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104TH CONGRESS

1ST SESSION H. R. 1904

To provide for various programs relating to improving the health of rural

populations.

IN THE HOUSE OF REPRESENTATIVES

JUNE 20, 1995

Mr. WILLIAMS introduced the following bill; which was referred to the Committee on Commerce, and in addition to the Committee on Ways and

Means, for a period to be subsequently determined by the Speaker, in

each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

A BILL

To provide for various programs relating to improving the

health of rural populations.

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

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Rural America Health

5 Care Improvement Act’’.
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1 TITLE I—PROVISIONS RELATING

2 TO PUBLIC HEALTH SERVICE

3 ACT

4 SEC. 101. ADMINISTRATOR OF PROGRAMS; FUNDING.

5 (a) ADMINISTRATOR.—For purposes of this title, the

6 term ‘‘Secretary’’ means the Secretary of Health and

7 Human Services.

8 (b) FUNDING.—The authorizations of appropriations

9 established in this title are in addition to any other author10 izations of appropriations that are available for the pur11 poses of this title.

12 SEC. 102. NATIONAL HEALTH SERVICE CORPS.

13 (a) ADDITIONAL FUNDING; GENERAL CORPS PRO14 GRAM; ALLOCATION FOR CERTAIN NONPHYSICIAN

15 HEALTH PROFESSIONALS.—For the purpose of carrying

16 out subpart II of part D of title III of the Public Health

17 Service Act, and for the purpose of carrying out subsection

18 (b), there are authorized to be appropriated $50,000,000

19 for fiscal year 1996, $100,000,000 for fiscal year 1997,

20 and $200,000,000 for fiscal year 1998.

21 (b) ALLOCATION FOR PARTICIPATION OF CERTAIN

22 NONPHYSICIAN HEALTH PROFESSIONALS IN SCHOLAR23 SHIP AND LOAN REPAYMENT PROGRAMS.—

24 (1) IN GENERAL.—Of the amounts appro25 priated under this section, the Secretary shall re-
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1 serve such amounts as may be necessary to ensure

2 that, of the number of individuals who are partici3 pants in the Scholarship Program under section

4 338A of the Public Health Service Act, or in the

5 Loan Repayment Program under section 338B of

6 such Act, the total number who are being educated

7 as health professionals specified in paragraph (2), or

8 are serving as such professionals, respectively, is in9 creased to 20 percent.

10 (2) RELEVANT PROFESSIONS.—The health pro11 fessionals referred to in paragraph (1) are nurse

12 practitioners, certified nurse midwives, and reg13 istered nurses, and physician assistants.

14 SEC. 103. DEVELOPMENT OF COMMUNITY-OPERATED

15 HEALTH PLANS IN RURAL AND FRONTIER

16 AREAS.

17 (a) COMMUNITY-OPERATED HEALTH PLANS.—

18 (1) IN GENERAL.—The Secretary may make

19 grants to public and nonprofit private entities for

20 the purpose of carrying out projects to develop

21 health plans to provide services exclusively in rural

22 and frontier areas.

23 (2) REQUIREMENTS FOR HEALTH PLANS.—For

24 purposes of this section, the term ‘‘health plan’’
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1 means a community-rated plan or an experience2 rated plan.

3 (b) COMMUNITY INVOLVEMENT.—The Secretary may

4 make a grant under subsection (a) only if the applicant

5 involved meets the following conditions:

6 (1) In developing the proposal of the applicant

7 for a project under such subsection, the applicant

8 has consulted with the local governments of the geo9 graphic area to be served by the health plan devel10 oped through the project, with individuals who reside

11 in the area, and with a reasonable number and vari12 ety of health professionals who provide services in

13 the area.

14 (2) The applicant agrees that the principal legal

15 authority over the operation of the health plan will

16 be vested in individuals who reside in such geo17 graphic area.

18 (3) In the proposal the applicant specifies how

19 a full continuum of services will be provided.

20 (4) In the proposal the applicant specifies how

21 the proposed health plan will utilize existing health

22 care facilities in a manner that avoids unnecessary

23 duplication.

24 (c) USE OF FUNDS.—
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1 (1) IN GENERAL.—Funds made available under

2 this section may be used for the following:

3 (A) To develop integrated health networks,

4 utilizing existing local providers and facilities

5 where appropriate, with community involve6 ment.

7 (B) For information systems, including

8 telecommunications.

9 (C) For transportation services.

10 (2) LIMITATIONS.—Funds made available under

11 this section shall not be used for the following:

12 (A) For a telecommunications system, un13 less the system is coordinated with, and does

14 not duplicate, such a system existing in the

15 area.

