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[110th Congress Public Law 355]
[From the U.S. Government Printing Office]

[DOCID: f:publ355.110]

[[Page 3987]]

                   HEALTH CARE SAFETY NET ACT OF 2008

[[Page 122 STAT. 3988]]

Public Law 110-355
110th Congress

                                 An Act

 
      To amend the Public Health Service Act to provide additional 
 authorizations of appropriations for the health centers program under 
    section 330 of such Act, and for other purposes. <<NOTE: Oct. 8, 
                         2008 -  [H.R. 1343]>> 

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, <<NOTE: Health 
Care Safety Net Act of 2008.>> 
SECTION 1. <<NOTE: 42 USC 201 note.>> SHORT TITLE.

    This Act may be cited as the ``Health Care Safety Net Act of 2008''.
SEC. 2. COMMUNITY HEALTH CENTERS PROGRAM OF THE PUBLIC HEALTH 
                    SERVICE ACT.

    (a) Additional Authorizations of Appropriations for the Health 
Centers Program of Public Health Service Act.--Section 330(r) of the 
Public Health Service Act (42 U.S.C. 254b(r)) is amended by amending 
paragraph (1) to read as follows:
            ``(1) In general.--For the purpose of carrying out this 
        section, in addition to the amounts authorized to be 
        appropriated under subsection (d), there are authorized to be 
        appropriated--
                    ``(A) $2,065,000,000 for fiscal year 2008;
                    ``(B) $2,313,000,000 for fiscal year 2009;
                    ``(C) $2,602,000,000 for fiscal year 2010;
                    ``(D) $2,940,000,000 for fiscal year 2011; and
                    ``(E) $3,337,000,000 for fiscal year 2012.''.

    (b) Studies <<NOTE: 42 USC 254b note.>> Relating to Community Health 
Centers.--
            (1) Definitions.--For purposes of this subsection--
                    (A) the term ``community health center'' means a 
                health center receiving assistance under section 330 of 
                the Public Health Service Act (42 U.S.C. 254b); and
                    (B) the term ``medically underserved population'' 
                has the meaning given that term in such section 330.
            (2) School-based health center study.--
                    (A) In general.--Not <<NOTE: Deadline.>> later than 
                2 years after the date of enactment of this Act, the 
                Comptroller General of the United States shall issue a 
                study of the economic costs and benefits of school-based 
                health centers and the impact on the health of students 
                of these centers.
                    (B) Content.--In conducting the study under 
                subparagraph (A), the Comptroller General of the United 
                States shall analyze--
                          (i) the impact that Federal funding could have 
                      on the operation of school-based health centers;

[[Page 122 STAT. 3989]]

                          (ii) any cost savings to other Federal 
                      programs derived from providing health services in 
                      school-based health centers;
                          (iii) the effect on the Federal Budget and the 
                      health of students of providing Federal funds to 
                      school-based health centers and clinics, including 
                      the result of providing disease prevention and 
                      nutrition information;
                          (iv) the impact of access to health care from 
                      school-based health centers in rural or 
                      underserved areas; and
                          (v) other sources of Federal funding for 
                      school-based health centers.
            (3) Health care quality study.--
                    (A) In general.--
                Not <<NOTE: Deadline. Reports.>> later than 1 year after 
                the date of enactment of this Act, the Secretary of 
                Health and Human Services (referred to in this Act as 
                the ``Secretary''), acting through the Administrator of 
                the Health Resources and Services Administration, and in 
                collaboration with the Agency for Healthcare Research 
                and Quality, shall prepare and submit to the Committee 
                on Health, Education, Labor, and Pensions of the Senate 
                and the Committee on Energy and Commerce of the House of 
                Representatives a report that describes agency efforts 
                to expand and accelerate quality improvement activities 
                in community health centers.
                    (B) Content.--The report under subparagraph (A) 
                shall focus on--
                          (i) Federal efforts, as of the date of 
                      enactment of this Act, regarding health care 
                      quality in community health centers, including 
                      quality data collection, analysis, and reporting 
                      requirements;
                          (ii) identification of effective models for 
                      quality improvement in community health centers, 
                      which may include models that--
                                    (I) incorporate care coordination, 
                                disease management, and other services 
                                demonstrated to improve care;
                                    (II) are designed to address 
                                multiple, co-occurring diseases and 
                                conditions;
                                    (III) improve access to providers 
                                through non-traditional means, such as 
                                the use of remote monitoring equipment;
                                    (IV) target various medically 
                                underserved populations, including 
                                uninsured patient populations;
                                    (V) increase access to specialty 
                                care, including referrals and diagnostic 
                                testing; and
                                    (VI) enhance the use of electronic 
                                health records to improve quality;
                          (iii) efforts to determine how effective 
                      quality improvement models may be adapted for 
                      implementation by community health centers that 
                      vary by size, budget, staffing, services offered, 
                      populations served, and other characteristics 
                      determined appropriate by the Secretary;

