PUBLIC LAW 107–251—OCT. 26, 2002 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.

Be it enacted by the Senate and House of Representatives of

the United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) SHORT TITLE.—This Act may be cited as the ‘‘Health Care

Safety Net Amendments of 2002’’.

(b) TABLE OF CONTENTS.—The table of contents for this Act

is as follows:

Sec. 1. Short title; table of contents.

TITLE I—CONSOLIDATED HEALTH CENTER PROGRAM AMENDMENTS

Sec. 101. Health centers.

Sec. 102. Telemedicine; incentive grants regarding coordination among States.

TITLE II—RURAL HEALTH

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

Sec. 201. Grant programs.

Subtitle B—Telehealth Grant Consolidation

Sec. 211. Short title.

Sec. 212. Consolidation and reauthorization of provisions.

Subtitle C—Mental Health Services Telehealth Program and Rural Emergency

Medical Service Training and Equipment Assistance Program

Sec. 221. Programs.

TITLE III—NATIONAL HEALTH SERVICE CORPS PROGRAM

Sec. 301. National Health Service Corps.

Sec. 302. Designation of health professional shortage areas.

Sec. 303. Assignment of Corps personnel.

Sec. 304. Priorities in assignment of Corps personnel.

Sec. 305. Cost-sharing.

Sec. 306. Eligibility for Federal funds.

Sec. 307. Facilitation of effective provision of Corps services.

Sec. 308. Authorization of appropriations.

Sec. 309. National Health Service Corps Scholarship Program.

Sec. 310. National Health Service Corps Loan Repayment Program.

Sec. 311. Obligated service.

Sec. 312. Private practice.

Sec. 313. Breach of scholarship contract or loan repayment contract.

Sec. 314. Authorization of appropriations.

Sec. 315. Grants to States for loan repayment programs.

Sec. 316. Demonstration grants to States for community scholarship programs.

Sec. 317. Demonstration project.

42 USC 201 note.

Health Care

Safety Net

Amendments of

2002.

Oct. 26, 2002

[S. 1533]

116 STAT. 1622 PUBLIC LAW 107–251—OCT. 26, 2002

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

PUBLIC LAW 107–251—OCT. 26, 2002 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.

116 STAT. 1624 PUBLIC LAW 107–251—OCT. 26, 2002

‘‘(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:

PUBLIC LAW 107–251—OCT. 26, 2002 116 STAT. 1625

‘‘(4) TEMPORARY CONTINUED PROVISION OF SERVICES TO CER- TAIN 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;

116 STAT. 1626 PUBLIC LAW 107–251—OCT. 26, 2002

(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

PUBLIC LAW 107–251—OCT. 26, 2002 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. 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.

42 USC 254c–17.

116 STAT. 1628 PUBLIC LAW 107–251—OCT. 26, 2002

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.

PUBLIC LAW 107–251—OCT. 26, 2002 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

116 STAT. 1630 PUBLIC LAW 107–251—OCT. 26, 2002

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

PUBLIC LAW 107–251—OCT. 26, 2002 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

116 STAT. 1632 PUBLIC LAW 107–251—OCT. 26, 2002

described in this section, to the extent practicable, with Federal

and State agencies and nonprofit organizations that are operating similar grant programs, to maximize the effect of public

dollars in funding meritorious proposals.

‘‘(3) PREFERENCE.—In awarding grants under this section,

the Secretary shall give preference to entities that— ‘‘(A) are located in health professional shortage areas

or medically underserved communities, or serve medically

underserved populations; or ‘‘(B) propose to develop projects with a focus on primary

care, and wellness and prevention strategies. ‘‘(i) REPORT.—Not later than September 30, 2005, the Secretary

shall prepare and submit to the appropriate committees of Congress

a report on the progress and accomplishments of the grant programs

described in subsections (e), (f), and (g). ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There are authorized

to be appropriated to carry out this section $40,000,000 for fiscal

year 2002, and such sums as may be necessary for each of fiscal

years 2003 through 2006.’’.

Subtitle B—Telehealth Grant

Consolidation

SEC. 211. SHORT TITLE.

This subtitle may be cited as the ‘‘Telehealth Grant Consolidation Act of 2002’’.

SEC. 212. CONSOLIDATION AND REAUTHORIZATION OF PROVISIONS.

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

Act (42 U.S.C. 254b et seq) is amended by adding at the end

the following:

‘‘SEC. 330I. TELEHEALTH NETWORK AND TELEHEALTH RESOURCE

CENTERS GRANT PROGRAMS.

‘‘(a) DEFINITIONS.—In this section:

‘‘(1) DIRECTOR; OFFICE.—The terms ‘Director’ and ‘Office’

mean the Director and Office specified in subsection (c).

