```

[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 1273 Introduced in Senate (IS)]

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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Improving Health Care in Rural 
America Act''.

SEC. 2. 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 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 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) Health services.--The term `health services' includes 
        mental and behavioral health services and substance abuse 
        services.
            ``(5) Medically underserved area.--The term `medically 
        underserved area' has the meaning given the term in section 
        799B.
            ``(6) 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 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 services, and enhance the delivery of 
                health care, in rural areas.
                    ``(B) Types of grants.--The Director may award the 
                grants--
                            ``(i) to promote expanded delivery of 
                        health 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 Services Outreach Grants.--
            ``(1) Grants.--The Director may award grants to eligible 
        entities to promote rural health services outreach by expanding 
        the delivery of health 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 nonprofit private 
                entity;
                    ``(B) shall represent a consortium composed of 
                members--
                            ``(i) that include 3 or more health care 
                        providers or providers of services; and
                            ``(ii) that may be nonprofit or for-profit 
                        entities; and
                    ``(C) shall not previously have received a grant 
                under this subsection or section 330A for 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 
                applicant 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 sustainability of the project 
                after Federal support for the project has ended; and
                    ``(E) a description of how the project will be 
                evaluated.
    ``(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 integrated 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 
                        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 networks, if the proposed 
                participants in the network have a history of 
                collaborative efforts and a 3-year implementation 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 nonprofit private 
                entity;
                    ``(B) shall represent a network composed of 
                members--
                            ``(i) that include 3 or more health care 
                        providers or providers of services; and
                            ``(ii) that may be nonprofit or for-profit 
                        entities; and
                    ``(C) shall not previously have received a grant 
                (other than a 1-year grant for planning activities) 
                under this subsection or section 330A for 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 
                applicant 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 services across the continuum of care as 
                a result of the integration activities carried out by 
                the network;
                    ``(E) a plan for sustainability of the project 
                after Federal support for the project has ended; and
                    ``(F) a description of how the project will be 
                evaluated.
    ``(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.--In order to be eligible for a grant 
        under this subsection, an entity--
                    ``(A) shall be a rural public or nonprofit private 
                health care provider, such as a critical access 
                hospital or a rural health clinic;
                    ``(B) shall be another rural provider or network of 
                small rural providers identified by the Secretary as a 
                key source of local care; or
                    ``(C) shall not previously have received a grant 
                under this subsection for 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 
                applicant 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 services across the continuum of care as 
                a result of the activities carried out by the entity;
                    ``(E) a plan for sustainability of the project 
                after Federal support for the project has ended; and
                    ``(F) a description of how the project will be 
                evaluated.
            ``(4) Preference.--In awarding grants under this 
        subsection, the Secretary shall give preference to entities 
        that--
                    ``(A) are located in health professional shortage 
                areas or medically underserved areas, or serve 
                medically underserved populations; or
                    ``(B) propose to develop projects with a focus on 
                primary care, and wellness and prevention strategies.
    ``(h) Coordination With Other Agencies.--The Secretary shall 
coordinate activities carried out under grant programs 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.
    ``(i) 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.''.

SEC. 3. 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. TELEHOMECARE DEMONSTRATION PROJECT.

    ``(a) Definitions.--In this section:
            ``(1) Distant site.--The term `distant site' means a site 
        at which a certified home care provider is located at the time 
        at which a health service (including a health care item) is 
        provided through a telecommunications system.
            ``(2) Telehomecare.--The term `telehomecare' means the 
        provision of health services through technology relating to the 
        use of electronic information, or through telemedicine or 
        telecommunication technology, to support and promote, at a 
        distant site, the monitoring and management of home health 
        services for a resident of a rural area.
    ``(b) Establishment.--Not later than 9 months after the date of 
enactment of the Health Care Safety Net Amendments of 2001, the 
Secretary may establish and carry out a telehomecare demonstration 
project.
    ``(c) Grants.--In carrying out the demonstration project referred 
to in subsection (b), the Secretary shall make not more than 5 grants 
to eligible certified home care providers, individually or as part of a 
network of home health agencies, for the provision of telehomecare to 
improve patient care, prevent health care complications, improve 
patient outcomes, and achieve efficiencies in the delivery of care to 
patients who reside in rural areas.
    ``(d) Periods.--The Secretary shall make the grants for periods of 
not more than 3 years.
    ``(e) Applications.--To be eligible to receive a grant under this 
section, a certified home care provider shall submit an application to 
the Secretary at such time, in such manner, and containing such 
information as the Secretary may require.
    ``(f) Use of Funds.--A provider that receives a grant under this 
section shall use the funds made available through the grant to carry 
out objectives that include--
            ``(1) improving access to care for home care patients 
        served by home health care agencies, improving the quality of 
        that care, increasing patient satisfaction with that care, and 
        reducing the cost of that care through direct 
        telecommunications links that connect the provider with 
        information networks;
            ``(2) developing effective care management practices and 
        educational curricula to train home care registered nurses and 
        increase their general level of competency through that 
        training; and
            ``(3) developing curricula to train health care 
        professionals, particularly registered nurses, serving home 
        care agencies in the use of telecommunications.
    ``(g) Coverage.--Nothing in this section shall be construed to 
supercede or modify the provisions relating to exclusion of coverage 
under section 1862(a) of the Social Security Act (42 U.S.C. 1395y(a)), 
or the provisions relating to the amount payable to a home health 
agency under section 1895 of that Act (42 U.S.C. 1395fff).
    ``(h) Report.--
            ``(1) Interim report.--The Secretary shall submit to 
        Congress an interim report describing the results of the 
        demonstration project.
            ``(2) Final report.--Not later than 6 months after the end 
        of the last grant period for a grant made under this section, 
        the Secretary shall submit to Congress a final report--
                    ``(A) describing the results of the demonstration 
                project; and
                    ``(B) including an evaluation of the impact of the 
                use of telehomecare, including telemedicine and 
                telecommunications, on--
                            ``(i) access to care for home care 
                        patients; and
                            ``(ii) the quality of, patient satisfaction 
                        with, and the cost of, that care.
    ``(i) 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.''.
                                 <all>
```