16 (B) For paying off existing debt.

17 (d) FUNDING.—For the purpose of carrying out this

18 section, there are authorized to be appropriated

19 $50,000,000 for fiscal year 1996, $50,000,000 for fiscal

20 year 1997, and $50,000,000 for fiscal year 1998.
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1 SEC. 104. PRIMARY HEALTH CARE FOR MEDICALLY UNDER2 SERVED RURAL COMMUNITIES; INCREASED

3 CAPACITY OF HOSPITALS AND OUTPATIENT

4 FACILITIES.

5 (a) IN GENERAL.—The Secretary may make grants

6 to public and nonprofit private hospitals in medically un7 derserved rural communities, and to public and nonprofit

8 private outpatient facilities in such communities, for the

9 purpose of carrying out projects to develop or increase the

10 capacity of the hospitals and facilities to provide primary

11 health services.

12 (b) MEDICALLY UNDERSERVED RURAL COMMU13 NITY.—For purposes of this section, the term ‘‘medically

14 underserved rural community’’ means—

15 (1) a rural area that has a substantial number

16 of individuals who are members of a medically un17 derserved population, as defined in section 330 of

18 the Public Health Service Act; or

19 (2) a rural area a significant portion of which

20 is a health professional shortage area designated

21 under section 332 of such Act.

22 (c) CERTAIN EXPENDITURES.—

23 (1) IN GENERAL.—The purposes for which the

24 Secretary may authorize a grant under subsection

25 (a) to be expended include the renovation of facili-
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1 ties, the purchase of equipment, and the recruitment

2 and retention of personnel.

3 (2) CERTAIN FACILITIES.—The purposes for

4 which the Secretary may authorize a grant under

5 subsection (a) to be expended include—

6 (A) the development of rural emergency

7 medical care hospitals; and

8 (B) the development of nurse-managaged

9 health centers for the provision of primary

10 health care services in rural areas and for co11 ordinating with health care providers and net12 works.

13 (d) DEFINITIONS.—

14 (1) RURAL EMERGENCY MEDICAL CARE HOS15 PITALS.—For purposes of this section, a rural emer16 gency medical care hospital is a facility with the fol17 lowing characteristics:

18 (A) It is a hospital that is in danger of

19 closing due to low inpatient utilization rates

20 and operating losses.

21 (B) The closure of the facility would limit

22 the access of individuals residing in the facili23 ty’s service area to emergency services.

24 (C) The facility has entered into (or in25 tends to enter into) an agreement with another
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1 hospital that will accept the transfer of pa2 tients.

3 (D) A physician is available on-call to pro4 vide emergency medical services on a 24-hour5 a-day basis.

6 (E) The facility must have a practitioner

7 who is qualified to provide advanced cardiac life

8 support services (as determined by the State in

9 which the facility is located) on-site at the facil10 ity on a 24-hour-a-day basis.

11 (F) The facility meets such staffing re12 quirements as would apply under section

13 1861(e) of the Social Security Act, except that

14 the facility need not meet hospital standards re15 lating to the number of hours during a day, or

16 days during a week, in which the facility must

17 be open, but must provide emergency care on a

18 24-hour-a-day basis.

19 (2) NURSE-MANAGED HEALTH CENTERS.—For

20 purposes of this section, the term ‘‘nurse-managed

21 health center’’ means a health center meeting the

22 following conditions (to the extent in accordance

23 with applicable law): The services of the center are

24 primary health services; the principal providers of

25 such services through the center are nurse practi-
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1 tioners, certified nurse midwives, and clinical nurse

2 specialists; the principal managers of the center are

3 professional nurses; and the procedures of the center

4 provide patients with direct access to nurse practi5 tioners, certified nurse midwives, or clinical nurse

6 specialists.

7 (e) FUNDING.—

8 (1) HOSPITALS.—For the purpose of making

9 grants to hospitals under subsection (a), there are

10 authorized to be appropriated $50,000,000 for fiscal

11 year 1996, $50,000,000 for fiscal year 1997, and

12 $50,000,000 for fiscal year 1998.

13 (2) OUTPATIENT FACILITIES.—For the purpose

14 of making grants to outpatient facilities under sub15 section (a), there are authorized to be appropriated

16 $50,000,000 for fiscal year 1996, $50,000,000 for

17 fiscal year 1997, and $50,000,000 for fiscal year

18 1998.

