I 

116TH CONGRESS 

1ST SESSION H. R. 5199 

To amend the Public Health Service Act to expand the capacity to improve 

health outcomes and increase access to specialized care. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 20, 2019 

Mr. LUJA ́N (for himself, Mr. BURGESS, Ms. TORRES SMALL of New Mexico, 

Mr. KINZINGER, Ms. HAALAND, and Mr. GIANFORTE) introduced the following bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To amend the Public Health Service Act to expand the 

capacity to improve health outcomes and increase access 

to specialized care. 

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 ‘‘Expanding Capacity 

5 for Health Outcomes Act of 2019’’ or the ‘‘ECHO Act 

6 of 2019’’. 


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1 SEC. 2. EXPANDING CAPACITY FOR HEALTH OUTCOMES. 

2 Title III of the Public Health Service Act is amended 

3 by inserting after section 330M (42 U.S.C. 254c–19) the 

4 following: 

5 ‘‘SEC. 330N. EXPANDING CAPACITY FOR HEALTH OUT6 COMES. 

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

8 ‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en9 tity’— 

10 ‘‘(A) means an entity that provides, or 

11 supports the provision of, health care services— 

12 ‘‘(i) in rural areas, frontier areas, 

13 health professional shortage areas, or 

14 medically underserved areas; or 

15 ‘‘(ii) to medically underserved popu16 lations or Native Americans, including In17 dian Tribes, Tribal organizations, or urban 

18 Indian organizations; and 

19 ‘‘(B) may include entities leading, or capa20 ble of leading, a technology-enabled collabo21 rative learning and capacity building model or 

22 engaging in technology-enabled collaborative 

23 training of participants in such model. 

24 ‘‘(2) HEALTH PROFESSIONAL SHORTAGE

25 AREA.—The term ‘health professional shortage area’ 


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1 means a health professional shortage area des2 ignated under section 332. 

3 ‘‘(3) INDIAN TRIBE.—The terms ‘Indian Tribe’ 

4 and ‘Tribal organization’ have the meanings given 

5 the terms ‘Indian tribe’ and ‘tribal organization’ in 

6 section 4 of the Indian Self-Determination and Edu7 cation Assistance Act. 

8 ‘‘(4) MEDICALLY UNDERSERVED POPU9 LATION.—The term ‘medically underserved popu10 lation’ has the meaning given the term in section 

11 330(b)(3). 

12 ‘‘(5) NATIVE AMERICANS.—The term ‘Native 

13 Americans’ has the meaning given such term in sec14 tion 736 and includes Indian Tribes and Tribal or15 ganizations. 

16 ‘‘(6) TECHNOLOGY-ENABLED COLLABORATIVE

17 LEARNING AND CAPACITY BUILDING MODEL.—The 

18 term ‘technology-enabled collaborative learning and 

19 capacity building model’ means a distance health 

20 education model that connects health care profes21 sionals, and particularly specialists, with multiple 

22 other health care professionals through simultaneous 

23 interactive videoconferencing for the purpose of fa24 cilitating case-based learning, disseminating best 

25 practices, and evaluating outcomes. 


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1 ‘‘(7) URBAN INDIAN ORGANIZATION.—The 

2 ‘urban Indian organization’ has the meaning given 

3 the term ‘Urban Indian organization’ in section 4 of 

4 the Indian Health Care Improvement Act. 

5 ‘‘(b) PROGRAM ESTABLISHED.—The Secretary shall, 

6 as appropriate, award grants to evaluate, develop, and, as 

7 appropriate, expand the use of technology-enabled collabo8 rative learning and capacity building models, to improve 

9 retention of health care providers and increase access to 

10 health care services, such as those to address chronic dis11 eases and conditions, infectious diseases, mental health, 

12 substance use disorders, prenatal and maternal health, pe13 diatric care, pain management, palliative care, and other 

14 specialty care in rural areas, frontier areas, health profes15 sional shortage areas, or medically underserved areas and 

16 for medically underserved populations or Native Ameri17 cans, including Indian Tribes and Tribal organizations. 