[[Page 122 STAT. 3990]]

                          (iv) types of technical assistance and 
                      resources provided to community health centers 
                      that may facilitate the implementation of quality 
                      improvement interventions;
                          (v) proposed or adopted methodologies for 
                      community health center evaluations of quality 
                      improvement interventions, including any 
                      development of new measures that are tailored to 
                      safety-net, community-based providers;
                          (vi) successful strategies for sustaining 
                      quality improvement interventions in the long-
                      term; and
                          (vii) partnerships with other Federal agencies 
                      and private organizations or networks as 
                      appropriate, to enhance health care quality in 
                      community health centers.
                    (C) Dissemination.--The Administrator of the Health 
                Resources and Services Administration shall establish a 
                formal mechanism or mechanisms for the ongoing 
                dissemination of agency initiatives, best practices, and 
                other information that may assist health care quality 
                improvement efforts in community health centers.
            (4) GAO study on integrated health systems model for the 
        delivery of health care services to medically underserved and 
        uninsured populations.--
                    (A) Study.--The Comptroller General of the United 
                States shall conduct a study on integrated health system 
                models of at least 15 sites for the delivery of health 
                care services to medically underserved and uninsured 
                populations. The study shall include an examination of--
                          (i) health care delivery models sponsored by 
                      public or private non-profit entities that--
                                    (I) integrate primary, specialty, 
                                and acute care; and
                                    (II) serve medically underserved and 
                                uninsured populations; and
                          (ii) such models in rural and urban areas.
                    (B) Report.--Not later than 1 year after the date of 
                the enactment of this Act, the Comptroller General of 
                the United States shall submit to Congress a report on 
                the study conducted under subparagraph (A). The report 
                shall include--
                          (i) an evaluation of the models, as described 
                      in subparagraph (A), in--
                                    (I) expanding access to primary, 
                                preventive, and specialty services for 
                                medically underserved and uninsured 
                                populations; and
                                    (II) improving care coordination and 
                                health outcomes;
                                    (III) increasing efficiency in the 
                                delivery of quality health care; and
                                    (IV) conducting some combination of 
                                the following services--
                                            (aa) outreach activities;
                                            (bb) case management and 
                                        patient navigation services;
                                            (cc) chronic care 
                                        management;

[[Page 122 STAT. 3991]]