19 SEC. 105. TRAINING OF RURAL HEALTH PROFESSIONALS

20 OTHER THAN PHYSICIANS.

21 (a) FUNDING FOR PROGRAMS UNDER PUBLIC

22 HEALTH SERVICE ACT.—With respect to programs of

23 title VII or VIII of the Public Health Service Act that

24 provide for the training of individuals as health profes25 sionals other than physicians, there are authorized to be
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1 appropriated for the purpose of carrying out such pro2 grams, through entities described in subsection (b),

3 $50,000,000 for each of the fiscal years 1996 through

4 1998.

5 (b) ELIGIBILITY.—With respect to a program re6 ferred to in subsection (a), an entity described in this sub7 section is an entity—

8 (1) that is eligible to receive grants or contracts

9 under the program (as provided in the applicable

10 provisions of title VII or VIII of the Public Health

11 Service Act); and

12 (2) a substantial number of whose designated

13 graduates are providing health services in a rural

14 area.

15 (c) DEFINITION OF DESIGNATED GRADUATE.—For

16 purposes of this section, the term ‘‘designated graduate’’,

17 with respect to an entity, means an individual completing

18 the training involved during the 5-year period preceding

19 the fiscal year for which the entity is applying to receive

20 a grant or contract under the applicable program referred

21 to in subsection (a).

22 (d) CERTAIN PROGRAMS.—Programs carried out

23 under subsection (a) shall include programs for nurse

24 practitioners, physician assistants, and nurse midwives.
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1 TITLE II—PROVISIONS

2 RELATING TO MEDICARE

3 SEC. 201. MEDICARE INCENTIVES FOR PHYSICIANS TO PRO4 VIDE PRIMARY CARE.

5 (a) UNDERSERVED AREA BONUS PAYMENTS; IN6 CREASE IN AMOUNT OF PAYMENT FOR PRIMARY CARE

7 SERVICES.—Section 1833(m) of the Social Security Act

8 (42 U.S.C. 1395l(m)) is amended—

9 (1) by striking ‘‘10 percent’’ and inserting ‘‘a

10 percent’’,

11 (2) by striking ‘‘service’’ the last place it ap12 pears and inserting ‘‘services’’, and

13 (3) by adding the following new sentence: ‘‘The

14 percent referred to in the previous sentence is 20

15 percent in the case of primary care services, as de16 fined in section 1842(i)(4), and 10 percent for serv17 ices other than primary care services furnished in

18 health professional shortage areas located in rural

19 areas as defined in section 1886(d)(2)(D).’’.

20 (b) EFFECTIVE DATE.—The amendments made by

21 subsection (a) are effective for services furnished on or

22 after January 1, 1996.
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1 TITLE III—TAX INCENTIVES FOR

2 HEALTH SERVICES PROVIDERS

3 SEC. 301. NONREFUNDABLE CREDIT FOR CERTAIN PRI4 MARY HEALTH SERVICES PROVIDERS.

5 (a) IN GENERAL.—Subpart A of part IV of sub6 chapter A of chapter 1 of the Internal Revenue Code of

7 1986 (relating to nonrefundable personal credits) is

8 amended by inserting after section 22 the following new

9 section:

10 ‘‘SEC. 23. PRIMARY HEALTH SERVICES PROVIDERS.

11 ‘‘(a) ALLOWANCE OF CREDIT.—There shall be al12 lowed as a credit against the tax imposed by this chapter

13 for the taxable year an amount equal to the product of—

14 ‘‘(1) the number of months during such taxable

15 year—

16 ‘‘(A) during which the taxpayer is a quali17 fied primary health services provider, and

18 ‘‘(B) which are within the taxpayer’s man19 datory service period, and

20 ‘‘(2) $1,000 ($500 in the case of a qualified

21 practitioner who is not a physician).

22 ‘‘(b) QUALIFIED PRIMARY HEALTH SERVICES PRO23 VIDER.—For purposes of this section, the term ‘qualified

24 primary health services provider’ means, with respect to

25 any month, any qualified practitioner who—
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1 ‘‘(1) has in effect a certification by the Bureau

2 as a provider of primary health services and such

3 certification is, when issued, for a health profes4 sional shortage area in which the qualified practi5 tioner is commencing the providing of primary

6 health services,

7 ‘‘(2) is providing primary health services full

8 time in the health professional shortage area identi9 fied in such certification, and

10 ‘‘(3) has not received a scholarship under the

11 National Health Service Corps Scholarship Program

12 or any loan repayments under the National Health

13 Service Corps Loan Repayment Program.

14 For purposes of paragraph (2), a provider shall be treated

15 as providing services in a health professional shortage area

16 when such area ceases to be such an area if it was such

17 an area when the provider commenced providing services

18 in the area.