18 ‘‘(c) USE OF FUNDS.— 

19 ‘‘(1) IN GENERAL.—Grants awarded under sub20 section (b) shall be used for— 

21 ‘‘(A) the development and acquisition of 

22 instructional programming, and the training of 

23 health care providers and other professionals 

24 that provide or assist in the provision of serv25 ices through models described in subsection (b), 


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1 such as training on best practices for data col2 lection and leading or participating in such 

3 technology-enabled activities consistent with 

4 technology-enabled collaborative learning and 

5 capacity building models; 

6 ‘‘(B) information collection and evaluation 

7 activities to study the impact of such models on 

8 patient outcomes and health care providers, and 

9 to identify best practices for the expansion and 

10 use of such models; or 

11 ‘‘(C) other activities consistent with achiev12 ing the objectives of the grants awarded under 

13 this section, as determined by the Secretary. 

14 ‘‘(2) OTHER USES.—In addition to any of the 

15 uses under paragraph (1), grants awarded under 

16 subsection (b) may be used for— 

17 ‘‘(A) equipment to support the use and ex18 pansion of technology-enabled collaborative 

19 learning and capacity building models, including 

20 for hardware and software that enables distance 

21 learning, health care provider support, and the 

22 secure exchange of electronic health informa23 tion; or 


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1 ‘‘(B) support for health care providers and 

2 other professionals that provide or assist in the 

3 provision of services through such models. 

4 ‘‘(d) LENGTH OF GRANTS.—Grants awarded under 

5 subsection (b) shall be for a period of up to 5 years. 

6 ‘‘(e) GRANT REQUIREMENTS.—The Secretary may 

7 require entities awarded a grant under this section to col8 lect information on the effect of the use of technology9 enabled collaborative learning and capacity building mod10 els, such as on health outcomes, access to health care serv11 ices, quality of care, and provider retention in areas and 

12 populations described in subsection (b). The Secretary 

13 may award a grant or contract to assist in the coordina14 tion of such models, including to assess outcomes associ15 ated with the use of such models in grants awarded under 

16 subsection (b), including for the purpose described in sub17 section (c)(1)(B). 

18 ‘‘(f) APPLICATION.—An eligible entity that seeks to 

19 receive a grant under subsection (b) shall submit to the 

20 Secretary an application, at such time, in such manner, 

21 and containing such information as the Secretary may re22 quire. Such application shall include plans to assess the 

23 effect of technology-enabled collaborative learning and ca24 pacity building models on patient outcomes and health 

25 care providers. 


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1 ‘‘(g) ACCESS TO BROADBAND.—In administering 

2 grants under this section, the Secretary may coordinate 

3 with other agencies to ensure that funding opportunities 

4 are available to support access to reliable, high-speed 

5 internet for grantees. 

6 ‘‘(h) TECHNICAL ASSISTANCE.—The Secretary shall 

7 provide (either directly through the Department of Health 

8 and Human Services or by contract) technical assistance 

9 to eligible entities, including recipients of grants under 

10 subsection (b), on the development, use, and evaluation 

11 of technology-enabled collaborative learning and capacity 

12 building models in order to expand access to health care 

13 services provided by such entities, including for medically 

14 underserved areas and to medically underserved popu15 lations or Native Americans, including Indian Tribes and 

16 Tribal organizations. 

17 ‘‘(i) RESEARCH AND EVALUATION.—The Secretary, 

18 in consultation with stakeholders with appropriate exper19 tise in such models, shall develop a strategic plan to re20 search and evaluate the evidence for such models. The 

21 Secretary shall use such plan to inform the activities car22 ried out under this section. 

23 ‘‘(j) REPORT BY SECRETARY.—Not later than 4 

24 years after the date of enactment of this section, the Sec25 retary shall prepare and submit to the Committee on 


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1 Health, Education, Labor, and Pensions of the Senate and 

2 the Committee on Energy and Commerce of the House 

3 of Representatives, and post on the internet website of the 

4 Department of Health and Human Services, a report in5 cluding, at minimum— 

6 ‘‘(1) a description of any new and continuing 

7 grants awarded to entities under subsection (b) and 

8 the specific purpose and amounts of such grants; 

9 ‘‘(2) an overview of— 

10 ‘‘(A) the evaluations conducted under sub11 section (b); 

12 ‘‘(B) technical assistance provided under 

13 subsection (h); and 

14 ‘‘(C) activities conducted by entities award15 ed grants under subsection (b); and 

16 ‘‘(3) a description of any significant findings or 

17 developments related to patient outcomes or health 

18 care providers and best practices for eligible entities 

19 expanding, using, or evaluating technology-enabled 

20 collaborative learning and capacity building models, 

21 including through the activities described in sub22 section (h). 


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1 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 

2 is authorized to be appropriated to carry out this section, 

3 $20,000,000 for each of fiscal years 2020 through 2024.’’. 

Æ 


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