                                            (dd) transportation to 
                                        health care facilities;
                                            (ee) development of provider 
                                        networks and other innovative 
                                        models to engage local 
                                        physicians and other providers 
                                        to serve the medically 
                                        underserved within a community;
                                            (ff) recruitment, training, 
                                        and compensation of necessary 
                                        personnel;
                                            (gg) acquisition of 
                                        technology for the purpose of 
                                        coordinating care;
                                            (hh) improvements to 
                                        provider communication, 
                                        including implementation of 
                                        shared information systems or 
                                        shared clinical systems;
                                            (ii) determination of 
                                        eligibility for Federal, State, 
                                        and local programs that provide, 
                                        or financially support the 
                                        provision of, medical, social, 
                                        housing, educational, or other 
                                        related services;
                                            (jj) development of 
                                        prevention and disease 
                                        management tools and processes;
                                            (kk) translation services;
                                            (ll) development and 
                                        implementation of evaluation 
                                        measures and processes to assess 
                                        patient outcomes;
                                            (mm) integration of primary 
                                        care and mental health services; 
                                        and
                                            (nn) carrying out other 
                                        activities that may be 
                                        appropriate to a community and 
                                        that would increase access by 
                                        the uninsured to health care, 
                                        such as access initiatives for 
                                        which private entities provide 
                                        non-Federal contributions to 
                                        supplement the Federal funds 
                                        provided through the grants for 
                                        the initiatives; and
                          (ii) an assessment of--
                                    (I) challenges, including barriers 
                                to Federal programs, encountered by such 
                                entities in providing care to medically 
                                underserved and uninsured populations; 
                                and
                                    (II) advantages and disadvantages of 
                                such models compared to other models of 
                                care delivery for medically underserved 
                                and uninsured populations, including--
                                            (aa) quality measurement and 
                                        quality outcomes;
                                            (bb) administrative 
                                        efficiencies; and
                                            (cc) geographic distribution 
                                        of federally-supported clinics 
                                        compared to geographic 
                                        distribution of integrated 
                                        health systems.
            (5) GAO study on volunteer enhancement.--
                    (A) In general.--
                Not <<NOTE: Deadline. Reports.>> later than 6 months 
                after the date of enactment of this Act, the Comptroller 
                General of the United States shall conduct a study, and 
                submit a report to Congress, concerning the implications 
                of extending Federal Tort Claims Act (chapter 171 of 
                title

[[Page 122 STAT. 3992]]

                28, United States Code) coverage to health care 
                professionals who volunteer to furnish care to patients 
                of health centers.
                    (B) Content.--In conducting the study under 
                subparagraph (A), the Comptroller General of the United 
                States shall analyze--
                          (i) the potential financial implications for 
                      the Federal Government of such an extension, 
                      including any increased funding needed for current 
                      health center Federal Tort Claims Act coverage;
                          (ii) an estimate of the increase in the number 
                      of health care professionals at health centers, 
                      and what types of such professionals would most 
                      likely volunteer given the extension of Federal 
                      Tort Claims Act coverage;
                          (iii) the increase in services provided by 
                      health centers as a result of such an increase in 
                      health care professionals, and in particular the 
                      effect of such action on the ability of health 
                      centers to secure specialty and diagnostic 
                      services needed by their uninsured and other 
                      patients;
                          (iv) the volume of patient workload at health 
                      centers and how volunteer health care 
                      professionals may help address the patient volume;
                          (v) the most appropriate manner of extending 
                      such coverage to volunteer health care 
                      professionals at health centers, including any 
                      potential difference from the mechanism currently 
                      used for health care professional volunteers at 
                      free clinics;
                          (vi) State laws that have been shown to 
                      encourage physicians and other health care 
                      providers to provide charity care as an agent of 
                      the State; and
                          (vii) other policies, including legislative or 
                      regulatory changes, that have the potential to 
                      increase the number of volunteer health care staff 
                      at health centers and the financial implications 
                      of such policies, including the cost savings 
                      associated with the ability to provide more 
                      services in health centers rather than more 
                      expensive sites of care.

    (c) Recognition of High Poverty.--
            (1) In general.--Section 330(c) of the Public Health Service 
        Act (42 U.S.C. 254b(c)) is amended by adding at the end the 
        following new paragraph:
            ``(3) Recognition of high poverty.--
                    ``(A) In general.--In making grants under this 
                subsection, the Secretary may recognize the unique needs 
                of high poverty areas.
                    ``(B) High poverty area defined.--For purposes of 
                subparagraph (A), the term `high poverty area' means a 
                catchment area which is established in a manner that is 
                consistent with the factors in subsection (k)(3)(J), and 
                the poverty rate of which is greater than the national 
                average poverty rate as determined by the Bureau of the 
                Census.''.
            (2) Effective <<NOTE: 42 USC 254b note.>> date.--The 
        amendment made by paragraph (1) shall apply to grants made on or 
        after January 1, 2009.

