II

107TH CONGRESS

1ST SESSION S. 1281

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.

IN THE SENATE OF THE UNITED STATES

JULY 31, 2001

Mr. KENNEDY (for himself and Mr. FRIST) 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 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.

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; TABLE OF CONTENTS.

4 (a) SHORT TITLE.—This Act may be cited as the

5 ‘‘Health Care Safety Net Amendments of 2001’’.
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1 (b) TABLE OF CONTENTS.—The table of contents for

2 this Act is as follows:

Sec. 1. Short title; table of contents.

TITLE I—CONSOLIDATED HEALTH CENTER PROGRAM

AMENDMENTS

Sec. 101. Health centers.

TITLE II—RURAL HEALTH

Subtitle A—Rural Health 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.

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.

TITLE IV—HEALTHY COMMUNITIES ACCESS PROGRAM ACT

Sec. 401. Purpose.

Sec. 402. Creation of Healthy Communities Access Program.

TITLE V—RURAL HEALTH CLINICS

Sec. 501. Exemptions for rural health clinics.

TITLE VI—CONFORMING AMENDMENTS

Sec. 601. Conforming amendments.
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1 TITLE I—CONSOLIDATED

2 HEALTH CENTER PROGRAM

3 AMENDMENTS

4 SEC. 101. HEALTH CENTERS.

5 Section 330 of the Public Health Service Act (42

6 U.S.C. 254b) is amended—

7 (1) in subsection (b)(1)(A)—

8 (A) in clause (i)(III)(bb), by striking

9 ‘‘screening for breast and cervical cancer’’ and

10 inserting ‘‘appropriate cancer screening’’;

11 (B) in clause (ii), by inserting ‘‘(including

12 specialty referral when medically indicated)’’

13 after ‘‘medical services’’; and

14 (C) in clause (iii), by inserting ‘‘housing,’’

15 after ‘‘social,’’;

16 (2) in subsection (b)(2)—

17 (A) in subparagraph (A)—

18 (i) in clause (vi), by striking ‘‘and’’;

19 (ii) by redesignating clause (vii) as

20 clause (x); and

21 (iii) by inserting after clause (vi) the

22 following:

23 ‘‘(vii) the detection and alleviation of

24 chemical and pesticide exposures;
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1 ‘‘(viii) the promotion of indoor and

2 outdoor air quality;

3 ‘‘(ix) the detection and remediation of

4 lead exposures; and’’;

5 (B) by redesignating subparagraphs (A) and

6 (B) as subparagraphs (D) and (E), respectively; and

7 (C) by inserting before subparagraph (D) (as

8 redesignated by subparagraph (B)) the following:

9 ‘‘(A) behavioral and mental health and

10 substance abuse services;

11 ‘‘(B) recuperative care services;

12 ‘‘(C) public health services;’’;

13 (3) in subsection (c)(1)—

14 (A) in subparagraph (B)—

15 (i) in the heading, by striking ‘‘COM16 PREHENSIVE SERVICE DELIVERY’’ and in17 serting ‘‘MANAGED CARE’’;

18 (ii) in the matter preceding clause (i),

19 by striking ‘‘network or plan’’ and all that

20 follows to the period and inserting ‘‘man21 aged care network or plan’’; and

22 (iii) in the matter following clause (ii),

23 by striking ‘‘Any such grant may include’’

24 and all that follows through the period;

25 and
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1 (B) by adding at the end the following:

2 ‘‘(C) PRACTICE MANAGEMENT NET3 WORKS.—The Secretary may make grants to

4 health centers that receive assistance under this

5 section to enable the centers to plan and de6 velop practice management networks that will

7 enable the centers to—

8 ‘‘(i) reduce costs associated with the

9 provision of health care services;

10 ‘‘(ii) improve access to, and avail11 ability of, health care services provided to

12 individuals served by the centers;

13 ‘‘(iii) enhance the quality and coordi14 nation of health care services; or

15 ‘‘(iv) improve the health status of

16 communities.

17 ‘‘(D) USE OF FUNDS.—The activities for

18 which a grant may be made under subpara19 graph (B) or (C) of this paragraph may include

20 the purchase or lease of equipment, which may

21 include data and information systems (including

22 the costs of amortizing the principal of, and

23 paying the interest on, loans for equipment),

24 the provision of training and technical assist25 ance related to the provision of health services
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1 on a prepaid basis or under another managed

2 care arrangement, and other activities that pro3 mote the development of practice management

4 or managed care networks and plans.’’;

5 (4) in subsection (d)—

6 (A) in paragraph (1)—

7 (i) in subparagraph (B)—

8 (I) in clause (i), by striking ‘‘or’’;

9 (II) in clause (ii), by striking the

10 period and inserting ‘‘; or’’; and

11 (III) by adding at the end the

12 following:

13 ‘‘(iii) to refinance a loan to the center

14 or centers, if the Secretary determines

15 that—

16 ‘‘(I) such refinancing will result

17 in more favorable terms;

18 ‘‘(II) the savings resulting from

19 the refinancing will be beneficial to

20 both the center (or centers) and the

21 Government; and

22 ‘‘(III) the center (or centers) can

23 demonstrate an ability to repay the

24 refinanced loan equal to or greater

25 than the ability of the center (or cen-
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1 ters) to repay the original loan, on the

2 date the original loan was made.’’;

3 and

4 (ii) by adding at the end the fol5 lowing:

6 ‘‘(D) LOAN GUARANTEES.—Notwith7 standing any other provision of law, the fol8 lowing funds shall be made available until ex9 pended for loan guarantees under this sub10 section:

11 ‘‘(i) Funds appropriated for fiscal

12 year 1997 under the Departments of

13 Labor, Health and Human Services, and

14 Education, and Related Agencies Appro15 priations Act, 1997, which were made

16 available for loan guarantees for loans

17 made by non-Federal lenders for construc18 tion, renovation, and modernization of

19 buildings or medical facilities that are

20 owned and operated by health centers and

21 for loan guarantees for loans to health cen22 ters for the costs of developing and oper23 ating managed care networks or plans and

24 which have not been expended.
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1 ‘‘(ii) Funds appropriated for fiscal

2 year 1998 under the Departments of

3 Labor, Health and Human Services, and

4 Education, and Related Agencies Appro5 priations Act, 1998, which were made

6 available for loan guarantees for loans

7 made by non-Federal lenders for the con8 struction, renovation, and modernization of

9 buildings and for loan guarantees for loans

10 for health centers.

11 ‘‘(E) PROVISION DIRECTLY TO NETWORKS

12 OR PLANS.—At the request of health centers re13 ceiving assistance under this section, loan guar14 antees provided under this paragraph may be

15 made directly to networks or plans at least ma16 jority controlled and, as applicable, at least ma17 jority owned by those health centers.

18 ‘‘(F) FEDERAL CREDIT REFORM.—The re19 quirements of the Federal Credit Reform Act of

20 1990 (2 U.S.C. 661 et seq.) shall apply with re21 spect to loans refinanced under subparagraph

22 (B)(iii).’’; and

23 (B) by striking paragraphs (6) and (7) and

24 redesignating paragraph (8) as paragraph (6);

25 (5) in subsection (e)—
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1 (A) in paragraph (1)—

2 (i) in subparagraph (B), by striking

3 ‘‘subsection (j)(3)’’ and inserting ‘‘sub4 section (k)(3)’’; and

5 (ii) by adding at the end the fol6 lowing:

7 ‘‘(C) OPERATION OF NETWORKS AND

8 PLANS.—The Secretary may make grants to

9 health centers that receive assistance under this

10 section, or at the request of the health center

11 or centers, directly to a network or plan (as de12 scribed in subparagraphs (B) and (C) of sub13 section (c)(1)) that is at least majority con14 trolled and, as applicable, at least majority

15 owned by such health center or centers receiv16 ing assistance under this section, for the costs

17 associated with the operation of such network

18 or plan, including the purchase or lease of

19 equipment (including the costs of amortizing

20 the principal of, and paying the interest on,

21 loans for equipment).’’; and

22 (B) in paragraph (5)—

23 (i) in subparagraph (A), by inserting

24 ‘‘subparagraphs (A) and (B) of’’ after

25 ‘‘any fiscal year under’’;
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1 (ii) by redesignating subparagraphs

2 (B) and (C) as subparagraphs (C) and

3 (D), respectively; and

4 (iii) by inserting after subparagraph

5 (A) the following:

6 ‘‘(B) NETWORKS AND PLANS.—The total

7 amount of grant funds made available for any

8 fiscal year under paragraph (1)(C) and sub9 paragraphs (B) and (C) of subsection (c)(1) to

10 a health center or to a network at least major11 ity controlled and as applicable at least majority

12 owned by health centers shall be determined by

13 the Secretary, but may not exceed 2 percent of

14 the total amount appropriated under this sec15 tion for such fiscal year.’’;

16 (6) in subsection (h)—

17 (A) in paragraph (1), by striking ‘‘home18 less children and children at risk of homeless19 ness’’ and inserting ‘‘homeless children and

20 youth and children and youth at risk of home21 lessness’’;

22 (B)(i) by redesignating paragraph (4) as

23 paragraph (5); and

24 (ii) by inserting after paragraph (3) the

25 following:
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1 ‘‘(4) TEMPORARY CONTINUED PROVISION OF

2 SERVICES TO CERTAIN FORMER HOMELESS INDIVID3 UALS.—If any grantee under subsection (h) has pro4 vided services described in this section to a homeless

5 individual, any such grantee may, notwithstanding

6 that the individual is no longer homeless as a result

7 of becoming a resident in permanent housing, ex8 pend the grant to continue to provide such services

9 to the individual for not more than 12 months.’’;

10 and

11 (C) in paragraph (5)(C) (as redesignated

12 by subparagraph (B)), by striking ‘‘and residen13 tial treatment’’ and inserting ‘‘, harm reduc14 tion, outpatient treatment, residential treat15 ment, and rehabilitation’’;

16 (7) in subsection (j)(3)—

17 (A) in subparagraph (E)—

18 (i) in clause (i), by striking ‘‘plan; or’’

19 and inserting ‘‘plan; and’’; and

20 (ii) by striking clause (ii) and insert21 ing the following:

22 ‘‘(ii) has or will have a contractual or

23 other arrangement with the State agency

24 administering the program under title XXI

25 of such Act with respect to individuals who
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1 are State children’s health insurance pro2 gram beneficiaries; or

3 ‘‘(iii) has made or will make every

4 reasonable effort to enter into such ar5 rangements under clauses (i) and (ii);’’;

6 (B) in subparagraph (G)—

7 (i) in clause (ii), by striking ‘‘; and’’

8 and inserting ‘‘;’’;

9 (ii) by redesignating clause (iii) as

10 clause (iv); and

11 (iii) inserting after clause (ii) the fol12 lowing:

13 ‘‘(iii)(I) will assure that no patient is

14 denied health care services due to an indi15 vidual’s inability to pay for such services;

16 and

17 ‘‘(II) will assure that any fees or pay18 ments required by the center for such serv19 ices shall be reduced or waived to enable

