I 

116TH CONGRESS 

1ST SESSION H. R. 4898 

To amend the Public Health Service Act to establish a rural health center 

innovation awards program and a rural health department enhancement 

program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

OCTOBER 29, 2019 

Mr. KUSTOFF of Tennessee (for himself, Mr. DAVID P. ROE of Tennessee, and 

Ms. KUSTER of New Hampshire) introduced the following bill; which was 

referred to the Committee on Energy and Commerce 

A BILL 

To amend the Public Health Service Act to establish a rural 

health center innovation awards program and a rural 

health department enhancement program, and for other 

purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Rural Health Innova5 tion Act of 2019’’. 


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1 SEC. 2. RURAL HEALTH CENTER INNOVATION AWARDS 

2 PROGRAM. 

3 Subpart I of part D of title III of the Public Health 

4 Service Act (42 U.S.C. 254b et seq.) is amended by adding 

5 at the end the following: 

6 ‘‘SEC. 330N. RURAL HEALTH CENTER INNOVATION AWARDS 

7 PROGRAM. 

8 ‘‘(a) DEFINITIONS.—In this section: 

9 ‘‘(1) COVERED RURAL AREA.—The term ‘cov10 ered rural area’ means a rural area— 

11 ‘‘(A) that is located not less than 30 min12 utes by automobile from the nearest emergency 

13 department, using the speed limit of the most 

14 direct route to such emergency department; or 

15 ‘‘(B) from which an individual cannot ac16 cess an emergency department by road. 

17 ‘‘(2) ELIGIBLE ENTITY.—The term ‘eligible en18 tity’ means an entity that— 

19 ‘‘(A) is a Federally qualified health center; 

20 ‘‘(B) is a rural health clinic; or 

21 ‘‘(C) agrees (as a condition of receiving a 

22 grant under this section) to establish such a 

23 center or clinic, including a hospital that agrees 

24 (as such a condition) to convert to a Federally 

25 qualified health center. 


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1 ‘‘(3) FEDERALLY QUALIFIED HEALTH CEN2 TER.—The term ‘Federally qualified health center’ 

3 has the meaning given such term in section 

4 1861(aa) of the Social Security Act. 

5 ‘‘(4) RURAL AREA.—The term ‘rural area’ has 

6 the meaning given such term in section 330J(e). 

7 ‘‘(5) RURAL HEALTH CLINIC.—The term ‘rural 

8 health clinic’ has the meaning given such term in 

9 section 1861(aa) of the Social Security Act. 

10 ‘‘(b) ESTABLISHMENT.— 

11 ‘‘(1) IN GENERAL.—The Secretary, acting 

12 through the Administrator of the Health Resources 

13 and Services Administration, shall establish a grant 

14 program to be known as the ‘Rural Health Center 

15 Innovation Awards program’ to award grants to eli16 gible entities that submit an application in accord17 ance with subsection (c) to enable such entities to 

18 establish or maintain a Federally qualified health 

19 center or rural health clinic that— 

20 ‘‘(A) serves individuals in a covered rural 

21 area as a walk-in urgent care center and as a 

22 triage center or staging facility for necessary 

23 air or ambulance transport to an emergency de24 partment; and 

25 ‘‘(B) includes— 


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1 ‘‘(i) professional clinical staff, includ2 ing physicians, physician interns, residents, 

3 nurse practitioners, physician assistants, 

4 nurse midwives, or other health care pro5 viders providing walk-in urgent care and 

6 emergency triage; and 

7 ‘‘(ii) resources, including laboratories, 

8 x-ray machines, and cardiac monitors. 

9 ‘‘(2) PERMISSIBLE USES OF FUNDS.—The 

10 funds of a grant awarded under this section may be 

11 used to— 

12 ‘‘(A) expand the hours of operation of a 

13 Federally qualified health center or rural health 

14 clinic; 

15 ‘‘(B) pay for the costs of construction and 

16 renovation of a Federally qualified health center 

17 or rural health clinic; or 

18 ‘‘(C) carry out any other activity for the 

19 purposes described in paragraph (1). 

