II

107TH CONGRESS

1ST SESSION S. 1273

To amend the Public Health Service Act to provide for rural health services

outreach, rural health network planning and implementation, and small

health care provider quality improvement grant programs, and

telehomecare demonstration projects.

IN THE SENATE OF THE UNITED STATES

JULY 31, 2001

Mr. HARKIN introduced the following bill; which was read twice and referred

to the Committee on Health, Education, Labor, and Pensions

A BILL

To amend the Public Health Service Act to provide for

rural health services outreach, rural health network planning and implementation, and small health care provider

quality improvement grant programs, and telehomecare

demonstration projects.

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 ‘‘Improving Health Care

5 in Rural America Act’’.
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1 SEC. 2. GRANT PROGRAMS.

2 Section 330A of the Public Health Service Act (42

3 U.S.C. 254c) is amended to read as follows:

4 ‘‘SEC. 330A. RURAL HEALTH SERVICES OUTREACH, RURAL

5 HEALTH NETWORK DEVELOPMENT, AND

6 SMALL HEALTH CARE PROVIDER QUALITY

7 IMPROVEMENT GRANT PROGRAMS.

8 ‘‘(a) PURPOSE.—The purpose of this section is to

9 provide grants for expanded delivery of health services in

10 rural areas, for the planning and implementation of inte11 grated health care networks in rural areas, and for the

12 planning and implementation of small health care provider

13 quality improvement activities.

14 ‘‘(b) DEFINITIONS.—

15 ‘‘(1) DIRECTOR.—The term ‘Director’ means

16 the Director specified in subsection (d).

17 ‘‘(2) FEDERALLY QUALIFIED HEALTH CENTER;

18 RURAL HEALTH CLINIC.—The terms ‘Federally

19 qualified health center’ and ‘rural health clinic’ have

20 the meanings given the terms in section 1861(aa) of

21 the Social Security Act (42 U.S.C. 1395x(aa)).

22 ‘‘(3) HEALTH PROFESSIONAL SHORTAGE

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

24 means a health professional shortage area des25 ignated under section 332.
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1 ‘‘(4) HEALTH SERVICES.—The term ‘health

2 services’ includes mental and behavioral health serv3 ices and substance abuse services.

4 ‘‘(5) MEDICALLY UNDERSERVED AREA.—The

5 term ‘medically underserved area’ has the meaning

6 given the term in section 799B.

7 ‘‘(6) MEDICALLY UNDERSERVED POPU8 LATION.—The term ‘medically underserved popu9 lation’ has the meaning given the term in section

10 330(b)(3).

11 ‘‘(c) PROGRAM.—The Secretary shall establish, under

12 section 301, a small health care provider quality improve13 ment grant program.

14 ‘‘(d) ADMINISTRATION.—

15 ‘‘(1) PROGRAMS.—The rural health services

16 outreach, rural health network development, and

17 small health care provider quality improvement

18 grant programs established under section 301 shall

19 be administered by the Director of the Office of

20 Rural Health Policy of the Health Resources and

21 Services Administration, in consultation with State

22 offices of rural health or other appropriate State

23 government entities.

24 ‘‘(2) GRANTS.—
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1 ‘‘(A) IN GENERAL.—In carrying out the

2 programs described in paragraph (1), the Di3 rector may award grants under subsections (e),

4 (f), and (g) to expand access to, coordinate, and

5 improve the quality of essential health services,

6 and enhance the delivery of health care, in rural

7 areas.

8 ‘‘(B) TYPES OF GRANTS.—The Director

9 may award the grants—

10 ‘‘(i) to promote expanded delivery of

11 health services in rural areas under sub12 section (e);

13 ‘‘(ii) to provide for the planning and

14 implementation of integrated health care

15 networks in rural areas under subsection

16 (f); and

17 ‘‘(iii) to provide for the planning and

18 implementation of small health care pro19 vider quality improvement activities under

20 subsection (g).

21 ‘‘(e) RURAL HEALTH SERVICES OUTREACH

22 GRANTS.—

23 ‘‘(1) GRANTS.—The Director may award grants

24 to eligible entities to promote rural health services

25 outreach by expanding the delivery of health services
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1 to include new and enhanced services in rural areas.

2 The Director may award the grants for periods of

3 not more than 3 years.

4 ‘‘(2) ELIGIBILITY.—To be eligible to receive a

5 grant under this subsection for a project, an

6 entity—

7 ‘‘(A) shall be a rural public or nonprofit

8 private entity;

9 ‘‘(B) shall represent a consortium com10 posed of members—

11 ‘‘(i) that include 3 or more health

12 care providers or providers of services; and

13 ‘‘(ii) that may be nonprofit or for14 profit entities; and

15 ‘‘(C) shall not previously have received a

16 grant under this subsection or section 330A for

17 the project.

