approval by the Secretary of an application under subparagraph 
(D), an entity described in paragraph (4), and any officer, 
governing board member, [or employee] employee, or (subject to 
subsection (k)(4)) volunteer practitioner of such an entity, 
and any contractor of such an entity who is a physician or 
other licensed or certified health care practitioner (subject 
to paragraph (5)), shall be deemed to be an employee of the 
Public Health Service for a calendar year that begins during a 
fiscal year for which a transfer was made under subsection 
(k)(3) (subject to paragraph (3)). The remedy against the 
United States for an entity described in paragraph (4) and any 
officer, governing board member, [employee, or contractor] 
employee, volunteer practitioner, or contractor (subject to 
paragraph (5) and subsection (k)(4)) of such an entity who is 
deemed to be an employee of the Public Health Service pursuant 
to this paragraph shall be exclusive of any other civil action 
or proceeding to the same extent as the remedy against the 
United States is exclusive pursuant to subsection (a).
  (B) The deeming of any entity or officer, governing board 
member, [employee, or contractor] employee, volunteer 
practitioner, or contractor of the entity to be an employee of 
the Public Health Service for purposes of this section shall 
apply with respect to services provided--
          (i) to all patients of the entity, and
          (ii) subject to subparagraph (C) and paragraph (6), 
        to individuals who are not patients of the entity.
  (C) Subparagraph (B)(ii) applies to services provided to 
individuals who are not patients of an entity if the Secretary 
determines, after reviewing an application submitted under 
subparagraph (D), that the provision of the services to such 
individuals--
          (i) * * *

           *       *       *       *       *       *       *

          (iii) are otherwise required under an employment 
        contract (or similar arrangement) between the entity 
        and an officer, governing board member, [employee, or 
        contractor] employee, volunteer practitioner, or 
        contractor of the entity.
  (D) The Secretary may not under subparagraph (A) deem an 
entity or an officer, governing board member, [employee, or 
contractor] employee, volunteer practitioner, or contractor of 
the entity to be an employee of the Public Health Service for 
purposes of this section, and may not apply such deeming to 
services described in subparagraph (B)(ii), unless the entity 
has submitted an application for such deeming to the Secretary 
in such form and such manner as the Secretary shall prescribe. 
The application shall contain detailed information, along with 
supporting documentation, to verify that the entity, and the 
officer, governing board member, [employee, or contractor] 
employee, volunteer practitioner, or contractor of the entity, 
as the case may be, meets the requirements of subparagraphs (B) 
and (C) of this paragraph and that the entity meets the 
requirements of paragraphs (1) through (4) of subsection (h).
  (E) The Secretary shall make a determination of whether an 
entity or an officer, governing board member, [employee, or 
contractor] employee, volunteer practitioner, or contractor of 
the entity is deemed to be an employee of the Public Health 
Service for purposes of this section within 30 days after the 
receipt of an application under subparagraph (D). The 
determination of the Secretary that an entity or an officer, 
governing board member, [employee, or contractor] employee, 
volunteer practitioner, or contractor of the entity is deemed 
to be an employee of the Public Health Service for purposes of 
this section shall apply for the period specified by the 
Secretary under subparagraph (A).
  (F) Once the Secretary makes a determination that an entity 
or an officer, governing board member, [employee, or 
contractor] employee, volunteer practitioner, or contractor of 
an entity is deemed to be an employee of the Public Health 
Service for purposes of this section, the determination shall 
be final and binding upon the Secretary and the Attorney 
General and other parties to any civil action or proceeding. 
Except as provided in subsection (i), the Secretary and the 
Attorney General may not determine that the provision of 
services which are the subject of such a determination are not 
covered under this section.

           *       *       *       *       *       *       *

  (H) In the case of an entity described in paragraph (4) for 
which an application under subparagraph (D) is in effect, the 
entity may, through notifying the Secretary in writing, elect 
to terminate the applicability of this subsection to the 
entity. With respect to such election by the entity:
          (i) * * *
          (ii) Upon taking effect, the election terminates the 
        applicability of this subsection to the entity and each 
        officer, governing board member, [employee, and 
        contractor] employee, volunteer practitioner, and 
        contractor of the entity.