20 ‘‘(c) APPLICATIONS AND SELECTION.— 

21 ‘‘(1) IN GENERAL.—An eligible entity seeking a 

22 grant under this section shall submit to the Sec23 retary an application at such time, in such manner, 

24 and containing such information as the Secretary 

25 may reasonably require. 


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1 ‘‘(2) START UP CENTERS AND CLINICS.—An 

2 application submitted under paragraph (1) by an eli3 gible entity that is not a Federally qualified health 

4 center, or a rural health clinic, on the date on which 

5 the entity submits the application under paragraph 

6 (1) shall include in such application a demonstration 

7 of the costs of the equipment and staffing needed to 

8 establish the center or clinic. 

9 ‘‘(3) EXPEDITED REVIEW.—The Secretary shall 

10 establish a process for expediting the review of any 

11 application submitted under paragraph (1) for a 

12 grant under this section from an eligible entity that 

13 plans to use the funds of the grant to serve individ14 uals in a covered rural area in which a hospital has 

15 closed in the 7 years preceding the date on which 

16 the entity submitted the application. 

17 ‘‘(d) GRANT PERIOD AND AMOUNTS.— 

18 ‘‘(1) PERIOD.—Each grant awarded under this 

19 section shall be for a period of 5 years. 

20 ‘‘(2) AMOUNT.— 

21 ‘‘(A) IN GENERAL.—A grant awarded 

22 under this section to an eligible entity shall not 

23 exceed— 

24 ‘‘(i) for the first year of the grant— 


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1 ‘‘(I) $500,000 if the entity is a 

2 Federally qualified health center, or a 

3 rural health clinic, on the date on 

4 which the award is made; and 

5 ‘‘(II) $750,000 if the entity is 

6 using the grant to establish a Feder7 ally qualified health center or a rural 

8 health clinic; and 

9 ‘‘(ii) for each of the third through 

10 fifth years of the grant, $500,000. 

11 ‘‘(B) CONSIDERATIONS.—In determining 

12 the amount of a grant under this section for an 

13 eligible entity for each year after the first year 

14 in which the grant is awarded, the Secretary 

15 shall, subject to subparagraph (A)(ii), consider 

16 the number of patients treated, and the type of 

17 treatment provided, by the entity in the prior 

18 year. 

19 ‘‘(e) REPORTING.— 

20 ‘‘(1) IN GENERAL.—Not later than 3 years 

21 after the date of enactment of this section, the Sec22 retary shall report to the committees described in 

23 paragraph (2) on the grant program under this sec24 tion, including— 


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1 ‘‘(A) an assessment of the success of the 

2 program, challenges with respect to the pro3 gram, and any action for regulatory flexibility 

4 or legislative authority needed to improve the 

5 program; 

6 ‘‘(B) any savings to Federal health care 

7 programs; 

8 ‘‘(C) any increase in access to care; and 

9 ‘‘(D) any increase in utilization of health 

10 services in covered rural areas. 

11 ‘‘(2) COMMITTEES.—The committees described 

12 in this paragraph are— 

13 ‘‘(A) the Committee on Health, Education, 

14 Labor, and Pensions, and the Committee on Fi15 nance, of the Senate; and 

16 ‘‘(B) the Committee on Energy and Com17 merce, and the Committee on Ways and Means, 

18 of the House of Representatives. 

19 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

20 is authorized to be appropriated to carry out this section 

21 $25,000,000 for each of fiscal years 2020 through 2024.’’. 

22 SEC. 3. RURAL HEALTH DEPARTMENT ENHANCEMENT PRO23 GRAM. 

24 Subpart I of part D of title III of the Public Health 

25 Service Act (42 U.S.C. 254b et seq.), as amended by secVerDate Sep 11 2014 15:50 Nov 02, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4898.IH H4898

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1 tion 2, is further amended by adding at the end the fol2 lowing: 

3 ‘‘SEC. 330O. RURAL HEALTH DEPARTMENT ENHANCEMENT 

4 PROGRAM. 

5 ‘‘(a) DEFINITIONS.—In this section: 

6 ‘‘(1) COVERED RURAL AREA.—The term ‘cov7 ered rural area’ has the meaning given the term in 

8 section 330N(a). 

9 ‘‘(2) RURAL HEALTH DEPARTMENT.—The term 

10 ‘rural health department’ means a health depart11 ment that is located in a covered rural area. 