[[Page 122 STAT. 3993]]

SEC. 3. NATIONAL HEALTH SERVICE CORPS.

    (a) Funding.--
            (1) Reauthorization of national health service corps 
        program.--Section 338(a) of the Public Health Service Act (42 
        U.S.C. 254k(a)) is amended by striking ``2002 through 2006'' and 
        inserting ``2008 through 2012''.
            (2) Scholarship and loan repayment programs.--Subsection (a) 
        of section 338H of such Act (42 U.S.C. 254q) is amended by 
        striking ``appropriated $146,250,000'' and all that follows 
        through the period and inserting the following: ``appropriated--
            ``(1) for fiscal year 2008, $131,500,000;
            ``(2) for fiscal year 2009, $143,335,000;
            ``(3) for fiscal year 2010, $156,235,150;
            ``(4) for fiscal year 2011, $170,296,310; and
            ``(5) for fiscal year 2012, $185,622,980.''.

    (b) Elimination of 6-Year Demonstration Requirement.--Section 
332(a)(1) of the Public Health Service Act (42 U.S.C. 254e(a)(1)) is 
amended by striking ``Not earlier than 6 years'' and all that follows 
through ``purposes of this section.''.
    (c) Assignment to Shortage Area.--Section 333(a)(1)(D)(ii) of the 
Public Health Service Act (42 U.S.C. 254f(a)(1)(D)(ii)) is amended--
            (1) in subclause (IV), by striking ``and'';
            (2) in subclause (V), by striking the period at the end and 
        inserting ``; and''; and
            (3) by adding at the end the following:
                                    ``(VI) the entity demonstrates 
                                willingness to support or facilitate 
                                mentorship, professional development, 
                                and training opportunities for Corps 
                                members.''.

    (d) Professional Development and Training.--Subsection (d) of 
section 336 of the Public Health Service Act (42 U.S.C. 254h-1) is 
amended to read as follows:
    ``(d) Professional Development and Training.--
            ``(1) In general.--The Secretary shall assist Corps members 
        in establishing and maintaining professional relationships and 
        development opportunities, including by--
                    ``(A) establishing appropriate professional 
                relationships between the Corps member involved and the 
                health professions community of the geographic area with 
                respect to which the member is assigned;
                    ``(B) establishing professional development, 
                training, and mentorship linkages between the Corps 
                member involved and the larger health professions 
                community, including through distance learning, direct 
                mentorship, and development and implementation of 
                training modules designed to meet the educational needs 
                of offsite Corps members;
                    ``(C) establishing professional networks among Corps 
                members; or
                    ``(D) engaging in other professional development, 
                mentorship, and training activities for Corps members, 
                at the discretion of the Secretary.
            ``(2) Assistance in establishing professional 
        relationships.--In providing such assistance under paragraph 
        (1), the

[[Page 122 STAT. 3994]]

        Secretary shall focus on establishing relationships with 
        hospitals, with academic medical centers and health professions 
        schools, with area health education centers under section 751, 
        with health education and training centers under section 752, 
        and with border health education and training centers under such 
        section 752. Such assistance shall include assistance in 
        obtaining faculty appointments at health professions schools.
            ``(3) Supplement not supplant.--Such efforts under this 
        subsection shall supplement, not supplant, non-government 
        efforts by professional health provider societies to establish 
        and maintain professional relationships and development 
        opportunities.''.

    (e) Eligibility of the District of Columbia and Territories for the 
State Loan Repayment Program.--
            (1) In general.--Section 338I(h) of the Public Health 
        Service Act (42 U.S.C. 254q-1(h)) is amended by striking 
        ``several States'' and inserting ``50 States, the District of 
        Columbia, the Commonwealth of Puerto Rico, the United States 
        Virgin Islands, Guam, American Samoa, Palau, the Marshall 
        Islands, and the Commonwealth of the Northern Mariana Islands''.
            (2) Authorization of appropriations.--Section 338I(i)(1) of 
        such Act (42 U.S.C. 254q-1(i)(1)) is amended by striking 
        ``2002'' and all that follows through the period and inserting 
        ``2008, and such sums as may be necessary for each of fiscal 
        years 2009 through 2012.''.
SEC. 4. REAUTHORIZATION OF RURAL HEALTH CARE PROGRAMS.