18 ‘‘(3) APPLICATIONS.—To be eligible to receive a

19 grant under this subsection, an eligible entity, in

20 consultation with the appropriate State office of

21 rural health or another appropriate State entity,

22 shall prepare and submit to the Secretary an appli23 cation, at such time, in such manner, and containing

24 such information as the Secretary may require,

25 including—
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1 ‘‘(A) a description of the project that the

2 applicant will carry out using the funds pro3 vided under the grant;

4 ‘‘(B) a description of the manner in which

5 the project funded under the grant will meet

6 the health care needs of rural underserved pop7 ulations in the local community or region to be

8 served;

9 ‘‘(C) a description of how the local commu10 nity or region to be served will be involved in

11 the development and ongoing operations of the

12 project;

13 ‘‘(D) a plan for sustainability of the

14 project after Federal support for the project

15 has ended; and

16 ‘‘(E) a description of how the project will

17 be evaluated.

18 ‘‘(f) RURAL HEALTH NETWORK DEVELOPMENT

19 GRANTS.—

20 ‘‘(1) GRANTS.—

21 ‘‘(A) IN GENERAL.—The Director may

22 award rural health network development grants

23 to eligible entities to promote, through planning

24 and implementation, the development of inte25 grated health care networks that have inte-
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1 grated the functions of the entities participating

2 in the networks in order to—

3 ‘‘(i) achieve efficiencies;

4 ‘‘(ii) expand access to, coordinate, and

5 improve the quality of essential health

6 services; and

7 ‘‘(iii) strengthen the rural health care

8 system as a whole.

9 ‘‘(B) GRANT PERIODS.—The Director may

10 award such a rural health network development

11 grant for implementation activities for a period

12 of 3 years. The Director may also award such

13 a rural health network development grant for

14 planning activities for a period of 1 year, to as15 sist in the development of an integrated health

16 care networks, if the proposed participants in

17 the network have a history of collaborative ef18 forts and a 3-year implementation grant would

19 be inappropriate.

20 ‘‘(2) ELIGIBILITY.—To be eligible to receive a

21 grant under this subsection, an entity—

22 ‘‘(A) shall be a rural public or nonprofit

23 private entity;

24 ‘‘(B) shall represent a network composed

25 of members—
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1 ‘‘(i) that include 3 or more health

2 care providers or providers of services; and

3 ‘‘(ii) that may be nonprofit or for4 profit entities; and

5 ‘‘(C) shall not previously have received a

6 grant (other than a 1-year grant for planning

7 activities) under this subsection or section 330A

8 for the project.

9 ‘‘(3) APPLICATIONS.—To be eligible to receive a

10 grant under this subsection, an eligible entity, in

11 consultation with the appropriate State office of

12 rural health or another appropriate State entity,

13 shall prepare and submit to the Secretary an appli14 cation, at such time, in such manner, and containing

15 such information as the Secretary may require,

16 including—

17 ‘‘(A) a description of the project that the

18 applicant will carry out using the funds pro19 vided under the grant;

20 ‘‘(B) an explanation of the reasons why

21 Federal assistance is required to carry out the

22 project;

23 ‘‘(C) a description of—
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1 ‘‘(i) the history of collaborative activi2 ties carried out by the participants in the

3 network;

4 ‘‘(ii) the degree to which the partici5 pants are ready to integrate their func6 tions; and

7 ‘‘(iii) how the local community or re8 gion to be served will benefit from and be

9 involved in the activities carried out by the

10 network;

11 ‘‘(D) a description of how the local com12 munity or region to be served will experience in13 creased access to quality health services across

14 the continuum of care as a result of the inte15 gration activities carried out by the network;

16 ‘‘(E) a plan for sustainability of the

17 project after Federal support for the project

18 has ended; and

19 ‘‘(F) a description of how the project will

20 be evaluated.

21 ‘‘(g) SMALL HEALTH CARE PROVIDER QUALITY IM22 PROVEMENT GRANTS.—

23 ‘‘(1) GRANTS.—The Director may award grants

24 to provide for the planning and implementation of

25 small health care provider quality improvement ac-
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1 tivities. The Director may award the grants for peri2 ods of 1 to 3 years.

3 ‘‘(2) ELIGIBILITY.—In order to be eligible for a

4 grant under this subsection, an entity—

5 ‘‘(A) shall be a rural public or nonprofit

6 private health care provider, such as a critical

7 access hospital or a rural health clinic;

8 ‘‘(B) shall be another rural provider or

9 network of small rural providers identified by

10 the Secretary as a key source of local care; or

11 ‘‘(C) shall not previously have received a

12 grant under this subsection for the project.

13 ‘‘(3) APPLICATIONS.—To be eligible to receive a

14 grant under this subsection, an eligible entity, in

15 consultation with the appropriate State office of

16 rural health or another appropriate State entity,

17 shall prepare and submit to the Secretary an appli18 cation, at such time, in such manner, and containing

19 such information as the Secretary may require,

20 including—

21 ‘‘(A) a description of the project that the

22 applicant will carry out using the funds pro23 vided under the grant;
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1 ‘‘(B) an explanation of the reasons why

2 Federal assistance is required to carry out the

3 project;

4 ‘‘(C) a description of the manner in which

5 the project funded under the grant will assure

6 continuous quality improvement in the provision

7 of services by the entity;

8 ‘‘(D) a description of how the local com9 munity or region to be served will experience in10 creased access to quality health services across

11 the continuum of care as a result of the activi12 ties carried out by the entity;

13 ‘‘(E) a plan for sustainability of the

14 project after Federal support for the project

15 has ended; and

16 ‘‘(F) a description of how the project will

17 be evaluated.