20 the center to fulfill the assurance described

21 in subclause (I); and’’; and

22 (C) in subparagraph (H)—

23 (i) in clause (ii), by inserting ‘‘ap24 proves any internal outreach plans for spe-
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1 cific subpopulations served by the center,’’

2 after ‘‘such services will be provided,’’; and

3 (ii) in the matter following clause (iii),

4 by striking ‘‘or (p)’’ and inserting ‘‘or

5 (q)’’;

6 (8)(A) by redesignating subsections (j) through

7 (q) as subsections (k) through (r), respectively; and

8 (B) by inserting after subsection (i) the fol9 lowing:

10 ‘‘(j) ENVIRONMENTAL CONCERNS.—The Secretary

11 may make grants to health centers for the purpose of as12 sisting such centers in identifying and detecting environ13 mental factors and conditions, and providing services, in14 cluding environmental health services described in sub15 section (b)(2)(D), to reduce the disease burden related to

16 environmental factors and exposure of populations to such

17 factors, and alleviate environmental conditions that affect

18 the health of individuals and communities served by health

19 centers funded under this section.’’;

20 (9) by striking subsection (l) (as redesignated

21 by paragraph (8)(A)) and inserting the following:

22 ‘‘(l) TECHNICAL ASSISTANCE.—The Secretary shall

23 establish a program through which the Secretary shall

24 provide technical and other assistance to eligible entities

25 to assist such entities to meet the requirements of sub-
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1 section (k)(2). Services provided through the program may

2 include necessary technical and nonfinancial assistance,

3 including fiscal and program management assistance,

4 training in program management, operational and admin5 istrative support, and the provision of information to the

6 entities of the variety of resources available under this title

7 and how those resources can be best used to meet the

8 health needs of the communities served by the entities.’’;

9 (10) in subsection (m) (as redesignated by

10 paragraph (8)(A))—

11 (A) in paragraph (1), by striking

12 ‘‘$802,124,000’’ and all that follows to the pe13 riod and inserting ‘‘$1,369,000,000 for fiscal

14 year 2002 and such sums as may be necessary

15 for each of the fiscal years 2003 through

16 2006’’; and

17 (B) in paragraph (2)—

18 (i) in subparagraph (A)—

19 (I) by striking ‘‘(j)(3))’’ and in20 serting ‘‘(k)(3))’’; and

21 (II) by striking ‘‘(j)(3)(G)(ii)’’

22 and inserting ‘‘(k)(3)(H)’’; and

23 (ii) by striking subparagraph (B) and

24 inserting the following:
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1 ‘‘(B) DISTRIBUTION OF GRANTS.—For fis2 cal year 2002 and each of the following fiscal

3 years, the Secretary, in awarding grants under

4 this section, shall ensure that the proportion of

5 the amounts made available under each of sub6 sections (g), (h), and (i), relative to the total

7 amount appropriated to carry out this section

8 for that fiscal year, is equal to the proportion

9 of the amounts made available under that sub10 section for fiscal year 2001, relative to the total

11 amount appropriated to carry out this section

12 for fiscal year 2001.’’;

13 (11) in subsection (q), by striking ‘‘(j)(3)(G)’’

14 and inserting ‘‘(k)(3)(G)’’; and

15 (12) by adding at the end the following:

16 ‘‘(r) LINGUISTIC ACCESS GRANTS.—

17 ‘‘(1) IN GENERAL.—The Administrator of the

18 Health Resources and Services Administration (re19 ferred to in this subsection as the ‘Administrator’)

20 may award grants to eligible health centers to pro21 vide translation, interpretation, and other such serv22 ices for clients of the centers for whom English is

23 a second language.

24 ‘‘(2) ELIGIBLE HEALTH CENTER.—The term

25 ‘eligible health center’ means an entity that—
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1 ‘‘(A) is a health center as defined under

2 subsection (a); and

3 ‘‘(B) provides health services for clients for

4 whom English is a second language.

5 ‘‘(3) GRANT AMOUNT.—The amount of a grant

6 awarded to a center under this subsection shall be

7 determined by the Administrator. Such determina8 tion of such amount shall be based on the number

9 of clients for whom English is a second language

10 that is served by such center, and larger grant

11 amounts shall be awarded to centers serving a larger

12 number of such clients.

13 ‘‘(4) USE OF FUNDS.—An eligible health center

14 that receives a grant under this subsection may use

15 funds received through such grant to—

16 ‘‘(A) provide translation and interpretation

17 services for clients for whom English is a sec18 ond language, including hiring professional

19 translation and interpretation services; and

20 ‘‘(B) compensate bilingual or multilingual

21 staff for language assistance services provided

22 by the staff for such clients.

23 ‘‘(5) APPLICATION.—An eligible health center

24 desiring a grant under this subsection shall submit

25 an application to the Administrator at such time, in
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1 such manner, and containing such information as

2 the Administrator may reasonably require,

3 including—

4 ‘‘(A) an estimate of the number of clients

5 that the center serves for whom English is a

6 second language;

7 ‘‘(B) the ratio of the number of clients for

8 whom English is a second language to the total

9 number of clients served by the center; and

10 ‘‘(C) a description of any language-assist11 ing services that the center proposes to provide

12 to aid clients for whom English is a second lan13 guage.

14 ‘‘(6) AUTHORIZATION OF APPROPRIATIONS.—

15 There is authorized to be appropriated to carry out

16 this subsection, in addition to any funds authorized

17 to be appropriated or appropriated for health centers

18 under this section, $10,000,000 for fiscal year 2002,

19 and such sums as may be necessary for each of fis20 cal years 2003 through 2006.’’.
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1 TITLE II—RURAL HEALTH

2 Subtitle A—Rural Health Services

3 Outreach, Rural Health Net4 work Development, and Small

5 Health Care Provider Quality

6 Improvement Grant Programs

7 SEC. 201. GRANT PROGRAMS.

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

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

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

11 HEALTH NETWORK DEVELOPMENT, AND

12 SMALL HEALTH CARE PROVIDER QUALITY

13 IMPROVEMENT GRANT PROGRAMS.

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

15 provide grants for expanded delivery of health services in

16 rural areas, for the planning and implementation of inte17 grated health care networks in rural areas, and for the

18 planning and implementation of small health care provider

19 quality improvement activities.

20 ‘‘(b) DEFINITIONS.—

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

22 the Director specified in subsection (d).

23 ‘‘(2) FEDERALLY QUALIFIED HEALTH CENTER;

24 RURAL HEALTH CLINIC.—The terms ‘Federally

25 qualified health center’ and ‘rural health clinic’ have
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1 the meanings given the terms in section 1861(aa) of

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

3 ‘‘(3) HEALTH PROFESSIONAL SHORTAGE

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

5 means a health professional shortage area des6 ignated under section 332.

7 ‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.—

8 The term ‘medically underserved community’ has the

9 meaning given the term ‘medically underserved area’

10 in section 799B.

11 ‘‘(5) MEDICALLY UNDERSERVED POPU12 LATION.—The term ‘medically underserved popu13 lation’ has the meaning given the term in section

14 330(b)(3).

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

16 section 301, a small health care provider quality improve17 ment grant program.

18 ‘‘(d) ADMINISTRATION.—

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

20 outreach, rural health network development, and

21 small health care provider quality improvement

22 grant programs established under section 301 shall

23 be administered by the Director of the Office of

24 Rural Health Policy of the Health Resources and

25 Services Administration, in consultation with State
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1 offices of rural health or other appropriate State

2 government entities.

3 ‘‘(2) GRANTS.—

4 ‘‘(A) IN GENERAL.—In carrying out the

5 programs described in paragraph (1), the Di6 rector may award grants under subsections (e),

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

8 improve the quality of essential health services,

9 and enhance the delivery of health care, in rural

10 areas.

11 ‘‘(B) TYPES OF GRANTS.—The Director

12 may award the grants—

13 ‘‘(i) to promote expanded delivery of

14 health services in rural areas under sub15 section (e);

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

17 implementation of integrated health care

18 networks in rural areas under subsection

19 (f); and

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

21 implementation of small health care pro22 vider quality improvement activities under

23 subsection (g).

24 ‘‘(e) RURAL HEALTH SERVICES OUTREACH

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

2 to eligible entities to promote rural health services

3 outreach by expanding the delivery of health services

4 to include new and enhanced services in rural areas.

5 The Director may award the grants for periods of

6 not more than 3 years.

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

8 grant under this subsection for a project, an

9 entity—

10 ‘‘(A) shall be a rural public or rural non11 profit private entity;

12 ‘‘(B) shall represent a consortium com13 posed of members—

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

15 care providers or providers of services; and

16 ‘‘(ii) that may be nonprofit or for17 profit entities; and

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

19 grant under this subsection for the same or a

20 similar project, unless the entity is proposing to

21 expand the scope of the project or the area that

22 will be served through the project.

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

24 grant under this subsection, an eligible entity, in

25 consultation with the appropriate State office of
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1 rural health or another appropriate State entity,

2 shall prepare and submit to the Secretary an appli3 cation, at such time, in such manner, and containing

4 such information as the Secretary may require,

5 including—

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

7 applicant will carry out using the funds pro8 vided under the grant;

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

10 the project funded under the grant will meet

11 the health care needs of rural underserved pop12 ulations in the local community or region to be

13 served;

14 ‘‘(C) a description of how the local commu15 nity or region to be served will be involved in

16 the development and ongoing operations of the

17 project;

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

19 project after Federal support for the project

20 has ended; and

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

22 be evaluated.

23 ‘‘(f) RURAL HEALTH NETWORK DEVELOPMENT

24 GRANTS.—

25 ‘‘(1) GRANTS.—
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1 ‘‘(A) IN GENERAL.—The Director may

2 award rural health network development grants

3 to eligible entities to promote, through planning

4 and implementation, the development of inte5 grated health care networks that have combined

6 the functions of the entities participating in the

7 networks in order to—

8 ‘‘(i) achieve efficiencies;

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

10 improve the quality of essential health

11 services; and

12 ‘‘(iii) strengthen the rural health care

13 system as a whole.

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

15 award such a rural health network development

16 grant for implementation activities for a period

17 of 3 years. The Director may also award such

18 a rural health network development grant for

19 planning activities for a period of 1 year, to as20 sist in the development of an integrated health

21 care network, if the proposed participants in

22 the network do not have a history of collabo23 rative efforts and a 3-year grant would be inap24 propriate.
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1 ‘‘(2) ELIGIBILITY.—To be eligible to receive a

2 grant under this subsection, an entity—

3 ‘‘(A) shall be a rural public or rural non4 profit private entity;

5 ‘‘(B) shall represent a network composed

6 of members—

7 ‘‘(i) that include 3 or more health

8 care providers or providers of services; and

9 ‘‘(ii) that may be nonprofit or for10 profit entities; and

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

12 grant under this subsection (other than a grant

13 for planning activities) for the same or a simi14 lar project.