           *       *       *       *       *       *       *

          (iv) If after making the election the entity submits 
        an application under subparagraph (D), the election 
        does not preclude the Secretary from approving the 
        application (and thereby restoring the applicability of 
        this subsection to the entity and each officer, 
        governing board member, [employee, and contractor] 
        employee, volunteer practitioner, and contractor of the 
        entity, subject to the provisions of this subsection 
        and the subsequent provisions of this section.

           *       *       *       *       *       *       *

  (6)(A) Subject to subparagraph (C), paragraph (1)(B)(ii) 
applies to health services provided to individuals who are not 
patients of the entity involved if, as determined under 
criteria issued by the Secretary, the following conditions are 
met:
          (i) The services are provided by a contractor, 
        volunteer practitioner (as defined in subsection 
        (k)(4)(B)), or employee of the entity who is a 
        physician or other licensed or certified health care 
        practitioner and who is otherwise deemed to be an 
        employee for purposes of paragraph (1)(A) when 
        providing services with respect to the entity.
          (ii) The services are provided in an emergency area 
        (as defined in subparagraph (D)), with respect to a 
        public health emergency or major disaster described in 
        subparagraph (D), and during the period for which such 
        emergency or disaster is determined or declared, 
        respectively.
          (iii) The services of the contractor, volunteer 
        practitioner, or employee (referred to in this 
        paragraph as the ``out-of-area practitioner'') are 
        provided under an arrangement with--
                  (I) an entity that is deemed to be an 
                employee for purposes of paragraph (1)(A) and 
                that serves the emergency area involved 
                (referred to in this paragraph as an 
                ``emergency-area entity''); or
                  (II) a Federal agency that has 
                responsibilities regarding the provision of 
                health services in such area during the 
                emergency.
          (iv) The purposes of the arrangement are--
                  (I) to coordinate, to the extent practicable, 
                the provision of health services in the 
                emergency area by the out-of-area practitioner 
                with the provision of services by the 
                emergency-area entity, or by the Federal 
                agency, as the case may be;
                  (II) to identify a location in the emergency 
                area to which such practitioner should report 
                for purposes of providing health services, and 
                to identify an individual or individuals in the 
                area to whom the practitioner should report for 
                such purposes; and
                  (III) to verify the identity of the 
                practitioner and that the practitioner is 
                licensed or certified by one or more of the 
                States.
          (v) With respect to the licensure or certification of 
        health care practitioners, the provision of services by 
        the out-of-area practitioner in the emergency area is 
        not a violation of the law of the State in which the 
        area is located.
  (B) In issuing criteria under subparagraph (A), the Secretary 
shall take into account the need to rapidly enter into 
arrangements under such subparagraph in order to provide health 
services in emergency areas promptly after the emergency 
begins.
  (C) Subparagraph (A) applies with respect to an act or 
omission of an out-of-area practitioner only to the extent that 
the practitioner is not immune from liability for such act or 
omission under the Volunteer Protection Act of 1997.
  (D) For purposes of this paragraph, the term ``emergency 
area'' means a geographic area for which--
          (i) the Secretary has made a determination under 
        section 319 that a public health emergency exists; or
          (ii) a presidential declaration of major disaster has 
        been issued under section 401 of the Robert T. Stafford 
        Disaster Relief and Emergency Assistance Act.
  (h) The Secretary may not approve an application under 
subsection (g)(1)(D) unless the Secretary determines that the 
entity--
          (1) * * *

           *       *       *       *       *       *       *

          (3) has no history of claims having been filed 
        against the United States as a result of the 
        application of this section to the entity or its 
        officers, [employees, or contractors] employees, 
        volunteer practitioners, or contractors as provided for 
        under this section, or, if such a history exists, has 
        fully cooperated with the Attorney General in defending 
        against any such claims and either has taken, or will 
        take, any necessary corrective steps to assure against 
        such claims in the future; and
          (4) will fully cooperate with the Attorney General in 
        providing information relating to an estimate described 
        under subsection (k).
  (i)(1) Notwithstanding subsection (g)(1), the Attorney 
General, in consultation with the Secretary, may on the record 
determine, after notice and opportunity for a full and fair 
hearing, that an individual physician or other licensed or 
certified health care practitioner who is an officer, 
[employee, or contractor] employee, volunteer practitioner, or 
contractor of an entity described in subsection (g)(4) shall 
not be deemed to be an employee of the Public Health Service 
for purposes of this section, if treating such individual as 
such an employee would expose the Government to an unreasonably 
high degree of risk of loss because such individual--
          (A) * * *