‘‘(2) FEDERALLY QUALIFIED HEALTH CENTER AND RURAL

HEALTH CLINIC.—The term ‘Federally qualified health center’

and ‘rural health clinic’ have the meanings given the terms

in section 1861(aa) of the Social Security Act (42 U.S.C.

1395x(aa)).

‘‘(3) FRONTIER COMMUNITY.—The term ‘frontier community’

shall have the meaning given the term in regulations issued

under subsection (r).

‘‘(4) MEDICALLY UNDERSERVED AREA.—The term ‘medically

underserved area’ has the meaning given the term ‘medically

underserved community’ in section 799B.

‘‘(5) MEDICALLY UNDERSERVED POPULATION.—The term

‘medically underserved population’ has the meaning given the

term in section 330(b)(3).

‘‘(6) TELEHEALTH SERVICES.—The term ‘telehealth services’

means services provided through telehealth technologies.

‘‘(7) TELEHEALTH TECHNOLOGIES.—The term ‘telehealth

technologies’ means technologies relating to the use of electronic

information, and telecommunications technologies, to support

42 USC 254c–14.

42 USC 201 note.

Telehealth Grant

Consolidation Act

of 2002.

Deadline.

PUBLIC LAW 107–251—OCT. 26, 2002 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):

116 STAT. 1634 PUBLIC LAW 107–251—OCT. 26, 2002

‘‘(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

PUBLIC LAW 107–251—OCT. 26, 2002 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. 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;

Publication.

Notice.

116 STAT. 1636 PUBLIC LAW 107–251—OCT. 26, 2002

‘‘(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;

PUBLIC LAW 107–251—OCT. 26, 2002 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.

116 STAT. 1638 PUBLIC LAW 107–251—OCT. 26, 2002

‘‘(n) COORDINATION WITH OTHER AGENCIES.—The Secretary

shall coordinate activities carried out under grant programs

described in subsection (b), to the extent practicable, with Federal

and State agencies and nonprofit organizations that are operating

similar programs, to maximize the effect of public dollars in funding

meritorious proposals.

‘‘(o) OUTREACH ACTIVITIES.—The Secretary shall establish and

implement procedures to carry out outreach activities to advise

potential end users of telehealth services in rural areas, frontier

communities, medically underserved areas, and medically underserved populations in each State about the grant programs

described in subsection (b).

‘‘(p) TELEHEALTH.—It is the sense of Congress that, for purposes

of this section, States should develop reciprocity agreements so

that a provider of services under this section who is a licensed

or otherwise authorized health care provider under the law of

1 or more States, and who, through telehealth technology, consults

with a licensed or otherwise authorized health care provider in

another State, is exempt, with respect to such consultation, from

any State law of the other State that prohibits such consultation

on the basis that the first health care provider is not a licensed

or authorized health care provider under the law of that State.

‘‘(q) REPORT.—Not later than September 30, 2005, the Secretary

shall prepare and submit to the appropriate committees of Congress

a report on the progress and accomplishments of the grant programs

described in subsection (b).

‘‘(r) REGULATIONS.—The Secretary shall issue regulations specifying, for purposes of this section, a definition of the term ‘frontier

area’. The definition shall be based on factors that include population density, travel distance in miles to the nearest medical

facility, travel time in minutes to the nearest medical facility,

and such other factors as the Secretary determines to be appropriate. The Secretary shall develop the definition in consultation

with the Director of the Bureau of the Census and the Administrator

of the Economic Research Service of the Department of Agriculture.

‘‘(s) AUTHORIZATION OF APPROPRIATIONS.—There are authorized

to be appropriated to carry out this section—

‘‘(1) for grants under subsection (d)(1), $40,000,000 for fiscal

year 2002, and such sums as may be necessary for each of

fiscal years 2003 through 2006; and

‘‘(2) for grants under subsection (d)(2), $20,000,000 for fiscal

year 2002, and such sums as may be necessary for each of

fiscal years 2003 through 2006.’’.

Subtitle C—Mental Health Services Telehealth Program and Rural Emergency

Medical Service Training and Equipment

Assistance Program

SEC. 221. PROGRAMS.

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

Act (42 U.S.C. 254b et seq.) (as amended by section 212) is further

amended by adding at the end the following:

Deadline.

PUBLIC LAW 107–251—OCT. 26, 2002 116 STAT. 1639

‘‘SEC. 330J. RURAL EMERGENCY MEDICAL SERVICE TRAINING AND

EQUIPMENT ASSISTANCE PROGRAM.

‘‘(a) GRANTS.—The Secretary, acting through the Administrator

of the Health Resources and Services Administration (referred to

in this section as the ‘Secretary’) shall award grants to eligible

entities to enable such entities to provide for improved emergency

medical services in rural areas.