18 ‘‘(4) PREFERENCE.—In awarding grants under

19 this subsection, the Secretary shall give preference

20 to entities that—

21 ‘‘(A) are located in health professional

22 shortage areas or medically underserved areas,

23 or serve medically underserved populations; or
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1 ‘‘(B) propose to develop projects with a

2 focus on primary care, and wellness and preven3 tion strategies.

4 ‘‘(h) COORDINATION WITH OTHER AGENCIES.—The

5 Secretary shall coordinate activities carried out under

6 grant programs described in this section, to the extent

7 practicable, with Federal and State agencies and nonprofit

8 organizations that are operating similar grant programs,

9 to maximize the effect of public dollars in funding meri10 torious proposals.

11 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There

12 are authorized to be appropriated to carry out this section

13 such sums as may be necessary for each of fiscal years

14 2002 through 2006.’’.

15 SEC. 3. CONSOLIDATION AND REAUTHORIZATION OF PRO16 VISIONS.

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

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

19 at the end the following:

20 ‘‘SEC. 330I. TELEHOMECARE DEMONSTRATION PROJECT.

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

22 ‘‘(1) DISTANT SITE.—The term ‘distant site’

23 means a site at which a certified home care provider

24 is located at the time at which a health service (in-
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1 cluding a health care item) is provided through a

2 telecommunications system.

3 ‘‘(2) TELEHOMECARE.—The term

4 ‘telehomecare’ means the provision of health services

5 through technology relating to the use of electronic

6 information, or through telemedicine or tele7 communication technology, to support and promote,

8 at a distant site, the monitoring and management of

9 home health services for a resident of a rural area.

10 ‘‘(b) ESTABLISHMENT.—Not later than 9 months

11 after the date of enactment of the Health Care Safety Net

12 Amendments of 2001, the Secretary may establish and

13 carry out a telehomecare demonstration project.

14 ‘‘(c) GRANTS.—In carrying out the demonstration

15 project referred to in subsection (b), the Secretary shall

16 make not more than 5 grants to eligible certified home

17 care providers, individually or as part of a network of

18 home health agencies, for the provision of telehomecare

19 to improve patient care, prevent health care complications,

20 improve patient outcomes, and achieve efficiencies in the

21 delivery of care to patients who reside in rural areas.

22 ‘‘(d) PERIODS.—The Secretary shall make the grants

23 for periods of not more than 3 years.

24 ‘‘(e) APPLICATIONS.—To be eligible to receive a grant

25 under this section, a certified home care provider shall
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1 submit an application to the Secretary at such time, in

2 such manner, and containing such information as the Sec3 retary may require.

4 ‘‘(f) USE OF FUNDS.—A provider that receives a

5 grant under this section shall use the funds made available

6 through the grant to carry out objectives that include—

7 ‘‘(1) improving access to care for home care pa8 tients served by home health care agencies, improv9 ing the quality of that care, increasing patient satis10 faction with that care, and reducing the cost of that

11 care through direct telecommunications links that

12 connect the provider with information networks;

13 ‘‘(2) developing effective care management

14 practices and educational curricula to train home

15 care registered nurses and increase their general

16 level of competency through that training; and

17 ‘‘(3) developing curricula to train health care

18 professionals, particularly registered nurses, serving

19 home care agencies in the use of telecommuni20 cations.

21 ‘‘(g) COVERAGE.—Nothing in this section shall be

22 construed to supercede or modify the provisions relating

23 to exclusion of coverage under section 1862(a) of the So24 cial Security Act (42 U.S.C. 1395y(a)), or the provisions
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1 relating to the amount payable to a home health agency

2 under section 1895 of that Act (42 U.S.C. 1395fff).

3 ‘‘(h) REPORT.—

4 ‘‘(1) INTERIM REPORT.—The Secretary shall

5 submit to Congress an interim report describing the

6 results of the demonstration project.

7 ‘‘(2) FINAL REPORT.—Not later than 6 months

8 after the end of the last grant period for a grant

9 made under this section, the Secretary shall submit

10 to Congress a final report—

11 ‘‘(A) describing the results of the dem12 onstration project; and

13 ‘‘(B) including an evaluation of the impact

14 of the use of telehomecare, including telemedi15 cine and telecommunications, on—

16 ‘‘(i) access to care for home care pa17 tients; and

18 ‘‘(ii) the quality of, patient satisfac19 tion with, and the cost of, that care.

20 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There

21 are authorized to be appropriated to carry out this section

22 such sums as may be necessary for each of fiscal years

23 2002 through 2006.’’.

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