           *       *       *       *       *       *       *

  (j) In the case of a health care provider who is an officer, 
[employee, or contractor] employee, volunteer practitioner, or 
contractor of an entity described in subsection (g)(4), section 
335(e) shall apply with respect to the provider to the same 
extent and in the same manner as such section applies to any 
member of the National Health Service Corps.
  (k)(1)(A) For each fiscal year, the Attorney General, in 
consultation with the Secretary, shall estimate by the 
beginning of the year the amount of all claims which are 
expected to arise under this section (together with related 
fees and expenses of witnesses) for which payment is expected 
to be made in accordance with section 1346 and chapter 171 of 
title 28, United States Code, from the acts or omissions, 
during the calendar year that begins during that fiscal year, 
of entities described in subsection (g)(4) and of officers, 
[employees, or contractors] employees, volunteer practitioners, 
or contractors (subject to subsection (g)(5)) of such entities.
  (B) The estimate under subparagraph (A) shall take into 
account--
          (i) the value and frequency of all claims for damage 
        for personal injury, including death, resulting from 
        the performance of medical, surgical, dental, or 
        related functions by entities described in subsection 
        (g)(4) or by officers, [employees, or contractors] 
        employees, volunteer practitioners, or contractors 
        (subject to subsection (g)(5)) of such entities who are 
        deemed to be employees of the Public Health Service 
        under subsection (g)(1) that, during the preceding 5-
        year period, are filed under this section or, with 
        respect to years occurring before this subsection takes 
        effect, are filed against persons other than the United 
        States,

           *       *       *       *       *       *       *

  (3) In order for payments to be made for judgments against 
the United States (together with related fees and expenses of 
witnesses) pursuant to this section arising from the acts or 
omissions of entities described in subsection (g)(4) and of 
officers, [employees, or contractors] employees, volunteer 
practitioners, or contractors (subject to subsection (g)(5)) of 
such entities, the total amount contained within the fund 
established by the Secretary under paragraph (2) for a fiscal 
year shall be transferred not later than the December 31 that 
occurs during the fiscal year to the appropriate accounts in 
the Treasury.
  (4)(A) Subsections (g) through (m) apply with respect to 
volunteer practitioners beginning with the first fiscal year 
for which an appropriations Act provides that amounts in the 
fund under paragraph (2) are available with respect to such 
practitioners.
  (B) For purposes of subsections (g) through (m), the term 
``volunteer practitioner'' means a practitioner who, with 
respect to an entity described in subsection (g)(4), meets the 
following conditions:
          (i) In the State involved, the practitioner is a 
        licensed physician, a licensed clinical psychologist, 
        or other licensed or certified health care 
        practitioner.
          (ii) At the request of such entity, the practitioner 
        provides services to patients of the entity, at a site 
        at which the entity operates or at a site designated by 
        the entity. The weekly number of hours of services 
        provided to the patients by the practitioner is not a 
        factor with respect to meeting conditions under this 
        subparagraph.
          (iii) The practitioner does not for the provision of 
        such services receive any compensation from such 
        patients, from the entity, or from third-party payors 
        (including reimbursement under any insurance policy or 
        health plan, or under any Federal or State health 
        benefits program).
  (l)(1) If a civil action or proceeding is filed in a State 
court against any entity described in subsection (g)(4) or any 
officer, governing board member, [employee, or any contractor] 
employee, volunteer practitioner, or contractor of such an 
entity for damages described in subsection (a), the Attorney 
General, within 15 days after being notified of such filing, 
shall make an appearance in such court and advise such court as 
to whether the Secretary has determined under subsections (g) 
and (h), that such entity, officer, governing board member, 
[employee, or contractor] employee, volunteer practitioner, or 
contractor of the entity is deemed to be an employee of the 
Public Health Service for purposes of this section with respect 
to the actions or omissions that are the subject of such civil 
action or proceeding. Such advice shall be deemed to satisfy 
the provisions of subsection (c) that the Attorney General 
certify that an entity, officer, governing board member, 
[employee, or contractor] employee, volunteer practitioner, or 
contractor of the entity was acting within the scope of their 
employment or responsibility.
  (2) If the Attorney General fails to appear in State court 
within the time period prescribed under paragraph (1), upon 
petition of any entity or officer, governing board member, 
[employee, or contractor] employee, volunteer practitioner, or 
contractor of the entity named, the civil action or proceeding 
shall be removed to the appropriate United States district 
court. The civil action or proceeding shall be stayed in such 
court until such court conducts a hearing, and makes a 
determination, as to the appropriate forum or procedure for the 
assertion of the claim for damages described in subsection (a) 
and issues an order consistent with such determination.
  (m)(1) An entity or officer, governing board member, 
[employee, or contractor] employee, volunteer practitioner, or 
contractor of an entity described in subsection (g)(1) shall, 
for purposes of this section, be deemed to be an employee of 
the Public Health Service with respect to services provided to 
individuals who are enrollees of a managed care plan if the 
entity contracts with such managed care plan for the provision 
of services.
  (2) Each managed care plan which enters into a contract with 
an entity described in subsection (g)(4) shall deem the entity 
and any officer, governing board member, [employee, or 
contractor] employee, volunteer practitioner, or contractor of 
the entity as meeting whatever malpractice coverage 
requirements such plan may require of contracting providers for 
a calendar year if such entity or officer, governing board 
member, [employee, or contractor] employee, volunteer 
practitioner, or contractor of the entity has been deemed to be 
an employee of the Public Health Service for purposes of this 
section for such calendar year. Any plan which is found by the 
Secretary on the record, after notice and an opportunity for a 
full and fair hearing, to have violated this subsection shall 
upon such finding cease, for a period to be determined by the 
Secretary, to receive and to be eligible to receive any Federal 
funds under titles XVIII or XIX of the Social Security Act.