‘‘(b) ELIGIBILITY.—To be eligible to receive a grant under this

section, an entity shall—

‘‘(1) be—

‘‘(A) a State emergency medical services office;

‘‘(B) a State emergency medical services association;

‘‘(C) a State office of rural health;

‘‘(D) a local government entity;

‘‘(E) a State or local ambulance provider; or

‘‘(F) any other entity determined appropriate by the

Secretary; and

‘‘(2) prepare and submit to the Secretary an application

at such time, in such manner, and containing such information

as the Secretary may require, that includes—

‘‘(A) a description of the activities to be carried out

under the grant; and

‘‘(B) an assurance that the eligible entity will comply

with the matching requirement of subsection (e).

‘‘(c) USE OF FUNDS.—An entity shall use amounts received

under a grant made under 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

42 USC 254c–15.

116 STAT. 1640 PUBLIC LAW 107–251—OCT. 26, 2002

‘‘(2) applications submitted by entities that intend to use

amounts provided under the grant to fund activities described

in any of paragraphs (1) through (5) of subsection (c).

‘‘(e) MATCHING REQUIREMENT.—The Secretary may not award

a grant under this section to an entity unless the entity agrees

that the entity will make available (directly or through contributions

from other public or private entities) non-Federal contributions

toward the activities to be carried out under the grant in an

amount equal to 25 percent of the amount received under the

grant. ‘‘(f) EMERGENCY MEDICAL SERVICES.—In this section, the term ‘emergency medical services’— ‘‘(1) means resources used by a qualified public or private

nonprofit entity, or by any other entity recognized as qualified

by the State involved, to deliver medical care outside of a

medical facility under emergency conditions that occur— ‘‘(A) as a result of the condition of the patient; or

‘‘(B) as a result of a natural disaster or similar situation; and

‘‘(2) includes services delivered by an emergency medical

services provider (either compensated or volunteer) or other

provider recognized by the State involved that is licensed or

certified by the State as an emergency medical technician or

its equivalent (as determined by the State), a registered nurse,

a physician assistant, or a physician that provides services

similar to services provided by such an emergency medical

services provider.

‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—

‘‘(1) IN GENERAL.—There are authorized to be appropriated

to carry out this section such sums as may be necessary for

each of fiscal years 2002 through 2006.

‘‘(2) ADMINISTRATIVE COSTS.—The Secretary may use not

more than 10 percent of the amount appropriated under paragraph (1) for a fiscal year for the administrative expenses

of carrying out this section.

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

‘‘(a) DEFINITIONS.—In this section:

‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible entity’ means a

public or nonprofit private telehealth provider network that

offers services that include mental health services provided

by qualified mental health providers.

‘‘(2) QUALIFIED MENTAL HEALTH PROFESSIONALS.—The term

‘qualified mental health professionals’ refers to providers of

mental health services reimbursed under the medicare program

carried out under title XVIII of the Social Security Act (42

U.S.C. 1395 et seq.) who have additional training in the treatment of mental illness in children and adolescents or who

have additional training in the treatment of mental illness

in the elderly.

‘‘(3) SPECIAL POPULATIONS.—The term ‘special populations’ refers to the following 2 distinct groups:

‘‘(A) Children and adolescents in mental health underserved rural areas or in mental health underserved urban

areas.

‘‘(B) Elderly individuals located in long-term care facilities in mental health underserved rural or urban areas.

42 USC 254c–16.

PUBLIC LAW 107–251—OCT. 26, 2002 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 longterm 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,

116 STAT. 1642 PUBLIC LAW 107–251—OCT. 26, 2002

in such manner, and containing such information as the Secretary

determines to be reasonable. ‘‘(f) REPORT.—Not later than 4 years after the date of enactment

of the Health Care Safety Net Amendments of 2002, the Secretary

shall prepare and submit to the appropriate committees of Congress

a report that shall evaluate activities funded with grants under

this section. ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There are authorized

to be appropriated to carry out this section, $20,000,000 for fiscal

year 2002 and such sums as may be necessary for fiscal years

2003 through 2006.’’.

TITLE III—NATIONAL HEALTH SERVICE

CORPS PROGRAM

SEC. 301. NATIONAL HEALTH SERVICE CORPS.

(a) IN GENERAL.—Section 331 of the Public Health Service

Act (42 U.S.C. 254d) is amended— (1) by adding at the end of subsection (a)(3) the following:

‘‘(E)(i) The term ‘behavioral and mental health professionals’ means health service psychologists, licensed clinical

social workers, licensed professional counselors, marriage and

family therapists, psychiatric nurse specialists, and psychiatrists. ‘‘(ii) The term ‘graduate program of behavioral and mental

health’ means a program that trains behavioral and mental

health professionals.’’;

(2) in subsection (b)— (A) in paragraph (1), by striking ‘‘health professions’’ and inserting ‘‘health professions, including schools at

which graduate programs of behavioral and mental health

are offered,’’; and

(B) in paragraph (2), by inserting ‘‘behavioral and

mental health professionals,’’ after ‘‘dentists,’’; and

(3) by striking subsection (c) and inserting the following: ‘‘(c)(1) The Secretary may reimburse an applicant for a position

in the Corps (including an individual considering entering into

a written agreement pursuant to section 338D) for the actual and

reasonable expenses incurred in traveling to and from the

applicant’s place of residence to an eligible site to which the

applicant may be assigned under section 333 for the purpose of

evaluating such site with regard to being assigned at such site.