12 ‘‘(b) ESTABLISHMENT.—The Secretary, acting 

13 through the Administrator of the Health Resources and 

14 Services Administration, shall award grants, on a competi15 tive basis, to rural health departments that submit an ap16 plication in accordance with subsection (c) to enhance 

17 such departments and enable them to provide individuals 

18 in covered rural areas with emergency services, triage and 

19 transport to emergency departments, primary care serv20 ices, and other services similar to services provided by 

21 emergency departments. 

22 ‘‘(c) APPLICATIONS.—A rural health department 

23 seeking a grant under this section shall submit an applica24 tion to the Secretary at such time, in such manner, and 


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1 containing such information as the Secretary may reason2 ably require, including— 

3 ‘‘(1) an indication of the estimated cost of the 

4 equipment and staffing needed by the department 

5 for the first year of the award to set up the activities 

6 and services under this section; 

7 ‘‘(2) a demonstration that the department has, 

8 on the date on which the application is submitted, 

9 a facility operating that is located in a covered rural 

10 area; and 

11 ‘‘(3) a demonstration that, on the date on 

12 which the application is submitted, the depart13 ment— 

14 ‘‘(A) has a nursing staff and medical 

15 equipment; and 

16 ‘‘(B) agrees to use such staff and equip17 ment towards providing the services and car18 rying out the activities under this section. 

19 ‘‘(d) GRANTS.— 

20 ‘‘(1) ANNUAL AWARDS.—The funds awarded 

21 through a grant under this section to a rural health 

22 department shall be awarded on an annual basis for 

23 each of 5 years. 

24 ‘‘(2) MAXIMUM AMOUNTS.—The funds awarded 

25 through a grant under this section to a rural health 


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1 department shall be in an amount that for a year 

2 does not exceed $500,000. 

3 ‘‘(3) CONSIDERATIONS.—The Secretary shall 

4 determine the amount awarded to a rural health de5 partment through a grant under this section for a 

6 year in accordance with the following: 

7 ‘‘(A) For the first year of the award, the 

8 amount shall be based on the amount the rural 

9 health department estimates for the cost of 

10 equipment and staffing needed to set up the ac11 tivities and services supported under this sec12 tion, as specified in the application under sub13 section (c). 

14 ‘‘(B) For the second through fifth years of 

15 the award, the amount shall be based on the 

16 number of patients treated, and the type of 

17 treatment provided, by the department in the 

18 prior year. 

19 ‘‘(e) USE OF FUNDS.— 

20 ‘‘(1) IN GENERAL.—A rural health department 

21 receiving a grant under this section shall use the 

22 funds awarded through the grant to provide the 

23 services and carry out the activities described in sub24 section (b) at a facility that is located in a covered 

25 rural area, including by— 


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1 ‘‘(A) obtaining additional medical equip2 ment and resources necessary for providing the 

3 services and activities described in subsection 

4 (b), such as laboratories, x-ray machines, and 

5 cardiac monitors; 

6 ‘‘(B) hiring additional providers to provide 

7 the services and carry out the activities de8 scribed in subsection (b), such as physician in9 terns, residents, nurse practitioners, physician 

10 assistants, and nurse midwives, which hiring 

11 may be through a partnership described in 

12 paragraph (2)(A); and 

13 ‘‘(C) providing outreach to the community 

14 regarding the services and activities of the rural 

15 health department as supported under this sec16 tion. 

17 ‘‘(2) LIMITATIONS.— 

18 ‘‘(A) PARTNERSHIPS.—Not more than 3 

19 percent of the funds awarded through a grant 

20 under this section for a year may be used to21 wards the rural health department entering into 

22 a partnership with an academic medical center 

23 to assist with the hiring described in paragraph 

24 (1)(B). 


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1 ‘‘(B) COMMUNITY OUTREACH.—For each 

2 of the first 2 years of a grant awarded under 

3 this section, not more than 3 percent of the 

4 funds may be used by the rural health depart5 ment receiving the grant for the outreach de6 scribed in paragraph (1)(C). 

7 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

8 are authorized to be appropriated to carry out this section 

9 $25,000,000 for each of fiscal years 2020 through 2024.’’. 

Æ 


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