[107th Congress Public Law 251]
[From the U.S. Government Printing Office]


<DOC>
[DOCID: f:publ251.107]


[[Page 116 STAT. 1621]]

Public Law 107-251
107th Congress

                                 An Act


 
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. <<NOTE: Oct. 26, 2002 -  [S. 1533]>> 

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress <<NOTE: Health Care Safety Net 
Amendments of 2002.>> assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This <<NOTE: 42 USC 201 note.>> 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.

[[Page 116 STAT. 1622]]

              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;'';
            (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

[[Page 116 STAT. 1623]]

                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.

[[Page 116 STAT. 1624]]

                    ``(E) Federal credit reform.--The requirements of 
                the Federal Credit Reform Act of 1990 (2 U.S.C. 661 et 
                seq.) shall apply with respect to loans refinanced under 
                subparagraph (B)(iii).''; and
                    (C)(i) by striking paragraphs (6) and (7); and
                    (ii) by redesignating paragraph (8) as paragraph 
                (6);
            (4) in subsection (e)--
                    (A) in paragraph (1)--
                          (i) in subparagraph (B), by striking 
                      ``subsection (j)(3)'' and inserting ``subsection 
                      (k)(3)''; and
                          (ii) by adding at the end the following:
                    ``(C) Operation of networks and plans.--The 
                Secretary may make grants to health centers that receive 
                assistance under this section, or at the request of the 
                health centers, directly to a network or plan (as 
                described in subparagraphs (B) and (C) of subsection 
                (c)(1)) that is at least majority controlled and, as 
                applicable, at least majority owned by such health 
                centers receiving assistance under this section, for the 
                costs associated with the operation of such network or 
                plan, including the purchase or lease of equipment 
                (including the costs of amortizing the principal of, and 
                paying the interest on, loans for equipment).'';
                    (B) in paragraph (5)--
                          (i) in subparagraph (A), by inserting 
                      ``subparagraphs (A) and (B) of'' after ``any 
                      fiscal year under'';
                          (ii) by redesignating subparagraphs (B) and 
                      (C) as subparagraphs (C) and (D), respectively; 
                      and
                          (iii) by inserting after subparagraph (A) the 
                      following:
                    ``(B) Networks and plans.--The total amount of grant 
                funds made available for any fiscal year under paragraph 
                (1)(C) and subparagraphs (B) and (C) of subsection 
                (c)(1) to a health center or to a network or plan shall 
                be determined by the Secretary, but may not exceed 2 
                percent of the total amount appropriated under this 
                section for such fiscal year.''; and
                    (C) by redesignating paragraphs (4) and (5) as 
                paragraphs (3) and (4), respectively;
            (5) in subsection (g)--
                    (A) in paragraph (2)--
                          (i) in subparagraph (A), by inserting ``and 
                      seasonal agricultural worker'' after 
                      ``agricultural worker''; and
                          (ii) in subparagraph (B), by striking ``and 
                      members of their families'' and inserting ``and 
                      seasonal agricultural workers, and members of 
                      their families,''; and
                    (B) in paragraph (3)(A), by striking ``on a seasonal 
                basis'';
            (6) in subsection (h)--
                    (A) in paragraph (1), by striking ``homeless 
                children and children at risk of homelessness'' and 
                inserting ``homeless children and youth and children and 
                youth at risk of homelessness'';
                    (B)(i) by redesignating paragraph (4) as paragraph 
                (5); and
                    (ii) by inserting after paragraph (3) the following:

[[Page 116 STAT. 1625]]

            ``(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;

[[Page 116 STAT. 1626]]

            (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

[[Page 116 STAT. 1627]]

        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. <<NOTE: 42 USC 254c-17.>> 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 116 STAT. 1628]]

                         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.

[[Page 116 STAT. 1629]]

                    ``(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

[[Page 116 STAT. 1630]]

                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

[[Page 116 STAT. 1631]]

                    ``(G) other such information as the Secretary 
                determines to be appropriate.