The Secretary may establish a maximum total amount that may

be paid to an individual as reimbursement for such expenses. ‘‘(2) The Secretary may also reimburse the applicant for the

actual and reasonable expenses incurred for the travel of 1 family

member to accompany the applicant to such site. The Secretary

may establish a maximum total amount that may be paid to an

individual as reimbursement for such expenses. ‘‘(3) In the case of an individual who has entered into a contract

for obligated service under the Scholarship Program or under the

Loan Repayment Program, the Secretary may reimburse such individual for all or part of the actual and reasonable expenses incurred

in transporting the individual, the individual’s family, and the

family’s possessions to the site of the individual’s assignment under

section 333. The Secretary may establish a maximum total amount

Deadline.

PUBLIC LAW 107–251—OCT. 26, 2002 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 fulltime.‘‘(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

116 STAT. 1644 PUBLIC LAW 107–251—OCT. 26, 2002

thereafter, each such center or clinic shall demonstrate

that the center or clinic meets the applicable requirements

of the Federal regulations, issued after the date of enactment of this Act, that revise the definition of a health

professional shortage area for purposes of this section.’’;

and

(B) in paragraph (3), by striking ‘‘340(r)) may be a

population group’’ and inserting ‘‘330(h)(4)), seasonal agricultural workers (as defined in section 330(g)(3)) and migratory agricultural workers (as so defined)), and residents

of public housing (as defined in section 3(b)(1) of the United

States Housing Act of 1937 (42 U.S.C. 1437a(b)(1))) may

be population groups’’;

(2) in subsection (b)(2), by striking ‘‘with special consideration to the indicators of’’ and all that follows through ‘‘services.’’ and inserting a period; and

(3) in subsection (c)(2)(B), by striking ‘‘XVIII or XIX’’ and

inserting ‘‘XVIII, XIX, or XXI’’.

(b) REGULATIONS.—

(1) REPORT.—

(A) IN GENERAL.—The Secretary shall submit the

report described in subparagraph (B) if the Secretary,

acting through the Administrator of the Health Resources

and Services Administration, issues—

(i) a regulation that revises the definition of a

health professional shortage area for purposes of section 332 of the Public Health Service Act (42 U.S.C.

254e); or

(ii) a regulation that revises the standards concerning priority of such an area under section 333A

of that Act (42 U.S.C. 254f–1).

(B) REPORT.—On issuing a regulation described in

subparagraph (A), the Secretary shall prepare and submit

to the Committee on Energy and Commerce of the House

of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate a report that

describes the regulation.

(2) EFFECTIVE DATE.—Each regulation described in paragraph (1)(A) shall take effect 180 days after the committees

described in paragraph (1)(B) receive a report referred to in

paragraph (1)(B) describing the regulation.

(c) SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS.—The Secretary of Health and Human Services, in consultation with organizations representing individuals in the dental field and organizations

representing publicly funded health care providers, shall develop

and implement a plan for increasing the participation of dentists

and dental hygienists in the National Health Service Corps Scholarship Program under section 338A of the Public Health Service

Act (42 U.S.C. 254l) and the Loan Repayment Program under

section 338B of such Act (42 U.S.C. 254l–1).

(d) SITE DESIGNATION PROCESS.—

(1) IMPROVEMENT OF DESIGNATION PROCESS.—The Administrator of the Health Resources and Services Administration,

in consultation with the Association of State and Territorial

Dental Directors, dental societies, and other interested parties,

shall revise the criteria on which the designations of dental

42 USC 254e

note.

42 USC 254l

note.

42 USC 254e

note.

PUBLIC LAW 107–251—OCT. 26, 2002 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 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

Deadline.

42 USC 254e

note.

116 STAT. 1646 PUBLIC LAW 107–251—OCT. 26, 2002

(II) by striking the period and inserting

‘‘, and (E) developing long-term plans for

addressing health professional shortages and

improving access to health care.’’; and

(ii) by adding at the end the following: ‘‘The Secretary shall encourage entities that receive technical

assistance under this paragraph to communicate with

other communities, State Offices of Rural Health, State

Primary Care Associations and Offices, and other entities concerned with site development and community

needs assessment.’’.

SEC. 304. PRIORITIES IN ASSIGNMENT OF CORPS PERSONNEL.