           *       *       *       *       *       *       *


TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE

           *       *       *       *       *       *       *


                      Part D--Primary Health Care

                       Subpart I--Health Centers

SEC. 330.  HEALTH CENTERS.

  (a) * * *

           *       *       *       *       *       *       *

  (c) Planning Grants.--
          (1) * * *

           *       *       *       *       *       *       *

          (3) Recognition of high poverty areas.--
                  (A) In general.--In making grants under this 
                subsection, the Secretary may recognize the 
                unique needs of high poverty areas.
                  (B) High poverty area defined.--For purposes 
                of subparagraph (A), the term ``high poverty 
                area'' means a catchment area which is 
                established in a manner that is consistent with 
                the factors in subsection (k)(3)(J), and the 
                poverty rate of which is greater than the 
                national average poverty rate as determined by 
                the Bureau of the Census.

           *       *       *       *       *       *       *

  (r) Authorization of Appropriations.--
          [(1) In general.--For the purpose of carrying out 
        this section, in addition to the amounts authorized to 
        be appropriated under subsection (d), there are 
        authorized to be appropriated $1,340,000,000 for fiscal 
        year 2002 and such sums as may be necessary for each of 
        the fiscal years 2003 through 2006.]
          (1) In general.--For the purpose of carrying out this 
        section, in addition to the amounts authorized to be 
        appropriated under subsection (d), there are authorized 
        to be appropriated--
                  (A) for fiscal year 2008, $2,213,020,000;
                  (B) for fiscal year 2009, $2,451,394,400;
                  (C) for fiscal year 2010, $2,757,818,700;
                  (D) for fiscal year 2011, $3,116,335,131; and
                  (E) for fiscal year 2012, $3,537,040,374.

           *       *       *       *       *       *       *


  Subpart XI--Demonstration Project for Integrated Health Systems to 
  Expand Access to Primary and Preventive Services for the Medically 
                              Underserved

SEC. 340H. DEMONSTRATION PROJECT FOR INTEGRATED HEALTH SYSTEMS TO 
                    EXPAND ACCESS TO PRIMARY AND PREVENTIVE CARE FOR 
                    THE MEDICALLY UNDERSERVED.