    ``(g) Small Health Care Provider Quality Improvement Grants.--
            ``(1) Grants.--The Director may award grants to provide for 
        the planning and implementation of small health care provider 
        quality improvement activities. The Director may award the 
        grants for periods of 1 to 3 years.
            ``(2) Eligibility.--To be eligible for a grant under this 
        subsection, an entity--
                    ``(A)(i) shall be a rural public or rural nonprofit 
                private health care provider or provider of health care 
                services, such as a critical access hospital or a rural 
                health clinic; or
                    ``(ii) shall be another rural provider or network of 
                small rural providers identified by the Secretary as a 
                key source of local care; and
                    ``(B) shall not previously have received a grant 
                under this subsection for the same or a similar project.
            ``(3) Applications.--To be eligible to receive a grant under 
        this subsection, an eligible entity, in consultation with the 
        appropriate State office of rural health or another appropriate 
        State entity shall prepare and submit to the Secretary an 
        application, at such time, in such manner, and containing such 
        information as the Secretary may require, including--
                    ``(A) a description of the project that the eligible 
                entity will carry out using the funds provided under the 
                grant;
                    ``(B) an explanation of the reasons why Federal 
                assistance is required to carry out the project;
                    ``(C) a description of the manner in which the 
                project funded under the grant will assure continuous 
                quality improvement in the provision of services by the 
                entity;
                    ``(D) a description of how the local community or 
                region to be served will experience increased access to 
                quality health care services across the continuum of 
                care as a result of the activities carried out by the 
                entity;
                    ``(E) a plan for sustaining the project after 
                Federal support for the project has ended;
                    ``(F) a description of how the project will be 
                evaluated; and
                    ``(G) other such information as the Secretary 
                determines to be appropriate.
            ``(4) Expenditures for small health care provider quality 
        improvement grants.--In awarding a grant under this subsection, 
        the Director shall ensure that the funds made available through 
        the grant will be used to provide services to residents of rural 
        areas. The Director shall award not less than 50 percent of the 
        funds made available under this subsection to providers located 
        in and serving rural areas.

    ``(h) General Requirements.--
            ``(1) Prohibited uses of funds.--An entity that receives a 
        grant under this section may not use funds provided through the 
        grant--
                    ``(A) to build or acquire real property; or
                    ``(B) for construction.
            ``(2) Coordination with other agencies.--The Secretary shall 
        coordinate activities carried out under grant programs

[[Page 116 STAT. 1632]]

        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 <<NOTE: Deadline.>> 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 <<NOTE: Telehealth Grant Consolidation Act of 
2002.>> Grant Consolidation

SEC. 211. <<NOTE: 42 USC 201 note.>> 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. <<NOTE: 42 USC 254c-14.>> 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

[[Page 116 STAT. 1633]]

        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):

[[Page 116 STAT. 1634]]

                                    ``(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

[[Page 116 STAT. 1635]]

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. <<NOTE: Publication. Notice.>> The Secretary shall 
publish, in a publication of the Health Resources and Services 
Administration, notice of the application requirements for each grant 
program described in subsection (b) for each fiscal year.

    ``(i) Preferences.--
            ``(1) Telehealth networks.--In awarding grants under 
        subsection (d)(1) for projects involving telehealth networks, 
        the Secretary shall give preference to an eligible entity that 
        meets at least 1 of the following requirements:
                    ``(A) Organization.--The eligible entity is a rural 
                community-based organization or another community-based 
                organization.
                    ``(B) Services.--The eligible entity proposes to use 
                Federal funds made available through such a grant to 
                develop plans for, or to establish, telehealth networks 
                that provide mental health, public health, long-term 
                care, home care, preventive, or case management 
                services.
                    ``(C) Coordination.--The eligible entity 
                demonstrates how the project to be carried out under the 
                grant will be coordinated with other relevant federally 
                funded projects in the areas, communities, and 
                populations to be served through the grant.
                    ``(D) Network.--The eligible entity demonstrates 
                that the project involves a telehealth network that 
                includes an entity that--
                          ``(i) provides clinical health care services, 
                      or educational services for health care providers 
                      and for patients or their families; and
                          ``(ii) is--
                                    ``(I) a public library;
                                    ``(II) an institution of higher 
                                education; or
                                    ``(III) a local government entity.
                    ``(E) Connectivity.--The eligible entity proposes a 
                project that promotes local connectivity within areas, 
                communities, or populations to be served through the 
                project.
                    ``(F) Integration.--The eligible entity demonstrates 
                that health care information has been integrated into 
                the project.
            ``(2) Telehealth resource centers.--In awarding grants under 
        subsection (d)(2) for projects involving telehealth resource 
        centers, the Secretary shall give preference to an eligible 
        entity that meets at least 1 of the following requirements:
                    ``(A) Provision of services.--The eligible entity 
                has a record of success in the provision of telehealth 
                services to medically underserved areas or medically 
                underserved populations.
                    ``(B) Collaboration and sharing of expertise.--The 
                eligible entity has a demonstrated record of 
                collaborating and sharing expertise with providers of 
                telehealth services at the national, regional, State, 
                and local levels.
                    ``(C) Broad range of telehealth services.--The 
                eligible entity has a record of providing a broad range 
                of telehealth services, which may include--
                          ``(i) a variety of clinical specialty 
                      services;