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

16 grant under this subsection, an eligible entity, in

17 consultation with the appropriate State office of

18 rural health or another appropriate State entity,

19 shall prepare and submit to the Secretary an appli20 cation, at such time, in such manner, and containing

21 such information as the Secretary may require,

22 including—

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

24 applicant will carry out using the funds pro25 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—

5 ‘‘(i) the history of collaborative activi6 ties carried out by the participants in the

7 network;

8 ‘‘(ii) the degree to which the partici9 pants are ready to integrate their func10 tions; and

11 ‘‘(iii) how the local community or re12 gion to be served will benefit from and be

13 involved in the activities carried out by the

14 network;

15 ‘‘(D) a description of how the local com16 munity or region to be served will experience in17 creased access to quality health services across

18 the continuum of care as a result of the inte19 gration activities carried out by the network;

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

21 project after Federal support for the project

22 has ended; and

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

24 be evaluated.
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1 ‘‘(g) SMALL HEALTH CARE PROVIDER QUALITY IM2 PROVEMENT GRANTS.—

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

4 to provide for the planning and implementation of

5 small health care provider quality improvement ac6 tivities. The Director may award the grants for peri7 ods of 1 to 3 years.

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

9 grant under this subsection, an entity—

10 ‘‘(A)(i) shall be a rural public or rural non11 profit private health care provider or provider

12 of health services, such as a critical access hos13 pital or a rural health clinic; or

14 ‘‘(ii) shall be another rural provider or net15 work of small rural providers identified by the

16 Secretary as a key source of local care; and

17 ‘‘(B) shall not previously have received a

18 grant under this subsection for the same or a

19 similar project.

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

21 grant under this subsection, an eligible entity, in

22 consultation with the appropriate State office of

23 rural health, another appropriate State entity, or a

24 hospital association, shall prepare and submit to the

25 Secretary an application, at such time, in such man-
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1 ner, and containing such information as the Sec2 retary may require, including—

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

4 applicant will carry out using the funds pro5 vided under the grant;

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

7 Federal assistance is required to carry out the

8 project;

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

10 the project funded under the grant will assure

11 continuous quality improvement in the provision

12 of services by the entity;

13 ‘‘(D) a description of how the local com14 munity or region to be served will experience in15 creased access to quality health services across

16 the continuum of care as a result of the activi17 ties carried out by the entity;

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

19 project after Federal support for the project

20 has ended; and

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

22 be evaluated.

23 ‘‘(4) EXPENDITURES FOR SMALL HEALTH CARE

24 PROVIDER QUALITY IMPROVEMENT GRANTS.—In

25 awarding a grant under this subsection, the Director
28

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1 shall ensure that the funds made available through

2 the grant will be used to provide services to resi3 dents of rural areas. The Director shall award not

4 less than 50 percent of the funds made available

5 under this subsection to providers located in and

6 serving rural areas.

7 ‘‘(h) GENERAL REQUIREMENTS.—

8 ‘‘(1) PROHIBITED USES OF FUNDS.—An entity

9 that receives a grant under this section may not use

10 funds provided through the grant—

11 ‘‘(A) to build or acquire real property; or

12 ‘‘(B) for construction, except that such

13 funds may be expended for minor renovations

14 relating to the installation of equipment.

15 ‘‘(2) COORDINATION WITH OTHER AGENCIES.—

16 The Secretary shall coordinate activities carried out

17 under grant programs described in this section, to

18 the extent practicable, with Federal and State agen19 cies and nonprofit organizations that are operating

20 similar grant programs, to maximize the effect of

21 public dollars in funding meritorious proposals.

22 ‘‘(3) PREFERENCE.—In awarding grants under

23 this section, the Secretary shall give preference to

24 entities that—
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1 ‘‘(A) are located in health professional

2 shortage areas or medically underserved com3 munities, or serve medically underserved popu4 lations; or

5 ‘‘(B) propose to develop projects with a

6 focus on primary care, and wellness and preven7 tion strategies.

8 ‘‘(i) REPORT.—Not later than September 30, 2005,

9 the Secretary shall prepare and submit to the appropriate

10 committees of Congress a report on the progress and ac11 complishments of the grant programs described in sub12 sections (e), (f), and (g).

13 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There

14 are authorized to be appropriated to carry out this section

15 $40,000,000 for fiscal year 2002, and such sums as may

16 be necessary for each of fiscal years 2003 through 2006.’’.

17 Subtitle B—Telehealth Grant

18 Consolidation

19 SEC. 211. SHORT TITLE.

20 This subtitle may be cited as the ‘‘Telehealth Grant

21 Consolidation Act of 2001’’.
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1 SEC. 212. CONSOLIDATION AND REAUTHORIZATION OF

2 PROVISIONS.

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

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

5 at the end the following:

6 ‘‘SEC. 330I. TELEHEALTH NETWORK AND TELEHEALTH RE7 SOURCE CENTERS GRANT PROGRAMS.

8 ‘‘(a) DEFINITIONS.—In this section:

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

10 and ‘Office’ mean the Director and Office specified

11 in subsection (c).

12 ‘‘(2) FEDERALLY QUALIFIED HEALTH CENTER

13 AND RURAL HEALTH CLINIC.—The term ‘Federally

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

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

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

17 ‘‘(3) FRONTIER COMMUNITY.—The term ‘fron18 tier community’ means a community that has a pop19 ulation of less than 6 per square mile.

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

21 term ‘medically underserved area’ has the meaning

22 given the term in section 799B.

23 ‘‘(5) MEDICALLY UNDERSERVED POPU24 LATION.—The term ‘medically underserved popu25 lation’ has the meaning given the term in section

26 330(b)(3).
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1 ‘‘(6) TELEHEALTH SERVICES.—The term ‘tele2 health services’ means services provided through

3 telehealth technologies.

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

5 ‘telehealth technologies’ means technologies relating

6 to the use of electronic information, and tele7 communications technologies, to support and pro8 mote, at a distance, health care, patient and profes9 sional health-related education, health administra10 tion, and public health.

11 ‘‘(b) PROGRAMS.—The Secretary shall establish,

12 under section 301, telehealth network and telehealth re13 source centers grant programs.

14 ‘‘(c) ADMINISTRATION.—

15 ‘‘(1) ESTABLISHMENT.—There is established in

16 the Health and Resources and Services Administra17 tion an Office for the Advancement of Telehealth.

18 The Office shall be headed by a Director.

19 ‘‘(2) DUTIES.—The telehealth network and tele20 health resource centers grant programs established

21 under section 301 shall be administered by the Di22 rector, in consultation with the State offices of rural

23 health, State offices concerning primary care, or

24 other appropriate State government entities.

25 ‘‘(d) GRANTS.—
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1 ‘‘(1) TELEHEALTH NETWORK GRANTS.—The

2 Director may, in carrying out the telehealth network

3 grant program referred to in subsection (b), award

4 grants to eligible entities for projects to demonstrate

5 how telehealth technologies can be used through tele6 health networks in rural areas, frontier communities,

7 and medically underserved areas, and for medically

8 underserved populations, to—

9 ‘‘(A) expand access to, coordinate, and im10 prove the quality of health services;

11 ‘‘(B) improve and expand the training of

12 health care providers; and

13 ‘‘(C) expand and improve the quality of

14 health information available to health care pro15 viders, and patients and their families, for deci16 sionmaking.

17 ‘‘(2) TELEHEALTH RESOURCE CENTERS

18 GRANTS.—The Director may, in carrying out the

19 telehealth resource center grant program referred to

20 in subsection (b), award grants to eligible entities

21 for projects to demonstrate how telehealth tech22 nologies can be used in the areas and communities,

23 and for the populations, described in paragraph (1),

24 to establish telehealth resource centers.
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1 ‘‘(e) GRANT PERIODS.—The Director may provide

2 grants under this section for periods of not more than 4

3 years.

4 ‘‘(f) ELIGIBLE ENTITIES.—

5 ‘‘(1) TELEHEALTH NETWORK GRANTS.—

6 ‘‘(A) GRANT RECIPIENT.—To be eligible to

7 receive a grant under subsection (d)(1), an enti8 ty shall be a nonprofit entity.

9 ‘‘(B) TELEHEALTH NETWORKS.—

10 ‘‘(i) IN GENERAL.—To be eligible to

11 receive a grant under subsection (d)(1), an

12 entity shall demonstrate that the entity

13 will provide services through a telehealth

14 network.

15 ‘‘(ii) NATURE OF ENTITIES.—Each

16 entity participating in the telehealth net17 work may be a nonprofit or for-profit enti18 ty.

19 ‘‘(iii) COMPOSITION OF NETWORK.—

20 The telehealth network shall include at

21 least 2 of the following entities (at least 1

22 of which shall be a community-based

23 health care provider):
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•S 1281 IS

1 ‘‘(I) Community or migrant

2 health centers or other Federally

3 qualified health centers.

4 ‘‘(II) Health care providers, in5 cluding pharmacists, in private prac6 tice.

7 ‘‘(III) Entities operating clinics,

8 including rural health clinics.

9 ‘‘(IV) Local health departments.

10 ‘‘(V) Nonprofit hospitals, includ11 ing community access hospitals.

12 ‘‘(VI) Other publicly funded

13 health or social service agencies.

14 ‘‘(VII) Long-term care providers.

15 ‘‘(VIII) Providers of health care

16 services in the home.

17 ‘‘(IX) Providers of outpatient

18 mental health services and entities op19 erating outpatient mental health fa20 cilities.

21 ‘‘(X) Local or regional emergency

22 health care providers.

23 ‘‘(XI) Institutions of higher edu24 cation.
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1 ‘‘(XII) Entities operating dental

2 clinics.

3 ‘‘(2) TELEHEALTH RESOURCE CENTERS

4 GRANTS.—To be eligible to receive a grant under

5 subsection (d)(2), an entity shall be a nonprofit enti6 ty.

7 ‘‘(g) APPLICATIONS.—To be eligible to receive a

8 grant under subsection (d), an eligible entity, in consulta9 tion with the appropriate State office of rural health or

10 another appropriate State entity, shall prepare and submit

11 to the Secretary an application, at such time, in such man12 ner, and containing such information as the Secretary may

13 require, including—

14 ‘‘(1) a description of the project that the appli15 cant will carry out using the funds provided under

16 the grant;

17 ‘‘(2) a description of the manner in which the

18 project funded under the grant will meet the health

19 care needs of rural or other populations to be served

20 through the project, or improve the access to serv21 ices of, and the quality of the services received by,

22 those populations;

23 ‘‘(3) evidence of local support for the project,

24 and a description of how the areas, communities, or
36

•S 1281 IS

1 populations to be served will be involved in the devel2 opment and ongoing operations of the project;

3 ‘‘(4) a plan for sustainability of the project

4 after Federal support for the project has ended;

5 ‘‘(5) information on the source and amount of

6 non-Federal funds that the entity will provide for

7 the project;

8 ‘‘(6) information demonstrating the long-term

9 viability of the project, and other evidence of institu10 tional commitment of the entity to the project; and

11 ‘‘(7) in the case of an application for a project

12 involving a telehealth network, information dem13 onstrating how the project will promote the integra14 tion of telehealth technologies into the operations of

15 health care providers, to avoid redundancy, and im16 prove access to and the quality of care.