Section 333A of the Public Health Service Act (42 U.S.C. 254f–

1) is amended—

(1) in subsection (a)(1)(A), by striking ‘‘, as determined

in accordance with subsection (b)’’;

(2) by striking subsection (b);

(3) in subsection (c), by striking the second sentence;

(4) in subsection (d)—

(A) by redesignating paragraphs (1) through (3) as

paragraphs (2) through (4), respectively;

(B) by inserting before paragraph (2) (as redesignated

by subparagraph (A)) the following:

‘‘(1) PROPOSED LIST.—The Secretary shall prepare and publish a proposed list of health professional shortage areas and

entities that would receive priority under subsection (a)(1) in

the assignment of Corps members. The list shall contain the

information described in paragraph (2), and the relative scores

and relative priorities of the entities submitting applications

under section 333, in a proposed format. All such entities

shall have 30 days after the date of publication of the list

to provide additional data and information in support of inclusion on the list or in support of a higher priority determination

and the Secretary shall reasonably consider such data and

information in preparing the final list under paragraph (2).’’;

(C) in paragraph (2) (as redesignated by subparagraph

(A)), in the matter before subparagraph (A)—

(i) by striking ‘‘paragraph (2)’’ and inserting ‘‘paragraph (3)’’;

(ii) by striking ‘‘prepare a list of health professional

shortage areas’’ and inserting ‘‘prepare and, as appropriate, update a list of health professional shortage

areas and entities’’; and

(iii) by striking ‘‘for the period applicable under

subsection (f)’’;

(D) by striking paragraph (3) (as redesignated by

subparagraph (A)) and inserting the following:

‘‘(3) NOTIFICATION OF AFFECTED PARTIES.—

‘‘(A) ENTITIES.—Not later than 30 days after the Secretary has added to a list under paragraph (2) an entity

specified as described in subparagraph (A) of such paragraph, the Secretary shall notify such entity that the entity

has been provided an authorization to receive assignments

of Corps members in the event that Corps members are

available for the assignments.

Deadline.

Publication.

PUBLIC LAW 107–251—OCT. 26, 2002 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 the Secretary proposes to make a revision in the list under paragraph (2), and the revision would

adversely alter the status of an entity with respect to the

list, the Secretary shall notify the entity of the revision. Any

entity adversely affected by such a revision shall be notified

in writing by the Secretary of the reasons for the revision

and shall have 30 days to file a written appeal of the determination involved which shall be reasonably considered by the Secretary before the revision to the list becomes final. The revision

to the list shall be effective with respect to assignment of

Corps members beginning on the date that the revision becomes

final.’’;

(5) by striking subsection (e) and inserting the following: ‘‘(e) LIMITATION ON NUMBER OF ENTITIES OFFERED AS ASSIGNMENT CHOICES IN SCHOLARSHIP PROGRAM.—

‘‘(1) DETERMINATION OF AVAILABLE CORPS MEMBERS.—By

April 1 of each calendar year, the Secretary shall determine

the number of participants in the Scholarship Program who

will be available for assignments under section 333 during

the program year beginning on July 1 of that calendar year.

‘‘(2) DETERMINATION OF NUMBER OF ENTITIES.—At all times

during a program year, the number of entities specified under

subsection (c)(2)(B)(i) shall be—

‘‘(A) not less than the number of participants determined with respect to that program year under paragraph

(1); and ‘‘(B) not greater than twice the number of participants

determined with respect to that program year under paragraph (1).’’;

(6) by striking subsection (f); and

(7) by redesignating subsections (c), (d), and (e) as subsections (b), (c), and (d) respectively.

SEC. 305. COST-SHARING.

Subpart II of part D of title III of the Public Health Service

Act (42 U.S.C. 254d et seq.) is amended by striking section 334

and inserting the following:

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

‘‘(a) AVAILABILITY OF SERVICES REGARDLESS OF ABILITY TO PAY

OR PAYMENT SOURCE.—An entity to which a Corps member is

assigned shall not deny requested health care services, and shall

not discriminate in the provision of services to an individual—

‘‘(1) because the individual is unable to pay for the services;

or

‘‘(2) because payment for the services would be made

under—

42 USC 254g.

Deadline.

Notification.

116 STAT. 1648 PUBLIC LAW 107–251—OCT. 26, 2002

‘‘(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’’.

PUBLIC LAW 107–251—OCT. 26, 2002 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

116 STAT. 1650 PUBLIC LAW 107–251—OCT. 26, 2002

(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—

PUBLIC LAW 107–251—OCT. 26, 2002 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) 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.’’;

Deadline.