[[Page 116 STAT. 1636]]

                          ``(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;

[[Page 116 STAT. 1637]]

                    ``(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.

[[Page 116 STAT. 1638]]

    ``(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 <<NOTE: Deadline.>> 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:

[[Page 116 STAT. 1639]]

``SEC. 330J. <<NOTE: 42 USC 254c-15.>> RURAL EMERGENCY MEDICAL 
                            SERVICE TRAINING AND EQUIPMENT 
                            ASSISTANCE PROGRAM.

    ``(a) Grants.--The Secretary, acting through the Administrator of 
the Health Resources and Services Administration (referred to in this 
section as the `Secretary') shall award grants to eligible entities to 
enable such entities to provide for improved emergency medical services 
in rural areas.
    ``(b) Eligibility.--To be eligible to receive a grant under this 
section, an entity shall--
            ``(1) be--
                    ``(A) a State emergency medical services office;
                    ``(B) a State emergency medical services 
                association;
                    ``(C) a State office of rural health;
                    ``(D) a local government entity;
                    ``(E) a State or local ambulance provider; or
                    ``(F) any other entity determined appropriate by the 
                Secretary; and
            ``(2) prepare and submit to the Secretary an application at 
        such time, in such manner, and containing such information as 
        the Secretary may require, that includes--
                    ``(A) a description of the activities to be carried 
                out under the grant; and
                    ``(B) an assurance that the eligible entity will 
                comply with the matching requirement of subsection (e).

    ``(c) Use of Funds.--An entity shall use amounts received under a 
grant made under subsection (a), either directly or through grants to 
emergency medical service squads that are located in, or that serve 
residents of, a nonmetropolitan statistical area, an area designated as 
a rural area by any law or regulation of a State, or a rural census 
tract of a metropolitan statistical area (as determined under the most 
recent Goldsmith Modification, originally published in a notice of 
availability of funds in the Federal Register on February 27, 1992, 57 
Fed. Reg. 6725), to--
            ``(1) recruit emergency medical service personnel;
            ``(2) recruit volunteer emergency medical service personnel;
            ``(3) train emergency medical service personnel in emergency 
        response, injury prevention, safety awareness, and other topics 
        relevant to the delivery of emergency medical services;
            ``(4) fund specific training to meet Federal or State 
        certification requirements;
            ``(5) develop new ways to educate emergency health care 
        providers through the use of technology-enhanced educational 
        methods (such as distance learning);
            ``(6) acquire emergency medical services equipment, 
        including cardiac defibrillators;
            ``(7) acquire personal protective equipment for emergency 
        medical services personnel as required by the Occupational 
        Safety and Health Administration; and
            ``(8) educate the public concerning cardiopulmonary 
        resuscitation, first aid, injury prevention, safety awareness, 
        illness prevention, and other related emergency preparedness 
        topics.

    ``(d) Preference.--In awarding grants under this section the 
Secretary shall give preference to--
            ``(1) applications that reflect a collaborative effort by 2 
        or more of the entities described in subparagraphs (A) through 
        (F) of subsection (b)(1); and

[[Page 116 STAT. 1640]]

            ``(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. <<NOTE: 42 USC 254c-16.>> 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.

[[Page 116 STAT. 1641]]

            ``(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,

[[Page 116 STAT. 1642]]

in such manner, and containing such information as the Secretary 
determines to be reasonable.
    ``(f) Report.--Not <<NOTE: Deadline.>> later than 4 years after the 
date of enactment of the Health Care Safety Net Amendments of 2002, the 
Secretary shall prepare and submit to the appropriate committees of 
Congress a report that shall evaluate activities funded with grants 
under this section.