  (a) Establishment of Demonstration.--
          (1) In general.--Not later than January 1, 2009, the 
        Secretary shall establish a demonstration project 
        (hereafter in this section referred to as the 
        ``demonstration'') under which up to 30 qualifying 
        integrated health systems receive grants for the costs 
        of their operations to expand access to primary and 
        preventive services for the medically underserved.
          (2) Rule of construction.--Nothing in this section 
        shall be construed as authorizing grants to be made or 
        used for the costs of specialty care or hospital care 
        furnished by an integrated health system.
  (b) Application.--Any integrated health system desiring to 
participate in the demonstration shall submit an application in 
such manner, at such time, and containing such information as 
the Secretary may require.
  (c) Criteria for Selection.--In selecting integrated health 
systems to participate in the demonstration (hereafter in this 
section referred to as ``participating integrated health 
systems''), the Secretary shall ensure representation of 
integrated health systems that are located in a variety of 
States (including the District of Columbia and the territories 
and possessions of the United States) and locations within 
States, including rural areas, inner-city areas, and frontier 
areas.
  (d) Duration.--Subject to the availability of appropriations, 
the demonstration shall be conducted (and operating grants be 
made to each participating integrated health system) for a 
period of 3 years.
  (e) Reports.--
          (1) In general.--The Secretary shall submit to the 
        appropriate committees of the Congress interim and 
        final reports with respect to the demonstration, with 
        an interim report being submitted not later than 3 
        months after the demonstration has been in operation 
        for 24 months and a final report being submitted not 
        later than 3 months after the close of the 
        demonstration.
          (2) Content.--Such reports shall evaluate the 
        effectiveness of the demonstration in providing greater 
        access to primary and preventive care for medically 
        underserved populations, and how the coordinated 
        approach offered by integrated health systems 
        contributes to improved patient outcomes.
  (f) Authorization of Appropriations.--
          (1) In general.--There is authorized to be 
        appropriated $25,000,000 for each of the fiscal years 
        2009, 2010, and 2011 to carry out this section.
          (2) Construction.--Nothing in this section shall be 
        construed as requiring or authorizing a reduction in 
        the amounts appropriated for grants to health centers 
        under section 330 for the fiscal years referred to in 
        paragraph (1).
  (g) Definitions.--For purposes of this section:
          (1) Frontier area.--The term ``frontier area'' has 
        the meaning given to such term in regulations 
        promulgated pursuant to section 330I(r).
          (2) Integrated health system.--The term ``integrated 
        health system'' means a health system that--
                  (A) has a demonstrated capacity and 
                commitment to provide a full range of primary 
                care, specialty care, and hospital care in both 
                inpatient and outpatient settings; and
                  (B) is organized to provide such care in a 
                coordinated fashion.
          (3) Qualifying integrated health system.--
                  (A) In general.--The term ``qualifying 
                integrated health system'' means a public or 
                private nonprofit entity that is an integrated 
                health system that meets the requirements of 
                subparagraph (B) and serves a medically 
                underserved population (either through the 
                staff and supporting resources of the 
                integrated health system or through contracts 
                or cooperative arrangements) by providing--
                          (i) required primary and preventive 
                        health and related services (as defined 
                        in paragraph (4)); and
                          (ii) as may be appropriate for a 
                        population served by a particular 
                        integrated health system, integrative 
                        health services (as defined in 
                        paragraph (5)) that are necessary for 
                        the adequate support of the required 
                        primary and preventive health and 
                        related services and that improve care 
                        coordination.
                  (B) Other requirements.--The requirements of 
                this subparagraph are that the integrated 
                health system--
                          (i) will make the required primary 
                        and preventive health and related 
                        services of the integrated health 
                        system available and accessible in the 
                        service area of the integrated health 
                        system promptly, as appropriate, and in 
                        a manner which assures continuity;
                          (ii) will demonstrate financial 
                        responsibility by the use of such 
                        accounting procedures and other 
                        requirements as may be prescribed by 
                        the Secretary;
                          (iii) provides or will provide 
                        services to individuals who are 
                        eligible for medical assistance under 
                        title XIX of the Social Security Act or 
                        for assistance under title XXI of such 
                        Act;
                          (iv) has prepared a schedule of fees 
                        or payments for the provision of its 
                        services consistent with locally 
                        prevailing rates or charges and 
                        designed to cover its reasonable costs 
                        of operation and has prepared a 
                        corresponding schedule of discounts to 
                        be applied to the payment of such fees 
                        or payments, which discounts are 
                        adjusted on the basis of the patient's 
                        ability to pay;
                          (v) will assure that no patient will 
                        be denied health care services due to 
                        an individual's inability to pay for 
                        such services;