116 STAT. 1652 PUBLIC LAW 107–251—OCT. 26, 2002

(B) by striking paragraphs (2) and (3) and inserting

the following:

‘‘(2) The Secretary may terminate a contract with an individual

under section 338B if, not later than 45 days before the end of

the fiscal year in which the contract was entered into, the

individual—

‘‘(A) submits a written request for such termination; and

‘‘(B) repays all amounts paid on behalf of the individual

under section 338B(g).’’; and

(C) by redesignating paragraph (4) as paragraph (3);

(4) in subsection (d)(3)(A), by striking ‘‘only if such discharge is granted after the expiration of the five-year period’’

and inserting ‘‘only if such discharge is granted after the expiration of the 7-year period’’; and

(5) by adding at the end the following new subsection:

‘‘(e) Notwithstanding any other provision of Federal or State

law, there shall be no limitation on the period within which suit

may be filed, a judgment may be enforced, or an action relating

to an offset or garnishment, or other action, may be initiated

or taken by the Secretary, the Attorney General, or the head of

another Federal agency, as the case may be, for the repayment

of the amount due from an individual under this section.’’.

(b) EFFECTIVE DATE.—The amendment made by subsection

(a)(4) shall apply to any obligation for which a discharge in bankruptcy has not been granted before the date that is 31 days after

the date of enactment of this Act.

SEC. 314. AUTHORIZATION OF APPROPRIATIONS.

Section 338H of the Public Health Service Act (42 U.S.C. 254q)

is amended to read as follows:

‘‘SEC. 338H. AUTHORIZATION OF APPROPRIATIONS.

‘‘(a) AUTHORIZATION OF APPROPRIATIONS.—For the purposes of

carrying out this subpart, there are authorized to be appropriated

$146,250,000 for fiscal year 2002, and such sums as may be necessary for each of fiscal years 2003 through 2006.

‘‘(b) SCHOLARSHIPS FOR NEW PARTICIPANTS.—Of the amounts

appropriated under subsection (a) for a fiscal year, the Secretary

shall obligate not less than 10 percent for the purpose of providing

contracts for—

‘‘(1) scholarships under this subpart to individuals who

have not previously received such scholarships; or

‘‘(2) scholarships or loan repayments under the Loan Repayment Program under section 338B to individuals from disadvantaged backgrounds.

‘‘(c) SCHOLARSHIPS AND LOAN REPAYMENTS.—With respect to

certification as a nurse practitioner, nurse midwife, or physician

assistant, the Secretary shall, from amounts appropriated under

subsection (a) for a fiscal year, obligate not less than a total of

10 percent for contracts for both scholarships under the Scholarship

Program under section 338A and loan repayments under the Loan

Repayment Program under section 338B to individuals who are

entering the first year of a course of study or program described

in section 338A(b)(1)(B) that leads to such a certification or individuals who are eligible for the loan repayment program as specified

in section 338B(b) for a loan related to such certification.’’.

42 USC 254o

note.

Deadline.

PUBLIC LAW 107–251—OCT. 26, 2002 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. 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

42 USC 254t.

116 STAT. 1654 PUBLIC LAW 107–251—OCT. 26, 2002

‘‘(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 the Secretary determines and

certifies to Congress by not later than September 30, 2004,

Deadline.

PUBLIC LAW 107–251—OCT. 26, 2002 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. PURPOSE.

The purpose of this title is to provide assistance to communities

and consortia of health care providers and others, to develop or

strengthen integrated community health care delivery systems that

coordinate health care services for individuals who are uninsured

or underinsured and to develop or strengthen activities related

to providing coordinated care for individuals with chronic conditions

who are uninsured or underinsured, through the— (1) coordination of services to allow individuals to receive

efficient and higher quality care and to gain entry into and

receive services from a comprehensive system of care;

(2) development of the infrastructure for a health care

delivery system characterized by effective collaboration,

information sharing, and clinical and financial coordination

among all providers of care in the community; and

(3) provision of new Federal resources that do not supplant

funding for existing Federal categorical programs that support

entities providing services to low-income populations.

SEC. 402. CREATION OF HEALTHY COMMUNITIES ACCESS PROGRAM.

Part D of title III of the Public Health Service Act (42 U.S.C.

254b et seq.) is amended by inserting after subpart IV the following

new subpart:

‘‘Subpart V—Healthy Communities Access

Program

‘‘SEC. 340. GRANTS TO STRENGTHEN THE EFFECTIVENESS, EFFICIENCY, AND COORDINATION OF SERVICES FOR THE

UNINSURED AND UNDERINSURED.

‘‘(a) IN GENERAL.—The Secretary may award grants to eligible

entities to assist in the development of integrated health care

delivery systems to serve communities of individuals who are uninsured and individuals who are underinsured—

‘‘(1) to improve the efficiency of, and coordination among,

the providers providing services through such systems;

‘‘(2) to assist communities in developing programs targeted

toward preventing and managing chronic diseases; and

‘‘(3) to expand and enhance the services provided through

such systems.

‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive a grant under

this section, an entity shall be an entity that—

‘‘(1) represents a consortium—

‘‘(A) whose principal purpose is to provide a broad

range of coordinated health care services for a community

42 USC 256.

42 USC 256 note.

116 STAT. 1656 PUBLIC LAW 107–251—OCT. 26, 2002

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 highquality, 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

PUBLIC LAW 107–251—OCT. 26, 2002 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—

116 STAT. 1658 PUBLIC LAW 107–251—OCT. 26, 2002

‘‘(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.

PUBLIC LAW 107–251—OCT. 26, 2002 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

116 STAT. 1660 PUBLIC LAW 107–251—OCT. 26, 2002

the Secretary is satisfied that the consortium represented by

the entity has made reasonable and demonstrable progress

in meeting the goals and measurable objectives set forth in

the entity’s grant application for the preceding fiscal year.

‘‘(g) MAINTENANCE OF EFFORT.—With respect to activities for

which a grant under this section is authorized, the Secretary may

award such a grant only if the applicant for the grant, and each

of the participating providers, agree that the grantee and each

such provider will maintain its expenditures of non-Federal funds

for such activities at a level that is not less than the level of

such expenditures during the fiscal year immediately preceding

the fiscal year for which the applicant is applying to receive such

grant.

‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may, either

directly or by grant or contract, provide any entity that receives

a grant under this section with technical and other nonfinancial

assistance necessary to meet the requirements of this section.

‘‘(i) EVALUATION OF PROGRAM.—Not later than September 30,

2005, the Secretary shall prepare and submit to the appropriate

committees of Congress a report that describes the extent to which

projects funded under this section have been successful in improving

the effectiveness, efficiency, and coordination of services for uninsured and underinsured individuals in the communities or

geographic areas served by such projects, including whether the

projects resulted in the provision of better quality health care

for such individuals, and whether such care was provided at lower

costs, than would have been provided in the absence of such projects.

‘‘(j) DEMONSTRATION AUTHORITY.—The Secretary may make

demonstration awards under this section to historically black health

professions schools for the purposes of—

‘‘(1) developing patient-based research infrastructure at

historically black health professions schools, which have an

affiliation, or affiliations, with any of the providers identified

in 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:

Deadline.

PUBLIC LAW 107–251—OCT. 26, 2002 116 STAT. 1661

‘‘Subpart X—Primary Dental Programs

‘‘SEC. 340F. DESIGNATED DENTAL HEALTH PROFESSIONAL SHORTAGE AREA.

‘‘In this subpart, the term ‘designated dental health professional

shortage area’ means an area, population group, or facility that

is designated by the Secretary as a dental health professional

shortage area under section 332 or designated by the applicable

State as having a dental health professional shortage.

‘‘SEC. 340G. GRANTS FOR INNOVATIVE PROGRAMS.

‘‘(a) GRANT PROGRAM AUTHORIZED.—The Secretary, acting

through the Administrator of the Health Resources and Services

Administration, is authorized to award grants to States for the

purpose of helping States develop and implement innovative programs to address the dental workforce needs of designated dental

health professional shortage areas in a manner that is appropriate

to the States’ individual needs.

‘‘(b) STATE ACTIVITIES.—A State receiving a grant under subsection (a) may use funds received under the grant for—

‘‘(1) loan forgiveness and repayment programs for dentists

who—

‘‘(A) agree to practice in designated dental health

professional shortage areas;

‘‘(B) are dental school graduates who agree to serve

as public health dentists for the Federal, State, or local

government; and

‘‘(C) agree to—

‘‘(i) provide services to patients regardless of such

patients’ ability to pay; and

‘‘(ii) use a sliding payment scale for patients who

are unable to pay the total cost of services;

‘‘(2) dental recruitment and retention efforts;

‘‘(3) grants and low-interest or no-interest loans to help

dentists who participate in the medicaid program under title

XIX of the Social Security Act (42 U.S.C. 1396 et seq.) to

establish or expand practices in designated dental health professional shortage areas by equipping dental offices or sharing

in the overhead costs of such practices;

‘‘(4) the establishment or expansion of dental residency

programs in coordination with accredited dental training

institutions in States without dental schools;

‘‘(5) programs developed in consultation with State and

local dental societies to expand or establish oral health services

and facilities in designated dental health professional shortage

areas, including services and facilities for children with special

needs, such as—

‘‘(A) the expansion or establishment of a communitybased 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;

42 USC 256g.

42 USC 256f.

116 STAT. 1662 PUBLIC LAW 107–251—OCT. 26, 2002

‘‘(6) placement and support of dental students, dental residents, and advanced dentistry trainees; ‘‘(7) continuing dental education, including distance-based

education;

‘‘(8) practice support through teledentistry conducted in

accordance with State laws;

‘‘(9) community-based prevention services such as water

fluoridation and dental sealant programs;

‘‘(10) coordination with local educational agencies within

the State to foster programs that promote children going into

oral health or science professions;

‘‘(11) the establishment of faculty recruitment programs

at accredited dental training institutions whose mission

includes community outreach and service and that have a demonstrated record of serving underserved States;

‘‘(12) the development of a State dental officer position

or the augmentation of a State dental office to coordinate oral

health and access issues in the State; and

‘‘(13) any other activities determined to be appropriate

by the Secretary.