17 ‘‘(h) TERMS; CONDITIONS; MAXIMUM AMOUNT OF

18 ASSISTANCE.—The Secretary shall establish the terms

19 and conditions of each grant program described in sub20 section (b) and the maximum amount of a grant to be

21 awarded to an individual recipient for each fiscal year

22 under this section. The Secretary shall publish, in a publi23 cation of the Health Resources and Services Administra24 tion, notice of the application requirements for each grant

25 program described in subsection (b) for each fiscal year.
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1 ‘‘(i) PREFERENCES.—

2 ‘‘(1) TELEHEALTH NETWORKS.—In awarding

3 grants under subsection (d)(1) for projects involving

4 telehealth networks, the Secretary shall give pref5 erence to an applicant that meets at least 1 of the

6 following requirements:

7 ‘‘(A) ORGANIZATION.— The applicant is a

8 rural community-based organization or another

9 community-based organization.

10 ‘‘(B) SERVICES.—The applicant proposes

11 to use Federal funds made available through

12 such a grant to develop plans for, or to estab13 lish, telehealth networks that provide mental

14 health, public health, long-term care, home

15 care, preventive, or case management services.

16 ‘‘(C) COORDINATION.—The applicant dem17 onstrates how the project to be carried out

18 under the grant will be coordinated with other

19 relevant federally funded projects in the areas,

20 communities, and populations to be served

21 through the grant.

22 ‘‘(D) NETWORK.—The applicant dem23 onstrates that the project involves a telehealth

24 network that includes an entity that—
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•S 1281 IS

1 ‘‘(i) provides clinical health care serv2 ices, or educational services for health care

3 providers and for patients or their families;

4 and

5 ‘‘(ii) is—

6 ‘‘(I) a public school;

7 ‘‘(II) a public library;

8 ‘‘(III) an institution of higher

9 education; or

10 ‘‘(IV) a local government entity.

11 ‘‘(E) CONNECTIVITY.—The applicant pro12 poses a project that promotes local connectivity

13 within areas, communities, or populations to be

14 served through the project.

15 ‘‘(F) INTEGRATION.—The applicant dem16 onstrates that health care information has been

17 integrated into the project.

18 ‘‘(2) TELEHEALTH RESOURCE CENTERS.—In

19 awarding grants under subsection (d)(2) for projects

20 involving telehealth resource centers, the Secretary

21 shall give preference to an applicant that meets at

22 least 1 of the following requirements:

23 ‘‘(A) PROVISION OF SERVICES.—The appli24 cant has a record of success in the provision of
39

•S 1281 IS

1 telehealth services to medically underserved

2 areas or medically underserved populations.

3 ‘‘(B) COLLABORATION AND SHARING OF

4 EXPERTISE.—The applicant has a demonstrated

5 record of collaborating and sharing expertise

6 with providers of telehealth services at the na7 tional, regional, State, and local levels.

8 ‘‘(C) BROAD RANGE OF TELEHEALTH

9 SERVICES.—The applicant has a record of pro10 viding a broad range of telehealth services,

11 which may include—

12 ‘‘(i) a variety of clinical specialty serv13 ices;

14 ‘‘(ii) patient or family education;

15 ‘‘(iii) health care professional edu16 cation; and

17 ‘‘(iv) rural residency support pro18 grams.

19 ‘‘(j) DISTRIBUTION OF FUNDS.—

20 ‘‘(1) IN GENERAL.—In awarding grants under

21 this section, the Director shall ensure, to the great22 est extent possible, that such grants are equitably

23 distributed among the geographical regions of the

24 United States.
40

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1 ‘‘(2) TELEHEALTH NETWORKS.—In awarding

2 grants under subsection (d)(1) for a fiscal year, the

3 Director shall ensure that—

4 ‘‘(A) not less than 50 percent of the funds

5 awarded shall be awarded for projects in rural

6 areas; and

7 ‘‘(B) the total amount of funds awarded

8 for such projects for that fiscal year shall be

9 not less than the total amount of funds award10 ed for such projects for fiscal year 2001 under

11 section 330A (as in effect on the day before the

12 date of enactment of the Health Care Safety

13 Net Amendments of 2001).

14 ‘‘(k) USE OF FUNDS.—

15 ‘‘(1) TELEHEALTH NETWORK PROGRAM.—The

16 recipient of a grant under subsection (d)(1) may use

17 funds received through such grant for salaries,

18 equipment, and operating or other costs, including

19 the cost of—

20 ‘‘(A) developing and delivering clinical tele21 health services that enhance access to commu22 nity-based health care services in rural areas,

23 frontier communities, or medically underserved

24 areas, or for medically underserved populations;
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•S 1281 IS

1 ‘‘(B) developing and acquiring, through

2 lease or purchase, computer hardware and soft3 ware, audio and video equipment, computer net4 work equipment, interactive equipment, data

5 terminal equipment, and other equipment that

6 furthers the objectives of the telehealth network

7 grant program;

8 ‘‘(C)(i) developing and providing distance

9 education, in a manner that enhances access to

10 care in rural areas, frontier communities, or

11 medically underserved areas, or for medically

12 underserved populations; or

13 ‘‘(ii) mentoring, precepting, or supervising

14 health care providers and students seeking to

15 become health care providers, in a manner that

16 enhances access to care in the areas and com17 munities, or for the populations, described in

18 clause (i);

19 ‘‘(D) developing and acquiring instruc20 tional programming;

21 ‘‘(E)(i) providing for transmission of med22 ical data, and maintenance of equipment; and

23 ‘‘(ii) providing for compensation (including

24 travel expenses) of specialists, and referring

25 health care providers, providing telehealth serv-
42

•S 1281 IS

1 ices through the telehealth network, if no third

2 party payment is available for the telehealth

3 services delivered through the telehealth net4 work;

5 ‘‘(F) developing projects to use telehealth

6 technology to facilitate collaboration between

7 health care providers;

8 ‘‘(G) collecting and analyzing usage statis9 tics and data to document the cost-effectiveness

10 of the telehealth services; and

11 ‘‘(H) carrying out such other activities as

12 are consistent with achieving the objectives of

13 this section, as determined by the Secretary.

14 ‘‘(2) TELEHEALTH RESOURCE CENTERS.—The

15 recipient of a grant under subsection (d)(2) may use

16 funds received through such grant for salaries,

17 equipment, and operating or other costs for—

18 ‘‘(A) providing technical assistance, train19 ing, and support, and providing for travel ex20 penses, for health care providers and a range of

21 health care entities that provide or will provide

22 telehealth services;

23 ‘‘(B) disseminating information and re24 search findings related to telehealth services;
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•S 1281 IS

1 ‘‘(C) promoting effective collaboration

2 among telehealth resource centers and the Of3 fice;

4 ‘‘(D) conducting evaluations to determine

5 the best utilization of telehealth technologies to

6 meet health care needs;

7 ‘‘(E) promoting the integration of the tech8 nologies used in clinical information systems

9 with other telehealth technologies;

10 ‘‘(F) fostering the use of telehealth tech11 nologies to provide health care information and

12 education for health care providers and con13 sumers in a more effective manner; and

14 ‘‘(G) implementing special projects or

15 studies under the direction of the Office.

16 ‘‘(l) PROHIBITED USES OF FUNDS.—An entity that

17 receives a grant under this section may not use funds

18 made available through the grant—

19 ‘‘(1) to acquire real property;

20 ‘‘(2) for expenditures to purchase or lease

21 equipment, to the extent that the expenditures would

22 exceed 40 percent of the total grant funds;

23 ‘‘(3) in the case of a project involving a tele24 health network, to purchase or install transmission

25 equipment (such as laying cable or telephone lines,
44

•S 1281 IS

1 or purchasing or installing microwave towers, sat2 ellite dishes, amplifiers, or digital switching equip3 ment), except on the premises of an entity partici4 pating in the telehealth network;

5 ‘‘(4) to pay for any equipment or transmission

6 costs not directly related to the purposes for which

7 the grant is awarded;

8 ‘‘(5) to purchase or install general purpose

9 voice telephone systems;

10 ‘‘(6) for construction, except that such funds

11 may be expended for minor renovations relating to

12 the installation of equipment; or

13 ‘‘(7) for expenditures for indirect costs (as de14 termined by the Secretary), to the extent that the

15 expenditures would exceed 20 percent of the total

16 grant funds.

17 ‘‘(m) COLLABORATION.—In providing services under

18 this section, an eligible entity shall collaborate, if feasible,

19 with entities that—

20 ‘‘(1)(A) are private or public organizations, that

21 receive Federal or State assistance; or

22 ‘‘(B) public or private entities that operate cen23 ters, or carry out programs, that receive Federal or

24 State assistance; and
45

•S 1281 IS

1 ‘‘(2) provide telehealth services or related activi2 ties.

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

4 Secretary shall coordinate activities carried out under

5 grant programs described in subsection (b), to the extent

6 practicable, with Federal and State agencies and nonprofit

7 organizations that are operating similar programs, to

8 maximize the effect of public dollars in funding meri9 torious proposals.

10 ‘‘(o) OUTREACH ACTIVITIES.—The Secretary shall

11 establish and implement procedures to carry out outreach

12 activities to advise potential end users of telehealth serv13 ices in rural areas, frontier communities, medically under14 served areas, and medically underserved populations in

15 each State about the grant programs described in sub16 section (b).

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

18 for purposes of this section, States should develop reci19 procity agreements so that a provider of services under

20 this section who is a licensed or otherwise authorized

21 health care provider under the law of 1 or more States,

22 and who, through telehealth technology, consults with a

23 licensed or otherwise authorized health care provider in

24 another State, is exempt, with respect to such consulta25 tion, from any State law of the other State that prohibits
46

•S 1281 IS

1 such consultation on the basis that the first health care

2 provider is not a licensed or authorized health care pro3 vider under the law of that State.

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

5 the Secretary shall prepare and submit to the appropriate

6 committees of Congress a report on the progress and ac7 complishments of the grant programs described in sub8 section (b).

9 ‘‘(r) AUTHORIZATION OF APPROPRIATIONS.—There

10 are authorized to be appropriated to carry out this

11 section—

12 ‘‘(1) for grants under subsection (d)(1),

13 $40,000,000 for fiscal year 2002, and such sums as

14 may be necessary for each of fiscal years 2003

15 through 2006; and

16 ‘‘(2) for grants under subsection (d)(2),

17 $20,000,000 for fiscal year 2002, and such sums as

18 may be necessary for each of fiscal years 2003

19 through 2006.