    ``(g) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, $20,000,000 for fiscal year 2002 
and such sums as may be necessary for fiscal years 2003 through 2006.''.

            TITLE III--NATIONAL HEALTH SERVICE CORPS PROGRAM

SEC. 301. NATIONAL HEALTH SERVICE CORPS.

    (a) In General.--Section 331 of the Public Health Service Act (42 
U.S.C. 254d) is amended--
            (1) by adding at the end of subsection (a)(3) the following:
            ``(E)(i) The term `behavioral and mental health 
        professionals' means health service psychologists, licensed 
        clinical social workers, licensed professional counselors, 
        marriage and family therapists, psychiatric nurse specialists, 
        and psychiatrists.
            ``(ii) The term `graduate program of behavioral and mental 
        health' means a program that trains behavioral and mental health 
        professionals.'';
            (2) in subsection (b)--
                    (A) in paragraph (1), by striking ``health 
                professions'' and inserting ``health professions, 
                including schools at which graduate programs of 
                behavioral and mental health are offered,''; and
                    (B) in paragraph (2), by inserting ``behavioral and 
                mental health professionals,'' after ``dentists,''; and
            (3) by striking subsection (c) and inserting the following:

    ``(c)(1) The Secretary may reimburse an applicant for a position in 
the Corps (including an individual considering entering into a written 
agreement pursuant to section 338D) for the actual and reasonable 
expenses incurred in traveling to and from the applicant's place of 
residence to an eligible site to which the applicant may be assigned 
under section 333 for the purpose of evaluating such site with regard to 
being assigned at such site. The Secretary may establish a maximum total 
amount that may be paid to an individual as reimbursement for such 
expenses.
    ``(2) The Secretary may also reimburse the applicant for the actual 
and reasonable expenses incurred for the travel of 1 family member to 
accompany the applicant to such site. The Secretary may establish a 
maximum total amount that may be paid to an individual as reimbursement 
for such expenses.
    ``(3) In the case of an individual who has entered into a contract 
for obligated service under the Scholarship Program or under the Loan 
Repayment Program, the Secretary may reimburse such individual for all 
or part of the actual and reasonable expenses incurred in transporting 
the individual, the individual's family, and the family's possessions to 
the site of the individual's assignment under section 333. The Secretary 
may establish a maximum total amount

[[Page 116 STAT. 1643]]

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

[[Page 116 STAT. 1644]]

                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) <<NOTE: 42 USC 254e note.>> 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 <<NOTE: 42 USC 254l note.>> 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 <<NOTE: 42 USC 254e note.>> 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

[[Page 116 STAT. 1645]]

        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 <<NOTE: Deadline. 42 USC 254e note.>> 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

[[Page 116 STAT. 1646]]

                                    (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 <<NOTE: Publication.>> Secretary 
        shall prepare and publish a proposed list of health professional 
        shortage areas and entities that would receive priority under 
        subsection (a)(1) in the assignment of Corps members. The list 
        shall contain the information described in paragraph (2), and 
        the relative scores and relative priorities of the entities 
        submitting applications under section 333, in a proposed format. 
        All such entities shall have 30 days after the date of 
        publication of the list to provide additional data and 
        information in support of inclusion on the list or in support of 
        a higher priority determination and the Secretary shall 
        reasonably consider such data and information in preparing the 
        final list under paragraph (2).'';
                    (C) in paragraph (2) (as redesignated by 
                subparagraph (A)), in the matter before subparagraph 
                (A)--
                          (i) by striking ``paragraph (2)'' and 
                      inserting ``paragraph (3)'';
                          (ii) by striking ``prepare a list of health 
                      professional shortage areas'' and inserting 
                      ``prepare and, as appropriate, update a list of 
                      health professional shortage areas and entities''; 
                      and
                          (iii) by striking ``for the period applicable 
                      under subsection (f)'';
                    (D) by striking paragraph (3) (as redesignated by 
                subparagraph (A)) and inserting the following:
            ``(3) Notification of affected parties.--
                    ``(A) Entities.--Not <<NOTE: Deadline.>> 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.

[[Page 116 STAT. 1647]]

                    ``(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 <<NOTE: Notification.>> 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 <<NOTE: Deadline.>> 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. <<NOTE: 42 USC 254g.>> 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--

[[Page 116 STAT. 1648]]

                    ``(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''.