‘‘(c) APPLICATION.—

‘‘(1) IN GENERAL.—Each State desiring a grant under this

section shall submit an application to the Secretary at such

time, in such manner, and containing such information as

the Secretary may reasonably require.

‘‘(2) ASSURANCES.—The application shall include assurances

that the State will meet the requirements of subsection (d)

and that the State possesses sufficient infrastructure to manage

the activities to be funded through the grant and to evaluate

and report on the outcomes resulting from such activities.

‘‘(d) MATCHING REQUIREMENT.—The Secretary may not make

a grant to a State under this section unless that State agrees

that, with respect to the costs to be incurred by the State in

carrying out the activities for which the grant was awarded, the

State will provide non-Federal contributions in an amount equal

to not less than 40 percent of Federal funds provided under the

grant. The State may provide the contributions in cash or in kind,

fairly evaluated, including plant, equipment, and services and may

provide the contributions from State, local, or private sources.

‘‘(e) REPORT.—Not later than 5 years after the date of enactment

of the Health Care Safety Net Amendments of 2002, the Secretary

shall prepare and submit to the appropriate committees of Congress

a report containing data relating to whether grants provided under

this section have increased access to dental services in designated

dental health professional shortage areas.

‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There is authorized

to be appropriated to carry out this section, $50,000,000 for the

5-fiscal year period beginning with fiscal year 2002.’’.

SEC. 404. STUDY REGARDING BARRIERS TO PARTICIPATION OF FARMWORKERS IN HEALTH PROGRAMS.

(a) IN GENERAL.—The Secretary shall conduct a study of the

problems experienced by farmworkers (including their families)

under Medicaid and SCHIP. Specifically, the Secretary shall

examine the following:

(1) BARRIERS TO ENROLLMENT.—Barriers to their enrollment, including a lack of outreach and outstationed eligibility

42 USC 1396a

note.

Deadline.

PUBLIC LAW 107–251—OCT. 26, 2002 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:

116 STAT. 1664 PUBLIC LAW 107–251—OCT. 26, 2002

(1) FARMWORKER.—The term ‘‘farmworker’’ means a migratory agricultural worker or seasonal agricultural worker, as

such terms are defined in section 330(g)(3) of the Public Health

Service Act (42 U.S.C. 254c(g)(3)), and includes a family

member of such a worker.

(2) MEDICAID.—The term ‘‘Medicaid’’ means the program

under title XIX of the Social Security Act.

(3) SCHIP.—The term ‘‘SCHIP’’ means the State children’s

health insurance program under title XXI of the Social Security

Act.

(e) REPORT.—Not later than one year after the date of the

enactment of this Act, the Secretary shall transmit a report to

the President and the Congress on the study conducted under

this section. The report shall contain a detailed statement of

findings and conclusions of the study, together with its recommendations for such legislation and administrative actions as the Secretary

considers appropriate.

TITLE V—STUDY AND MISCELLANEOUS

PROVISIONS

SEC. 501. GUARANTEE STUDY.

The Secretary of Health and Human Services shall conduct

a study regarding the ability of the Department of Health and

Human Services to provide for solvency for managed care networks

involving health centers receiving funding under section 330 of

the Public Health Service Act. The Secretary shall prepare and

submit a report to the appropriate Committees of Congress

regarding such ability not later than 2 years after the date of

enactment of the Health Care Safety Net Amendments of 2002.

SEC. 502. GRADUATE MEDICAL EDUCATION.

Section 762(k) of the Public Health Service Act (42 U.S.C.

294o(k)) is amended by striking ‘‘2002’’ and inserting ‘‘2003’’.

TITLE VI—CONFORMING AMENDMENTS

SEC. 601. CONFORMING AMENDMENTS.

(a) HOMELESS PROGRAMS.—Subsections (g)(1)(G)(ii), (k)(2), and

(n)(1)(C) of section 224, and sections 317A(a)(2), 317E(c), 318A(e),

332(a)(2)(C), 340D(c)(5), 799B(6)(B), 1313, and 2652(2) of the Public

Health Service Act (42 U.S.C. 233, 247b–1(a)(2), 247b–6(c), 247c–

1(e), 254e(a)(2)(C), 256d(c)(5), 295p(6)(B), 300e–12, and 300ff–52(2))

are amended by striking ‘‘340’’ and inserting ‘‘330(h)’’.

42 USC 254b

note.

Deadline.

PUBLIC LAW 107–251—OCT. 26, 2002 116 STAT. 1665

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.

Æ

(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.