20 ‘‘SEC. 330J. 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-
47

•S 1281 IS

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
49

•S 1281 IS

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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1 TITLE III—NATIONAL HEALTH

2 SERVICE CORPS PROGRAM

3 SEC. 301. NATIONAL HEALTH SERVICE CORPS.

4 Section 331 of the Public Health Service Act (42

5 U.S.C. 254d) is amended—

6 (1) by adding at the end of subsection (a)(3)

7 the following:

8 ‘‘(E) The term ‘graduate programs of behav9 ioral and mental health’ means programs that train

10 health service psychologists, licensed clinical social

11 workers, licensed professional counselors, marriage

12 and family therapists, psychiatric nurse specialists,

13 and psychiatrists.’’;

14 (2) in subsection (b)—

15 (A) in paragraph (1), by striking ‘‘health

16 professions,’’ and inserting ‘‘health professions,

17 including schools at which graduate programs

18 of behavioral and mental health are offered,’’;

19 and

20 (B) in paragraph (2), by inserting ‘‘behav21 ioral and mental health professionals,’’ after

22 ‘‘dentists,’’; and

23 (3) by striking subsection (c) and inserting the

24 following:
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•S 1281 IS

1 ‘‘(c)(1) The Secretary may reimburse an applicant

2 for a position in the Corps (including an individual consid3 ering entering into a written agreement pursuant to sec4 tion 338D) for actual and reasonable expenses incurred

5 in traveling to and from the applicant’s place of residence

6 to an eligible site to which the applicant may be assigned

7 under section 333 for the purpose of evaluating such site

8 with regard to being assigned at such site. The Secretary

9 may establish a maximum total amount that may be paid

10 to an individual as reimbursement for such expenses.

11 ‘‘(2) The Secretary may also reimburse the actual

12 and reasonable expenses incurred for the travel of 1 family

13 member to accompany the applicant to such site. The Sec14 retary may establish a maximum total amount that may

15 be paid to an individual as reimbursement for such ex16 penses.

17 ‘‘(3) In the case of an individual who has entered into

18 a contract for obligated service under the Scholarship Pro19 gram or under the Loan Repayment Program, the Sec20 retary may reimburse such individual for all or part of

21 the actual and reasonable expenses incurred in trans22 porting the individual, the individual’s family, and the

23 family’s possessions to the individual’s assignment under

24 section 333. The Secretary may establish a maximum total
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1 amount that may be paid to an individual as reimburse2 ment for such expenses.’’.

3 SEC. 302. DESIGNATION OF HEALTH PROFESSIONAL

4 SHORTAGE AREAS.

5 (a) IN GENERAL.—Section 332 of the Public Health

6 Service Act (42 U.S.C. 254e) is amended—

7 (1) in subsection (a)—

8 (A) in paragraph (1)(C), by striking ‘‘de9 termines has such a shortage.’’ and inserting

10 ‘‘determines has such a shortage. All Federally

11 qualified health centers and rural health clinics,

12 as defined by section 1861(aa) of the Social Se13 curity Act, that meet the requirements of sec14 tion 334 shall be automatically designated, on

15 the date of enactment of the Health Care Safe16 ty Net Amendments of 2001, as having such a

17 shortage. Not later than 3 years after such date

18 of enactment, and every 3 years thereafter,

19 each such center or clinic shall demonstrate

20 that the center or clinic meets the applicable re21 quirements of any Federal regulation, issued

22 after the date of enactment of this Act, that re23 vises the definition of a health professional

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

25 and
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1 (B) in paragraph (3), by striking ‘‘340(r)’’

2 and inserting ‘‘330(h)(4), seasonal and migra3 tory agricultural workers (as defined in section

4 330(g)(3)), and residents of public housing (as

5 defined in section 3(b)(1) of the United States

6 Housing Act of 1937)’’;

7 (2) in subsection (b)(2), by striking ‘‘with spe8 cial consideration to the indicators of’’ and all that

9 follows through ‘‘services.’’; and

10 (3) in subsection (c)(2)(B), by striking ‘‘XVIII

11 or XIX’’ and inserting ‘‘XVIII, XIX, or XXI’’.

12 (b) REGULATIONS.—

13 (1) REPORT.—

14 (A) IN GENERAL.—The Secretary shall

15 submit the report described in subparagraph

16 (B) if the Secretary, acting through the Admin17 istrator of the Health Resources and Services

18 Administration, issues—

19 (i) a regulation that revises the defini20 tion of a health professional shortage area

21 for purposes of section 332 of the Public

22 Health Service Act (42 U.S.C. 254e); or

23 (ii) a regulation that revises the

24 standards concerning priority of such an
54

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1 area under section 333A of that Act (42

2 U.S.C. 254f–1).

3 (B) REPORT.—On issuing a regulation de4 scribed in subparagraph (A), the Secretary shall

5 prepare and submit to the Committee on En6 ergy and Commerce of the House of Represent7 atives and the Committee on Health, Edu8 cation, Labor, and Pensions of the Senate a re9 port that describes the regulation.

10 (2) EFFECTIVE DATE.—Each regulation de11 scribed in paragraph (1)(A) shall take effect 180

12 days after the committees described in paragraph

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

14 (1)(B) describing the regulation.

15 SEC. 303. ASSIGNMENT OF CORPS PERSONNEL.

16 Section 333 of the Public Health Service Act (42

17 U.S.C. 254f) is amended—

18 (1) in subsection (a)—

19 (A) in paragraph (1)—

20 (i) in the matter before subparagraph

21 (A), by striking ‘‘(specified in the agree22 ment described in section 334)’’;

23 (ii) in subparagraph (A), by striking

24 ‘‘nonprofit’’; and
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1 (iii) by striking subparagraph (C) and

2 inserting the following:

3 ‘‘(C) the entity agrees to comply with the

4 requirements of section 334; and’’; and

5 (B) in paragraph (3), by adding at the end

6 ‘‘In approving such applications, the Secretary

7 shall give preference to applications in which a

8 nonprofit entity or public entity shall serve as

9 a placement site.’’; and

10 (2) in subsection (d)—

11 (A) in paragraphs (1), (2), and (4), by

12 striking ‘‘nonprofit’’ each place it appears; and

13 (B) in paragraph (1)—

14 (i) in the first sentence, by striking

15 ‘‘may’’ and inserting ‘‘shall’’;

16 (ii) in the second sentence—

17 (I) in subparagraph (C), by strik18 ing ‘‘and’’ at the end; and

19 (II) by striking the period and

20 inserting ‘‘, and (E) developing long21 term plans for addressing health pro22 fessional shortages and improving ac23 cess to health care.’’; and

24 (iii) by adding at the end the fol25 lowing: ‘‘The Secretary shall encourage en-
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1 tities that receive technical assistance

2 under this paragraph to communicate with

3 other communities, State Offices of Rural

4 Health, State Primary Care Associations

5 and Offices, and other entities concerned

6 with site development and community

7 needs assessment.’’.

8 SEC. 304. PRIORITIES IN ASSIGNMENT OF CORPS PER9 SONNEL.

10 Section 333A of the Public Health Service Act (42

11 U.S.C. 254f–1) is amended—

12 (1) by striking subsection (b);

13 (2) in subsection (d)—

14 (A) by redesignating paragraphs (1)

15 through (3) as paragraphs (2) through (4), re16 spectively;

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

18 redesignated by subparagraph (A)) the fol19 lowing:

20 ‘‘(1) PROPOSED LIST.—The Secretary shall pre21 pare and publish a proposed list of health profes22 sional shortage areas and entities that would receive

23 priority under subsection (a)(1) in the assignment of

24 Corps members. The list shall contain the informa25 tion described in paragraph (2), and the relative
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1 scores and relative priorities of the entities submit2 ting applications under section 333, in a proposed

3 format. All entities that have submitted applications

4 under section 333 shall have 30 days after the date

5 of publication of the list to provide additional data

6 and information in support of inclusion on the list

7 or in support of a higher priority determination and

8 the Secretary shall reasonably consider such data

9 and information in preparing the final list under

10 paragraph (2).’’;

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

12 subparagraph (A)), in the matter before sub13 paragraph (A)—

14 (i) by striking ‘‘paragraph (2)’’ and

15 inserting ‘‘paragraph (3)’’;

16 (ii) by striking ‘‘prepare a list of

17 health professional shortage areas’’ and in18 serting ‘‘prepare and, as appropriate, up19 date a list of health professional shortage

20 areas and entities’’; and

21 (iii) by striking ‘‘for the period appli22 cable under subsection (f)’’;

23 (D) by striking paragraph (3) (as redesig24 nated by subparagraph (A)) and inserting the

25 following:
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1 ‘‘(3) NOTIFICATION OF AFFECTED PARTIES.—

2 ‘‘(A) ENTITIES.—Not later than 30 days

3 after the Secretary has added to a list under

4 paragraph (2) an entity specified as described

5 in subparagraph (A) of such paragraph, the

6 Secretary shall notify such entity that the entity

7 has been provided an authorization to receive

8 assignments of Corps members in the event

9 that Corps members are available for the as10 signments.

11 ‘‘(B) INDIVIDUALS.—In the case of an in12 dividual obligated to provide service under the

13 Scholarship Program, not later than 3 months

14 before the date described in section 338C(b)(5),

15 the Secretary shall provide to such individual

16 the names of each of the entities specified as

17 described in paragraph (2)(B)(i) that is appro18 priate for the individual’s medical specialty and

19 discipline.’’; and

20 (E) by striking paragraph (4) (as redesig21 nated by subparagraph (A)) and inserting the

22 following:

23 ‘‘(4) REVISIONS.—If the Secretary proposes to

24 make a revision in the list under paragraph (2), and

25 the revision would adversely alter the status of an
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1 entity with respect to the list, the Secretary shall no2 tify the entity of the revision. Any entity adversely

3 affected by such a revision shall be notified in writ4 ing by the Secretary of the reasons for the revision

5 and shall have 30 days to file a written appeal of the

6 determination involved which shall be reasonably

7 considered by the Secretary before the revision to

8 the list becomes final. The revision to the list shall

9 be effective with respect to assignment of Corps

10 members beginning on the date that the revision be11 comes final.’’;

12 (3) by striking subsection (e) and inserting the

13 following:

14 ‘‘(e) LIMITATION ON NUMBER OF ENTITIES OF15 FERED AS ASSIGNMENT CHOICES IN SCHOLARSHIP PRO16 GRAM.—

17 ‘‘(1) DETERMINATION OF AVAILABLE CORPS

18 MEMBERS.—By April 1 of each calendar year, the

19 Secretary shall determine the number of participants

20 in the Scholarship Program who will be available for

21 assignments under section 333 during the program

22 year beginning on July 1 of that calendar year.

23 ‘‘(2) DETERMINATION OF NUMBER OF ENTI24 TIES.—At all times during a program year, the
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1 number of entities specified under subsection

2 (c)(2)(B)(i) shall be—

3 ‘‘(A) not less than the number of partici4 pants identified with respect to that program

5 year in paragraph (1); and

6 ‘‘(B) not greater than twice the number of

7 participants identified with respect to that pro8 gram year in paragraph (1).’’;

9 (4) by striking subsection (f); and

10 (5) by redesignating subsections (c), (d), and

11 (e) as subsections (b), (c), and (d) respectively.