[[Page 116 STAT. 1649]]

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

[[Page 116 STAT. 1650]]

            (6) by striking subsection (i).
SEC. 310. NATIONAL HEALTH SERVICE CORPS LOAN REPAYMENT PROGRAM.

    Section 338B of the Public Health Service Act (42 U.S.C. 254l-1) is 
amended--
            (1) in subsection (a)--
                    (A) in paragraph (1), by inserting ``behavioral and 
                mental health professionals,'' after ``dentists,''; and
                    (B) in paragraph (2), by striking ``(including 
                mental health professionals)'';
            (2) in subsection (b)(1), by striking subparagraph (A) and 
        inserting the following:
            ``(A) have a degree in medicine, osteopathic medicine, 
        dentistry, or another health profession, or an appropriate 
        degree from a graduate program of behavioral and mental health, 
        or be certified as a nurse midwife, nurse practitioner, or 
        physician assistant;'';
            (3) in subsection (e), by striking ``(1) In general.--''; 
        and
            (4) by striking subsection (i).

SEC. 311. OBLIGATED SERVICE.

    Section 338C of the Public Health Service Act (42 U.S.C. 254m) is 
amended--
    (1) in subsection (b)--
                    (A) in paragraph (1), in the matter preceding 
                subparagraph (A), by striking ``section 
                338A(f)(1)(B)(iv)'' and inserting ``section 
                338A(f)(1)(B)(v)''; and
                    (B) in paragraph (5)--
                          (i) by striking all that precedes subparagraph 
                      (C) and inserting the following:

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

SEC. 312. PRIVATE PRACTICE.

    Section 338D of the Public Health Service Act (42 U.S.C. 254n) is 
amended by striking subsection (b) and inserting the following:
    ``(b)(1) The written agreement described in subsection (a) shall--

[[Page 116 STAT. 1651]]

            ``(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) <<NOTE: Deadline.>> 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.'';

[[Page 116 STAT. 1652]]

                    (B) by striking paragraphs (2) and (3) and inserting 
                the following:

    ``(2) <<NOTE: Deadline.>> 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 <<NOTE: 42 USC 254o note.>> 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.''.

[[Page 116 STAT. 1653]]

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. <<NOTE: 42 USC 254t.>> 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

[[Page 116 STAT. 1654]]

                    ``(B) such physician or other health professional 
                will provide obligated service at such site concurrently 
                with the individual receiving assistance under this 
                section.
            ``(3) Rules of construction.--
                    ``(A) Supervision of individuals.--Nothing in this 
                section shall be construed to require or imply that a 
                physician or other health professional licensed to 
                prescribe drugs must supervise an individual receiving 
                assistance under the demonstration project under this 
                section, with respect to such project.
                    ``(B) Licensure of health professionals.--Nothing in 
                this section shall be construed to supersede State law 
                regarding licensure of health professionals.

    ``(d) Designations.--The demonstration project described in this 
section, and any providers who are selected to participate in such 
project, shall not be considered by the Secretary in the designation of 
a health professional shortage area under section 332 during fiscal 
years 2002 through 2004.
    ``(e) Rule of Construction.--This section shall not be construed to 
require any State to participate in the project described in this 
section.
    ``(f) Report.--
            ``(1) In general.--The Secretary shall evaluate the 
        participation of individuals in the demonstration projects under 
        this section and prepare and submit a report containing the 
        information described in paragraph (2) to--
                    ``(A) the Committee on Health, Education, Labor, and 
                Pensions of the Senate;
                    ``(B) the Subcommittee on Labor, Health and Human 
                Services, and Education of the Committee on 
                Appropriations of the Senate;
                    ``(C) the Committee on Energy and Commerce of the 
                House of Representatives; and
                    ``(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 <<NOTE: Deadline.>> the 
        Secretary determines and certifies to Congress by not later than 
        September 30, 2004,

[[Page 116 STAT. 1655]]

        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. <<NOTE: 42 USC 256 note.>> 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. <<NOTE: 42 USC 256.>> 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

[[Page 116 STAT. 1656]]

                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

[[Page 116 STAT. 1657]]

                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--

[[Page 116 STAT. 1658]]