    Section 330A(j) of the Public Health Service Act (42 U.S.C. 254c(j)) 
is amended by striking ``$40,000,000'' and all that follows through the 
period and inserting ``$45,000,000 for each of fiscal years 2008 through 
2012.''.
SEC. 5. REAUTHORIZATION OF PRIMARY DENTAL HEALTH WORKFORCE 
                    PROGRAMS.

    Section 340G(f) of the Public Health Service Act (42 U.S.C. 256g(f)) 
is amended--
            (1) by striking ``$50,000,000'' and inserting 
        ``$25,000,000''; and
            (2) by striking ``2002'' and inserting ``2008''.
SEC. 6. EMERGENCY RESPONSE COORDINATION OF PRIMARY CARE PROVIDERS.

    (a) In General.--Subtitle B of title XXVIII of the Public Health 
Service Act (42 U.S.C. 300hh-10 et seq.) is amended by adding at the end 
the following:
``SEC. 2815. <<NOTE: 42 USC 300hh-17.>> EMERGENCY RESPONSE 
                          COORDINATION OF PRIMARY CARE PROVIDERS.

    ``The Secretary, acting through Administrator of the Health 
Resources and Services Administration, and in coordination with the 
Assistant Secretary for Preparedness and Response, shall
            ``(1) provide guidance and technical assistance to health 
        centers funded under section 330 and to State and local health 
        departments and emergency managers to integrate health centers 
        into State and local emergency response plans and to better meet 
        the primary care needs of populations served by health centers 
        during public health emergencies; and

[[Page 122 STAT. 3995]]

            ``(2) encourage employees at health centers funded under 
        section 330 to participate in emergency medical response 
        programs including the National Disaster Medical System 
        authorized in section 2812, the Volunteer Medical Reserve Corps 
        authorized in section 2813, and the Emergency System for Advance 
        Registration of Health Professions Volunteers authorized in 
        section 319I.''.

    (b) Sense of the Congress.--It is the Sense of Congress that the 
Secretary of Health and Human Services, to the extent permitted by law, 
utilize the existing authority provided under the Federal Tort Claims 
Act for health centers funded under section 330 of the Public Health 
Service Act (42 U.S.C. 254b) in order to establish expedited procedures 
under which such health centers and their health care professionals that 
have been deemed eligible for Federal Tort Claims Act coverage are able 
to respond promptly in a coordinated manner and on a temporary basis to 
public health emergencies outside their traditional service area and 
sites, and across State lines, as necessary and appropriate.
SEC. 7. REVISION OF THE TIMEFRAME FOR THE RECOGNITION OF CERTAIN 
                    DESIGNATIONS IN CERTIFYING RURAL HEALTH 
                    CLINICS UNDER THE MEDICARE PROGRAM.

    (a) In General.--The second sentence of section 1861(aa)(2) of the 
Social Security Act (42 U.S.C. 1395x(aa)(2)) is amended by striking ``3-
year period'' and inserting ``4-year period'' in the matter in clause 
(i) preceding subclause (I).
    (b) Effective <<NOTE: 42 USC 1395x note.>> Date.--The amendment made 
by subsection (a) shall take effect on the date of the enactment of this 
Act.

    Approved October 8, 2008.

LEGISLATIVE HISTORY--H.R. 1343 (S. 901):
---------------------------------------------------------------------------

HOUSE REPORTS: No. 110-680 (Comm. on Energy and Commerce).
SENATE REPORTS: No. 110-274 accompanying S. 901 (Comm. on Health, 
Education, Labor, and Pensions).
CONGRESSIONAL RECORD, Vol. 154 (2008):
            June 4, considered and passed House.
            Sept. 24, considered and passed Senate, amended.
            Sept. 25, House concurred in Senate amendment.

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