12 SEC. 305. COST-SHARING.

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

14 Service Act (42 U.S.C. 254d et seq.) is amended by strik15 ing section 334 and inserting the following:

16 ‘‘SEC. 334. CHARGES FOR SERVICES BY ENTITIES USING

17 CORPS MEMBERS.

18 ‘‘(a) AVAILABILITY OF SERVICES REGARDLESS OF

19 ABILITY TO PAY OR PAYMENT SOURCE.—An entity to

20 which a Corps member is assigned shall not deny re21 quested health services, and shall not discriminate in the

22 provision of services to an individual—

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

24 the services; or
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1 ‘‘(2) because payment for the services would be

2 made under—

3 ‘‘(A) the medicare program under title

4 XVIII of the Social Security Act;

5 ‘‘(B) a medicaid plan under title XIX of

6 such Act; or

7 ‘‘(C) the State children’s health insurance

8 program under title XXI of such Act.

9 ‘‘(b) CHARGES FOR SERVICES.—The following rules

10 shall apply to charges for services provided by an entity

11 to which a Corps member is assigned:

12 ‘‘(1) IN GENERAL.—Except as provided in para13 graphs (2) and (3), the entity shall charge the usual

14 and customary rate for such services that is pre15 vailing in the area in which the services are pro16 vided.

17 ‘‘(2) SERVICES TO BENEFICIARIES OF FEDERAL

18 AND FEDERALLY-ASSISTED PROGRAMS.—In the case

19 of health services furnished to an individual who is

20 a beneficiary of a program or plan listed in sub21 section (a)(2), the entity—

22 ‘‘(A) shall accept an assignment pursuant

23 to section 1842(b)(3)(B)(ii) of the Social Secu24 rity Act with respect to an individual who is a

25 medicare beneficiary; and
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1 ‘‘(B) shall enter into an appropriate agree2 ment with—

3 ‘‘(i) the State agency administering

4 the program under title XIX of such Act

5 with respect to individuals who are med6 icaid beneficiaries; and

7 ‘‘(ii) the State agency administering

8 the program under title XXI of such Act

9 with respect to individuals who are State

10 children’s health insurance program bene11 ficiaries.

12 ‘‘(3) INDIVIDUALS UNABLE TO PAY.—In the

13 case of health services furnished to an individual

14 who is unable, as determined under regulations pro15 mulgated by the Secretary, to pay the charge as16 sessed in accordance with paragraph (1), the entity

17 shall, as prescribed by such regulations, waive or re18 duce such charges.

19 ‘‘(4) COLLECTION OF PAYMENTS.—The entity

20 shall take reasonable and appropriate steps to collect

21 all payments due for health services provided by the

22 entity, including payments from any third party (in23 cluding a Federal, State, or local government agency

24 and any other third party) that is responsible for

25 part or all of the charge for such services.’’.
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1 SEC. 306. ELIGIBILITY FOR FEDERAL FUNDS.

2 Section 335(e)(1)(B) of the Public Health Service

3 Act (42 U.S.C. 254h(e)(1)(B)) is amended by striking

4 ‘‘XVIII or XIX’’ and inserting ‘‘XVIII, XIX, or XXI’’.

5 SEC. 307. FACILITATION OF EFFECTIVE PROVISION OF

6 CORPS SERVICES.

7 Section 336 of the Public Health Service Act (42

8 U.S.C. 254h–1) is amended—

9 (1) in subsection (c), by striking ‘‘health man10 power’’ and inserting ‘‘health professional’’; and

11 (2) in subsection (f)(1), by striking ‘‘health

12 manpower’’ and inserting ‘‘health professional’’.

13 SEC. 308. AUTHORIZATION OF APPROPRIATIONS.

14 Section 338(a) of the Public Health Service Act (42

15 U.S.C. 254k(a)) is amended—

16 (1) by striking ‘‘(1) For’’ and inserting ‘‘For’’;

17 (2) by striking ‘‘1991 through 2000’’ and in18 serting ‘‘2002 through 2006’’; and

19 (3) by striking paragraph (2).

20 SEC. 309. NATIONAL HEALTH SERVICE CORPS SCHOLAR21 SHIP PROGRAM.

22 Section 338A of the Public Health Service Act (42

23 U.S.C. 254l) is amended—

24 (1) in subsection (a)(1), by inserting ‘‘mental

25 and behavioral health professionals,’’ after ‘‘den26 tists,’’;
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1 (2) in subsection (b)(1)(B), by inserting ‘‘, or

2 an appropriate degree from a graduate program in

3 mental and behavioral health’’ after ‘‘other health

4 profession’’;

5 (3) in subsection (c)(1)—

6 (A) in subparagraph (A), by striking

7 ‘‘338D’’ and inserting ‘‘338E’’; and

8 (B) in subparagraph (B), by striking

9 ‘‘338C’’ and inserting ‘‘338D’’;

10 (4) in subsection (d)(1)—

11 (A) in subparagraph (A), by striking

12 ‘‘and’’ at the end;

13 (B) by redesignating subparagraph (B) as

14 subparagraph (C); and

15 (C) by inserting after subparagraph (A)

16 the following:

17 ‘‘(B) the Secretary, in considering applica18 tions from individuals accepted for enrollment

19 or enrolled in dental school, shall consider ap20 plications from all individuals accepted for en21 rollment or enrolled in any accredited dental

22 school in a State; and’’;

23 (5) in subsection (f)—

24 (A) in paragraph (1)(B)—
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1 (i) in clause (iii), by striking ‘‘and’’

2 after the semicolon;

3 (ii) by redesignating clause (iv) as

4 clause (v); and

5 (iii) by inserting after clause (iii) the

6 following new clause:

7 ‘‘(iv) if pursuing a degree from a

8 school of medicine or osteopathic medicine,

9 to complete a residency in a specialty that

10 the Secretary determines is consistent with

11 the needs of the Corps; and’’; and

12 (B) in paragraph (3), by striking ‘‘338D’’

13 and inserting ‘‘338E’’; and

14 (6) by striking subsection (i).

15 SEC. 310. NATIONAL HEALTH SERVICE CORPS LOAN REPAY16 MENT PROGRAM.

17 Section 338B of the Public Health Service Act (42

18 U.S.C. 254l–1) is amended—

19 (1) in subsection (a)—

20 (A) in paragraph (1), by inserting ‘‘mental

21 and behavioral health professionals,’’ after

22 ‘‘dentists,’’; and

23 (B) in paragraph (2), by striking ‘‘(includ24 ing mental health professionals)’’;
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1 (2) in subsection (b)(1), by striking subpara2 graph (A) and inserting the following:

3 ‘‘(A) have a degree in medicine, osteopathic

4 medicine, dentistry, or other health profession, or an

5 appropriate degree from a graduate program in

6 mental and behavioral health, or be certified as a

7 nurse midwife, nurse practitioner, or physician as8 sistant;’’;

9 (3) in subsection (e), by striking ‘‘(1) IN GEN10 ERAL.—’’; and

11 (4) by striking subsection (i).

12 SEC. 311. OBLIGATED SERVICE.

13 Section 338C of the Public Health Service Act (42

14 U.S.C. 254m) is amended—

15 (1) in subsection (b)—

16 (A) in paragraph (1), in the matter pre17 ceding subparagraph (A), by striking ‘‘section

18 338A(f)(1)(B)(iv)’’ and inserting ‘‘section

19 338A(f)(1)(B)(v)’’; and

20 (B) in paragraph (5)—

21 (i) by striking all that precedes sub22 paragraph (C) and inserting the following:

23 ‘‘(5)(A) In the case of the Scholarship Program, the

24 date referred to in paragraphs (1) through (4) shall be

25 the date on which the individual completes the training
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1 required for the degree for which the individual receives

2 the scholarship, except that—

3 ‘‘(i) for an individual receiving such a degree

4 after September 30, 2000, from a school of medicine

5 or osteopathic medicine, such date shall be the date

6 the individual completes a residency in a specialty

7 that the Secretary determines is consistent with the

8 needs of the Corps; and

9 ‘‘(ii) at the request of an individual, the Sec10 retary may, consistent with the needs of the Corps,

11 defer such date until the end of a period of time re12 quired for the individual to complete advanced train13 ing (including an internship or residency).’’;

14 (ii) by striking subparagraph (D);

15 (iii) by redesignating subparagraphs

16 (C) and (E) as subparagraphs (B) and

17 (C), respectively; and

18 (iv) in clause (i) of subparagraph (C)

19 (as redesignated by clause (iii)) by striking

20 ‘‘subparagraph (A), (B), or (D)’’ and in21 serting ‘‘subparagraph (A)’’; and

22 (2) by striking subsection (e).
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1 SEC. 312. PRIVATE PRACTICE.

2 Section 338D of the Public Health Service Act (42

3 U.S.C. 254n) is amended by striking subsection (b) and

4 inserting the following:

5 ‘‘(b)(1) The written agreement described in sub6 section (a) shall—

7 ‘‘(1) provide that during the period of private

8 practice by an individual pursuant to the agreement

9 that the individual complies with section 334; and

10 ‘‘(2) contain such additional provisions as the

11 Secretary may require to carry out the purposes of

12 this section.

13 ‘‘(2) The Secretary shall take such action as may be

14 appropriate to ensure that the conditions of the written

15 agreement prescribed by this subsection are adhered to.’’.

16 SEC. 313. BREACH OF SCHOLARSHIP CONTRACT OR LOAN

17 REPAYMENT CONTRACT.

18 (a) IN GENERAL.—Section 338E of the Public

19 Health Service Act (42 U.S.C. 254o) is amended—

20 (1) in subsection (a)(1)—

21 (A) in subparagraph (A), by striking the

22 comma and inserting a semicolon;

23 (B) in subparagraph (B), by striking the

24 comma and inserting ‘‘; or’’;

25 (C) in subparagraph (C), by striking ‘‘or’’

26 at the end; and
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1 (D) by striking subparagraph (D);

2 (2) in subsection (b)—

3 (A) in paragraph (1)(A)—

4 (i) by striking ‘‘338F(d)’’ and insert5 ing ‘‘338G(d)’’;

6 (ii) by striking ‘‘either’’;

7 (iii) by striking ‘‘338D or’’ and insert8 ing ‘‘338D,’’; and

9 (iv) by inserting ‘‘or to complete a re10 quired residency as specified in section

11 338A(f)(1)(B)(iv),’’ before ‘‘the United

12 States’’; and

13 (B) by adding at the end the following new

14 paragraph:

15 ‘‘(3) The Secretary may terminate a contract with an

16 individual under section 338A if, not later than 30 days

17 before the end of the school year to which the contract

18 pertains, the individual—

19 ‘‘(A) submits a written request for such termi20 nation; and

21 ‘‘(B) repays all amounts paid to, or on behalf

22 of, the individual under section 338A(g).’’;

23 (3) in subsection (c)—

24 (A) in paragraph (1)—
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1 (i) in the matter preceding subpara2 graph (A), by striking ‘‘338F(d)’’ and in3 serting ‘‘338G(d)’’; and

4 (ii) by striking subparagraphs (A)

5 through (C) and inserting the following:

6 ‘‘(A) the total of the amounts paid by the

7 United States under section 338B(g)(2) on be8 half of the individual for any period of obligated

9 service not served;

10 ‘‘(B) an amount equal to the product of

11 the number of months of obligated service that

12 were not completed by the individual, multiplied

13 by $7,500; and

14 ‘‘(C) the interest on the amounts described

15 in subparagraphs (A) and (B), at the maximum

16 legal prevailing rate, as determined by the

17 Treasurer of the United States, from the date

18 of the breach.’’;

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

20 inserting the following:

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

22 individual under section 338B if, not later than 45 days

23 before the end of the fiscal year in which the contract was

24 entered into, the individual—
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1 ‘‘(A) submits a written request for such termi2 nation; and

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

4 individual under section 338B(g).’’; and

5 (C) by redesignating paragraph (4) as

6 paragraph (3);

7 (4) in subsection (d)(3)(A), by striking ‘‘only if

8 such discharge is granted after the expiration of the

9 five-year period’’ and inserting ‘‘only if such dis10 charge is granted after the expiration of the 7-year

11 period’’; and

12 (5) by adding at the end the following new sub13 section:

14 ‘‘(e) Notwithstanding any other provision of Federal

15 or State law, there shall be no limitation on the period

16 within which suit may be filed, a judgment may be en17 forced, or an action relating to an offset or garnishment,

18 or other action, may be initiated or taken by the Secretary,

19 the Attorney General, or the head of another Federal

20 agency, as the case may be, for the repayment of the

21 amount due from an individual under this section.’’.