19 ‘‘(c) MANDATORY SERVICE PERIOD.—For purposes

20 of this section, the term ‘mandatory service period’ means

21 the period of 60 consecutive calendar months beginning

22 with the first month the taxpayer is a qualified primary

23 health services provider. A taxpayer shall not have more

24 than 1 mandatory service period.
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1 ‘‘(d) DEFINITIONS AND SPECIAL RULES.—For pur2 poses of this section—

3 ‘‘(1) BUREAU.—The term ‘Bureau’ means the

4 Bureau of Primary Health Care, Health Resources

5 and Services Administration of the United States

6 Public Health Service.

7 ‘‘(2) QUALIFIED PRACTITIONER.—The term

8 ‘qualified practitioner’ means a physician, a physi9 cian assistant, a nurse practitioner, or a certified

10 nurse-midwife.

11 ‘‘(3) PHYSICIAN.—The term ‘physician’ has the

12 meaning given to such term by section 1861(r) of

13 the Social Security Act.

14 ‘‘(4) PHYSICIAN ASSISTANT; NURSE PRACTI15 TIONER.—The terms ‘physician assistant’ and ‘nurse

16 practitioner’ have the meanings given to such terms

17 by section 1861(aa)(5) of the Social Security Act.

18 ‘‘(5) CERTIFIED NURSE-MIDWIFE.—The term

19 ‘certified nurse-midwife’ has the meaning given to

20 such term by section 1861(gg)(2) of the Social Secu21 rity Act.

22 ‘‘(6) PRIMARY HEALTH SERVICES.—The term

23 ‘primary health services’ has the meaning given such

24 term by section 330(b)(1) of the Public Health Serv25 ice Act.
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1 ‘‘(7) HEALTH PROFESSIONAL SHORTAGE

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

3 has the meaning given such term by section

4 332(a)(1)(A) of the Public Health Service Act.

5 ‘‘(e) RECAPTURE OF CREDIT.—

6 ‘‘(1) IN GENERAL.—If there is a recapture

7 event during any taxable year, then—

8 ‘‘(A) no credit shall be allowed under sub9 section (a) for such taxable year and any suc10 ceeding taxable year, and

11 ‘‘(B) the tax of the taxpayer under this

12 chapter for such taxable year shall be increased

13 by an amount equal to the product of—

14 ‘‘(i) the applicable percentage, and

15 ‘‘(ii) the aggregate unrecaptured cred16 its allowed to such taxpayer under this sec17 tion for all prior taxable years.

18 ‘‘(2) APPLICABLE RECAPTURE PERCENTAGE.—

19 ‘‘(A) IN GENERAL.—For purposes of this

20 subsection, the applicable recapture percentage

21 shall be determined from the following table:

‘‘If the recapture The applicable recapevent occurs during: ture percentage is:

Months 1–24 .............................................. 100

Months 25–36 ............................................ 75

Months 37–48 ............................................ 50

Months 49–60 ............................................ 25

Months 61 and thereafter .......................... 0.
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1 ‘‘(B) TIMING.—For purposes of subpara2 graph (A), month 1 shall begin on the first day

3 of the mandatory service period.

4 ‘‘(3) RECAPTURE EVENT DEFINED.—

5 ‘‘(A) IN GENERAL.—For purposes of this

6 subsection, the term ‘recapture event’ means

7 the failure of the taxpayer to be a qualified pri8 mary health services provider for any month

9 during the taxpayer’s mandatory service period.

10 ‘‘(B) CESSATION OF DESIGNATION.—The

11 cessation of the designation of any area as a

12 health professional shortage area after the be13 ginning of the mandatory service period for any

14 taxpayer shall not constitute a recapture event.

15 ‘‘(C) SECRETARIAL WAIVER.—The Sec16 retary, in consultation with the Secretary of

17 Health and Human Services, may waive any re18 capture event caused by extraordinary cir19 cumstances.

20 ‘‘(4) NO CREDITS AGAINST TAX; MINIMUM

21 TAX.—Any increase in tax under this subsection

22 shall not be treated as a tax imposed by this chapter

23 for purposes of determining the amount of any cred24 it under subpart A, B, or D of this part or for pur25 poses of section 55.’’
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1 (b) CLERICAL AMENDMENT.—The table of sections

2 for subpart A of part IV of subchapter A of chapter 1

3 of such Code is amended by inserting after the item relat4 ing to section 22 the following new item:

‘‘Sec. 23. Primary health services providers.’’

5 (c) EFFECTIVE DATE.—The amendments made by

6 this section shall apply to taxable years beginning after

7 December 31, 1995.

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