                          (vi) will assure that any fees or 
                        payments required by the system for 
                        such services will be reduced or waived 
                        to enable the system to fulfill the 
                        assurance described in clause (v);
                          (vii) provides assurances that any 
                        grant funds will be expended to 
                        supplement, and not supplant, the 
                        expenditures of the integrated health 
                        system for primary and preventive 
                        health services for the medically 
                        underserved; and
                          (viii) submits to the Secretary such 
                        reports as the Secretary may require to 
                        determine compliance with this 
                        subparagraph.
                  (C) Treatment of certain entities.--The term 
                ``qualifying integrated health system'' may 
                include a nurse-managed health clinic if such 
                clinic meets the requirements of subparagraphs 
                (A) and (B) (except those requirements that 
                have been waived under paragraph (4)(B)).h 
                (4)(B)).
          (4) Required primary and preventive health and 
        related services.--
                  (A) In general.--Except as provided in 
                subparagraph (B), the term ``required primary 
                and preventive health and related services'' 
                means basic health services consisting of--
                          (i) health services related to family 
                        medicine, internal medicine, 
                        pediatrics, obstetrics, or gynecology 
                        that are furnished by physicians where 
                        appropriate, physician assistants, 
                        nurse practitioners, and nurse 
                        midwives;
                          (ii) diagnostic laboratory services 
                        and radiologic services;
                          (iii) preventive health services, 
                        including prenatal and perinatal care; 
                        appropriate cancer screening; well-
                        child services; immunizations against 
                        vaccine-preventable diseases; 
                        screenings for elevated blood lead 
                        levels, communicable diseases, and 
                        cholesterol; pediatric eye, ear, and 
                        dental screenings to determine the need 
                        for vision and hearing correction and 
                        dental care; and voluntary family 
                        planning services;
                          (iv) emergency medical services; and
                          (v) pharmaceutical services, 
                        behavioral, mental health, and 
                        substance abuse services, preventive 
                        dental services, and recuperative care, 
                        as may be appropriate.
                  (B) Exception.--In the case of an integrated 
                health system serving a targeted population, 
                the Secretary shall, upon a showing of good 
                cause, waive the requirement that the 
                integrated health system provide each required 
                primary and preventive health and related 
                service under this paragraph if the Secretary 
                determines one or more such services are 
                inappropriate or unnecessary for such 
                population.
          (5) Integrative health services.--The term 
        ``integrative health services'' means services that are 
        not included as required primary and preventive health 
        and related services and are associated with achieving 
        the greater integration of a health care delivery 
        system to improve patient care coordination so that the 
        system either directly provides or ensures the 
        provision of a broad range of culturally competent 
        services. Integrative health services include but are 
        not limited to the following:
                  (A) Outreach activities.
                  (B) Case management and patient navigation 
                services.
                  (C) Chronic care management.
                  (D) Transportation to health care facilities.
                  (E) Development of provider networks and 
                other innovative models to engage local 
                physicians and other providers to serve the 
                medically underserved within a community.
                  (F) Recruitment, training, and compensation 
                of necessary personnel.
                  (G) Acquisition of technology for the purpose 
                of coordinating care.
                  (H) Improvements to provider communication, 
                including implementation of shared information 
                systems or shared clinical systems.
                  (I) Determination of eligibility for Federal, 
                State, and local programs that provide, or 
                financially support the provision of, medical, 
                social, housing, educational, or other related 
                services.
                  (J) Development of prevention and disease 
                management tools and processes.
                  (K) Translation services.
                  (L) Development and implementation of 
                evaluation measures and processes to assess 
                patient outcomes.
                  (M) Integration of primary care and mental 
                health services.
                  (N) 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.
          (6) Specialty care.--The term ``specialty care'' 
        means care that is provided through a referral and by a 
        physician or nonphysician practitioner, such as 
        surgical consultative services, radiology services 
        requiring the immediate presence of a physician, 
        audiology, optometric services, cardiology services, 
        magnetic resonance imagery (MRI) services, computerized 
        axial tomography (CAT) scans, nuclear medicine studies, 
        and ambulatory surgical services.
          (7) Nurse-managed health clinic.--The term ``nurse-
        managed health clinic'' means a nurse-practice 
        arrangement, managed by advanced practice nurses, that 
        provides care for underserved and vulnerable 
        populations and is associated with a school, college, 
        or department of nursing or an independent nonprofit 
        health or social services agency.

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