            ``(1) shall accord priority to applicants that demonstrate 
        the extent of unmet need in the community involved for a more 
        coordinated system of care; and
            ``(2) may accord priority to applicants that best promote 
        the objectives of this section, taking into consideration the 
        extent to which the application involved--
                    ``(A) identifies a community whose geographical area 
                has a high or increasing percentage of individuals who 
                are uninsured;
                    ``(B) demonstrates that the applicant has included 
                in its consortium providers, support systems, and 
                programs that have a tradition of serving uninsured 
                individuals and underinsured individuals in the 
                community;
                    ``(C) shows evidence that the program would expand 
                utilization of preventive and primary care services for 
                uninsured and underinsured individuals and families in 
                the community, including behavioral and mental health 
                services, oral health services, or substance abuse 
                services;
                    ``(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.

[[Page 116 STAT. 1659]]

                          ``(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

[[Page 116 STAT. 1660]]

        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) <<NOTE: Deadline.>>  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 subsection (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:

[[Page 116 STAT. 1661]]

                  ``Subpart X--Primary Dental Programs

``SEC. 340F. <<NOTE: 42 USC 256f.>> DESIGNATED DENTAL HEALTH 
                            PROFESSIONAL SHORT-
                            AGE 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. <<NOTE: 42 USC 256g.>> GRANTS FOR INNOVATIVE PROGRAMS.

    ``(a) Grant Program Authorized.--The Secretary, acting through the 
Administrator of the Health Resources and Services Administration, is 
authorized to award grants to States for the purpose of helping States 
develop and implement innovative programs to address the dental 
workforce needs of designated dental health professional shortage areas 
in a manner that is appropriate to the States' individual needs.
    ``(b) State Activities.--A State receiving a grant under subsection 
(a) may use funds received under the grant for--
            ``(1) loan forgiveness and repayment programs for dentists 
        who--
                    ``(A) agree to practice in designated dental health 
                professional shortage areas;
                    ``(B) are dental school graduates who agree to serve 
                as public health dentists for the Federal, State, or 
                local government; and
                    ``(C) agree to--
                          ``(i) provide services to patients regardless 
                      of such patients' ability to pay; and
                          ``(ii) use a sliding payment scale for 
                      patients who are unable to pay the total cost of 
                      services;
            ``(2) dental recruitment and retention efforts;
            ``(3) grants and low-interest or no-interest loans to help 
        dentists who participate in the medicaid program under title XIX 
        of the Social Security Act (42 U.S.C. 1396 et seq.) to establish 
        or expand practices in designated dental health professional 
        shortage areas by equipping dental offices or sharing in the 
        overhead costs of such practices;
            ``(4) the establishment or expansion of dental residency 
        programs in coordination with accredited dental training 
        institutions in States without dental schools;
            ``(5) programs developed in consultation with State and 
        local dental societies to expand or establish oral health 
        services and facilities in designated dental health professional 
        shortage areas, including services and facilities for children 
        with special needs, such as--
                    ``(A) the expansion or establishment of a community-
                based dental facility, free-standing dental clinic, 
                consolidated health center dental facility, school-
                linked dental facility, or United States dental school-
                based facility;
                    ``(B) the establishment of a mobile or portable 
                dental clinic; and
                    ``(C) the establishment or expansion of private 
                dental services to enhance capacity through additional 
                equipment or additional hours of operation;

[[Page 116 STAT. 1662]]

            ``(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 <<NOTE: Deadline.>> 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. <<NOTE: 42 USC 1396a note.>> 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

[[Page 116 STAT. 1663]]

        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 solutions 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:

[[Page 116 STAT. 1664]]

            (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 <<NOTE: Deadline.>> 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. <<NOTE: 42 USC 254b note.>> 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)''.

[[Page 116 STAT. 1665]]

    (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)''.

    Approved October 26, 2002.

LEGISLATIVE HISTORY--S. 1533 (H.R. 3450):
---------------------------------------------------------------------------

SENATE REPORTS: No. 107-83 (Comm. on Health, Education, Labor, and 
Pensions).
CONGRESSIONAL RECORD, Vol. 148 (2002):
            Apr. 16, considered and passed Senate.
            Oct. 16, considered and passed House, amended.
            Oct. 17, Senate concurred in House amendment.
WEEKLY COMPILATION OF PRESIDENTIAL DOCUMENTS, Vol. 38 (2002):
            Oct. 26, Presidential remarks.

                                  <all>