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

23 subsection (a)(4) shall apply to any obligation for which

24 a discharge in bankruptcy has not been granted before the
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1 date that is 31 days after the date of enactment of this

2 Act.

3 SEC. 314. AUTHORIZATION OF APPROPRIATIONS.

4 Section 338H of the Public Health Service Act (42

5 U.S.C. 254q) is amended by striking subsections (a) and

6 (b) and inserting the following:

7 ‘‘(a) AUTHORIZATION OF APPROPRIATIONS.—For the

8 purposes of carrying out this subpart, there are authorized

9 to be appropriated $146,250,000 for fiscal year 2002, and

10 such sums as may be necessary for each of the fiscal years

11 2003 through 2006.

12 ‘‘(b) SCHOLARSHIPS FOR NEW PARTICIPANTS.—Of

13 the amounts appropriated under subsection (a) for a fiscal

14 year, the Secretary shall obligate not less than 30 percent

15 for the purpose of providing contracts for scholarships

16 under this subpart to individuals who have not previously

17 received such scholarships.

18 ‘‘(c) SCHOLARSHIPS AND LOAN REPAYMENTS.—With

19 respect to certification as a nurse practitioner, nurse mid20 wife, or physician assistant, the Secretary shall, from

21 amounts appropriated under subsection (a) for a fiscal

22 year, obligate not less than a total of 10 percent for con23 tracts for both scholarships under the Scholarship Pro24 gram under section 338A and loan repayments under the

25 Loan Repayment Program under section 338B to individ-
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1 uals who are entering the first year of study or programs

2 described in section 338A(b)(1)(B) that lead to such a cer3 tification or individuals who are eligible for the loan repay4 ment program as outlined in section 338B(b).’’.

5 SEC. 315. GRANTS TO STATES FOR LOAN REPAYMENT PRO6 GRAMS.

7 Section 338I of the Public Health Service Act (42

8 U.S.C. 254q–1) is amended—

9 (1) in subsection (a), by striking paragraph (1)

10 and inserting the following:

11 ‘‘(1) AUTHORITY FOR GRANTS.—The Secretary,

12 acting through the Administrator of the Health Re13 sources and Services Administration may make

14 grants to States for the purpose of assisting the

15 States in operating programs described in paragraph

16 (2) in order to provide for the increased availability

17 of primary health services in health professional

18 shortage areas. The National Advisory Council es19 tablished under section 337 shall advise the Admin20 istrator regarding the program under this section.’’;

21 (2) in subsection (e), by striking paragraph (1)

22 and inserting the following:

23 ‘‘(1) to submit to the Secretary reports regard24 ing their loan repayment program, as determined

25 appropriate by the Secretary; and’’; and
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1 (3) in subsection (i), by striking paragraph (1)

2 and inserting the following:

3 ‘‘(1) IN GENERAL.—For the purpose of making

4 grants under subsection (a), there is authorized to

5 be appropriated $12,000,000 for fiscal year 2002

6 and such sums as may be necessary for each of the

7 fiscal years 2003 through 2006.’’.

8 SEC. 316. DEMONSTRATION GRANTS TO STATES FOR COM9 MUNITY SCHOLARSHIP PROGRAMS.

10 Subpart III of part D of title III of the Public Health

11 Service Act (42 U.S.C. 254l et seq.) is amended by strik12 ing section 338L.

13 SEC. 317. DEMONSTRATION PROJECT.

14 (a) FINDINGS.—Congress makes the following find15 ings:

16 (1) Chiropractic doctors are skilled at providing

17 a wide range of primary health care services.

18 (2) Chiropractic doctors are often the only pro19 viders available to provide health care in many rural

20 communities.

21 (b) AMENDMENT TO PHSA.—Subpart III of part D

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

23 254l et seq.) is amended by adding at the end the fol24 lowing:
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1 ‘‘SEC. 338L. DEMONSTRATION PROJECT.

2 ‘‘(a) PROGRAM AUTHORIZED.—The Secretary shall

3 establish a demonstration project to provide for the par4 ticipation of individuals who are seeking a chiropractic de5 gree in the Scholarship Program described in section 338A

6 and for the participation of individuals who are chiro7 practic doctors in the Loan Repayment Program described

8 in section 338B.

9 ‘‘(b) PROCEDURE.—An individual that receives as10 sistance under this section with regard to the programs

11 described in sections 338A and 338B shall comply with

12 all rules and requirements described in such sections in

13 order to receive assistance under this section.

14 ‘‘(c) LIMITATIONS.—The demonstration project de15 scribed in subsection (a) shall provide for the participation

16 of individuals who shall provide services in both rural and

17 urban areas, and shall also provide for the participation

18 of enough individuals to allow the Secretary to properly

19 analyze the effectiveness of such project.

20 ‘‘(d) REPORT.—The Secretary shall prepare and sub21 mit a report describing how the project described in sub22 section (a) has effected access to health care, patient satis23 faction, and quality of care, especially how the project has

24 effected health services in traditionally underserved popu25 lations, to—
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1 ‘‘(1) the Committee on Health, Education,

2 Labor, and Pensions of the Senate;

3 ‘‘(2) the Subcommittee on Labor, Health and

4 Human Services, and Education of the Committee

5 on Appropriations of the Senate;

6 ‘‘(3) the Committee on Energy and Commerce

7 of the House of Representatives; and

8 ‘‘(4) the Subcommittee on Labor, Health and

9 Human Services, and Education of the Committee

10 on Appropriations of the House of Representatives.

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

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

13 such sums as may be necessary for the fiscal years 2002

14 through 2005.’’.

15 TITLE IV—HEALTHY COMMU16 NITIES ACCESS PROGRAM

17 ACT

18 SEC. 401. PURPOSE.

19 The purpose of this title is to provide assistance to

20 communities and consortia of health care providers and

21 others, to develop or strengthen integrated community

22 health care delivery systems that coordinate health serv23 ices for individuals who are uninsured and underinsured

24 and to develop or strengthen activities related to providing
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1 coordinated care for individuals who are uninsured and

2 underinsured with chronic conditions, through the—

3 (1) coordination of services to allow individuals

4 to receive efficient and higher quality care and to

5 gain entry into and receive services from a com6 prehensive system of care;

7 (2) development of the infrastructure for a

8 health care delivery system characterized by effective

9 collaboration, information sharing, and clinical and

10 financial coordination among all providers of care in

11 the community; and

12 (3) provision of new Federal resources that do

13 not supplant funding for existing Federal categorical

14 programs that support entities providing services to

15 low-income populations.

16 SEC. 402. CREATION OF HEALTHY COMMUNITIES ACCESS

17 PROGRAM.

18 Part D of title III of the Public Health Service Act

19 (42 U.S.C. 254b et seq.) is amended by inserting after

20 subpart IV the following new subpart:
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1 ‘‘Subpart V—Healthy Communities Access Program

2 ‘‘SEC. 340. GRANTS TO STRENGTHEN THE EFFECTIVENESS,

3 EFFICIENCY, AND COORDINATION OF SERV4 ICES FOR THE UNINSURED AND UNDER5 INSURED.

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

7 to eligible entities to assist in the development of inte8 grated health care delivery systems to serve communities

9 of individuals who are uninsured and individuals who are

10 underinsured—

11 ‘‘(1) to improve the efficiency and coordination

12 among the providers services through such systems;

13 ‘‘(2) to assist communities in developing pro14 grams targeted toward preventing and managing

15 chronic diseases; and

16 ‘‘(3) to expand and enhance the services pro17 vided.

18 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive

19 a grant under this section, an entity must be a public or

20 nonprofit entity that—

21 ‘‘(1) represents a consortium—

22 ‘‘(A) whose principal purpose is to provide

23 a broad range of coordinated health care serv24 ices for a community defined in the entity’s

25 grant application; and
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1 ‘‘(B) that includes health care providers

2 that serve the community and that have tradi3 tionally provided care to uninsured and under4 insured individuals without regard to the indi5 viduals’ ability to pay (including federally quali6 fied health centers (as defined in section

7 1861(aa) of the Social Security Act (42 U.S.C.

8 1395x(aa))), public hospitals, public health de9 partments, and private health care providers

10 and organizations);

11 ‘‘(2) submits to the Secretary an application, in

12 such form and manner as the Secretary shall pre13 scribe, that—

14 ‘‘(A) defines a community of uninsured

15 and underinsured individuals that consists of all

16 such individuals—

17 ‘‘(i) in a specified geographical area,

18 such as a rural area; or

19 ‘‘(ii) in a specified population within

20 such an area, such as American Indians,

21 Native Alaskans, Native Hawaiians, home22 less individuals, migrant and seasonal

23 farmworkers, individuals with disabilities,

24 and public housing residents;
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1 ‘‘(B) identifies the providers who will par2 ticipate in the consortium’s program under the

3 grant, and specifies each one’s contribution to

4 the care of uninsured and underinsured individ5 uals in the community, including the volume of

6 care it provides to medicare, medicaid, and

7 State child health insurance program (SCHIP)

8 beneficiaries and to privately paid patients;

9 ‘‘(C) describes the activities that the appli10 cant and the consortium propose to perform

11 under the grant to further the purposes of this

12 section;

13 ‘‘(D) demonstrates the consortium’s ability

14 to build on the current system for serving unin15 sured and underinsured individuals by involving

16 providers who have traditionally provided a sig17 nificant volume of care for that community;

18 ‘‘(E) demonstrates the consortium’s ability

19 to develop coordinated systems of care that ei20 ther directly provide or ensure the prompt pro21 vision of a broad range of high-quality, acces22 sible services, including, as appropriate, pri23 mary, secondary, and tertiary services, as well

24 as substance abuse treatment and mental
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1 health services in a manner which assures con2 tinuity of care in the community;

3 ‘‘(F) demonstrates the consortium’s ability

4 to create comprehensive programs to address

5 the prevention and management of chronic dis6 eases of high importance within their commu7 nities where applicable;

8 ‘‘(G) provides evidence of community in9 volvement in the development, implementation,

10 and direction of the program that it proposes to

11 operate;

12 ‘‘(H) demonstrates the consortium’s ability

13 to ensure that individuals participating in the

14 program are enrolled in public insurance pro15 grams for which they are eligible;

16 ‘‘(I) presents a plan for leveraging other

17 sources of revenue, which may include State

18 and local sources and private grant funds, and

19 integrating current and proposed new funding

20 sources in a way to assure long-term sustain21 ability;

22 ‘‘(J) describes a plan for evaluation of the

23 activities carried out under the grant, including

24 measurement of progress toward the goals and
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1 objectives of the program and the use of evalua2 tion findings to improve program performance;

3 ‘‘(K) demonstrates fiscal responsibility

4 through the use of appropriate accounting pro5 cedures and appropriate management systems;

6 ‘‘(L) demonstrates the consortium’s com7 mitment to serve the community without regard

8 to the ability of the individual or family to pay

9 by arranging for or providing free or reduced

10 charge care for the poor; and

11 ‘‘(M) includes such other information as

12 the Secretary may prescribe;

13 ‘‘(3) agrees along with each of the participating

14 providers that each one will commit to use grant

15 monies awarded under this section to supplement,

16 not supplant, any other sources of funding available

17 to cover the expenditures (including the value of any

18 in-kind contributions) of the consortium and of its

19 participating providers in carrying out the activities

20 for which the grant would be awarded; and

21 ‘‘(4) has established or will establish before the

22 receipt of any grant under this section, a decision23 making body that has full and complete authority to

24 determine and oversee all the activities undertaken

25 by the consortium with finds made available through
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1 such grant and that includes at least 1 representa2 tive of each participating provider identified under

3 paragraph (2)(B).

4 ‘‘(c) PRIORITIES.—In awarding grants under this

5 section, the Secretary—

6 ‘‘(1) shall accord priority to applicants that

7 demonstrate the extent of unmet need in the com8 munity involved for a more coordinated system of

9 care; and

10 ‘‘(2) may accord priority to applicants that best

11 promote the purposes of this section, taking into

12 consideration the extent to which the application

13 involved—

14 ‘‘(A) identifies a community whose geo15 graphical area has a high or increasing percent16 age of individuals who are uninsured;

17 ‘‘(B) includes in its consortium providers,

18 support systems, and programs that have a tra19 dition of serving uninsured individuals and

20 underinsured individuals in the community;

21 ‘‘(C) shows evidence that the program

22 would expand utilization of preventive and pri23 mary care services for uninsured and under24 insured individuals and families in the commu25 nity, including mental and behavioral health
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1 services, oral health services, or substance

2 abuse services;

3 ‘‘(D) proposes a program that would im4 prove coordination between health care pro5 viders and appropriate social service providers,

6 including local and regional human services

7 agencies, school systems, and agencies on aging;

8 ‘‘(E) demonstrates collaboration with State

9 and local governments;

10 ‘‘(F) makes use of non-Federal contribu11 tions to the greatest extent possible; or

12 ‘‘(G) demonstrates a likelihood that the

13 proposed program will continue after support

14 under this section ceases.

15 ‘‘(d) USE OF FUNDS.—

16 ‘‘(1) USE BY GRANTEES.—

17 ‘‘(A) IN GENERAL.—Except as provided in

18 paragraphs (2) and (3), a grantee may use

19 amounts provided under this section only for—

20 ‘‘(i) direct expenses associated with

21 planning, developing, and operating the

22 greater integration of a health care deliv23 ery system so that it either directly pro24 vides or ensures the provision of a broad

25 range of services, as appropriate, including
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1 primary, secondary, and tertiary services,

2 as well as substance abuse treatment and

3 mental health services; and

4 ‘‘(ii) direct patient care and service

5 expansions to fill identified or documented

6 gaps within an integrated delivery system.

7 ‘‘(B) SPECIFIC USES.—The following are

8 examples of purposes for which a grantee may

9 use grant funds, when such use meets the con10 ditions stated in subparagraph (A):

11 ‘‘(i) Increase in outreach activities.

12 ‘‘(ii) Improvements to case manage13 ment.

14 ‘‘(iii) Improvements to coordination of

15 transportation to health care facilities.

16 ‘‘(iv) Development of provider net17 works and other innovative models to en18 gage physicians in voluntary efforts to

19 serve the medically underserved within a

20 community.

21 ‘‘(v) Recruitment, training, and com22 pensation of necessary personnel.

23 ‘‘(vi) Acquisition of technology, such

24 as telehealth technologies to increase ac25 cess to tertiary care.
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1 ‘‘(vii) Identifying and closing gaps in

2 services being provided.

3 ‘‘(viii) Improvements to provider com4 munication, including implementation of

5 shared information systems or shared clin6 ical systems.

7 ‘‘(ix) Development of common proc8 esses for determining eligibility for the pro9 grams, including creating common identi10 fication cards and single ‘sliding fee’ dis11 counts.

12 ‘‘(x) Creation of a triage system to co13 ordinate referrals and to screen and route

14 individuals to appropriate locations of pri15 mary, specialty, and inpatient care.

16 ‘‘(xi) Development of specific preven17 tion and disease management tools and

18 processes, including—

19 ‘‘(I) carrying out a protocol or

20 plan for each individual patient about

21 what needs to be done, at what inter22 vals, and by whom;

23 ‘‘(II) redesigning practice to in24 corporate regular patient contact, col25 lection of critical data on health and
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1 disease status, and strategies to meet

2 the educational and psychosocial

3 needs of patients who may need to

4 make lifestyle and other changes to

5 manage their disease;

6 ‘‘(III) the promotion of the avail7 ability of specialized expertise through

8 the use of—

9 ‘‘(aa) teams of providers

10 with specialized knowledge;

11 ‘‘(bb) collaborative care ar12 rangements;

13 ‘‘(cc) computer decision sup14 port services; or

15 ‘‘(dd) telehealth tech16 nologies.

17 ‘‘(IV) providing patient edu18 cational and support tools that are

19 culturally competent and demonstrate

20 appropriate health literacy and lit21 eracy requirements; and

22 ‘‘(V) the collection of data re23 lated to patient care and outcomes.

24 ‘‘(xii) Carrying out other activities

25 that may be appropriate to a community
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1 that would increase access to the unin2 sured such as access initiatives for which

3 private entities provide non-Federal con4 tributions to supplement the Federal funds

5 provided through the grants for the initia6 tives.

7 ‘‘(2) DIRECT PATIENT CARE LIMITATION.—No

8 more than 15 percent of the funds provided under

9 a grant may be used for providing direct patient

10 care and services.

11 ‘‘(3) RESERVATION OF FUNDS FOR NATIONAL

12 PROGRAM PURPOSES.—The Secretary may use not

13 more than 3 percent of funds appropriated to carry

14 out this section for technical assistance to grantees,

15 obtaining assistance of experts and consultants,

16 meetings, development of tools, dissemination of in17 formation, evaluation, and activities that will extend

18 the benefits of funded programs to communities

19 other than the one funded.

20 ‘‘(e) GRANTEE REQUIREMENTS.—The recipient of a

21 grant under this section shall—

22 ‘‘(1) report to the Secretary annually

23 regarding—
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1 ‘‘(A) progress in meeting the goals and

2 measurable objectives stated in its grant appli3 cation; and

4 ‘‘(B) such additional information as the

5 Secretary may require, and the Secretary may

6 not renew an annual grant under this section

7 unless the Secretary is satisfied that the consor8 tium has made reasonable and demonstrable

9 progress in meeting the goals and measurable

10 objectives set forth in its grant application for

11 the preceding year; and

12 ‘‘(2) provide for an independent annual finan13 cial audit of all records that relate to the disposition

14 of funds received through this grant.

15 ‘‘(f) TECHNICAL ASSISTANCE.—The Secretary may,

16 either directly or by grant or contract, provide any funded

17 entity with technical and other nonfinancial assistance

18 necessary to meet the requirements of this section.

19 ‘‘(g) REPORT.—Not later than September 30, 2005,

20 the Secretary shall prepare and submit to the appropriate

21 committees of Congress a report on the progress and ac22 complishments of the grant programs described in this

23 section.

24 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—For the

25 purpose of carrying out this section, there are authorized
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1 to be appropriated such sums as may be necessary for

2 each of fiscal years 2002 through 2006.’’.

3 TITLE V—RURAL HEALTH

4 CLINICS

5 SEC. 501. EXEMPTIONS FOR RURAL HEALTH CLINICS.

6 (a) EXEMPTIONS FROM COPAYMENT REQUIRE7 MENTS.—Section 1128B(b)(3)(D) of the Social Security

8 Act (42 U.S.C.1320a–7b(b)(3)(D)) is amended by striking

9 ‘‘a Federally qualified health care center’’ and inserting

10 ‘‘a Federally qualified health center or rural health clinic,

11 as defined in section 1861(aa) of the Social Security

12 Act,’’.

13 (b) EXEMPTIONS FROM DEDUCTIBLE REQUIRE14 MENTS.—Section 1833(b)(4) of the Social Security Act

15 (42 U.S.C. 1395l(b)(4)) is amended by striking ‘‘such de16 ductible shall not apply to Federally qualified health cen17 ter services,’’ and inserting ‘‘such deductible shall not

18 apply to Federally qualified health center services or rural

19 health clinic services, as defined in section 1861(aa) of the

20 Social Security Act, provided to an individual who quali21 fies for subsidized services under the Public Health Serv22 ice Act,’’.
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1 TITLE VI—CONFORMING

2 AMENDMENTS

3 SEC. 601. CONFORMING AMENDMENTS.

4 (a) HOMELESS PROGRAMS.—Subsections

5 (g)(1)(G)(ii), (k)(2), and (n)(1)(C) of section 224, and

6 sections 317A(a)(2), 317E(c), 318A(e), 332(a)(2)(C),

7 340D(c)(5), 799B(6)(B), 1313, and 2652(2) of the Public

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

9 6(c), 247c–1(e), 254e(a)(2)(C), 256d(c)(5), 295p(6)(B),

10 300e–12, and 300ff–52(2)) are amended by striking

11 ‘‘340’’ and inserting ‘‘330(h)’’.

12 (b) HOMELESS INDIVIDUAL.—Section 534(2) of the

13 Public Health Service Act (42 U.S.C. 290cc–34(2)) is

14 amended by striking ‘‘340(r)’’ and inserting ‘‘330(h)(5)’’.

Æ