I 

109TH CONGRESS 

2D SESSION H. R. 4858 

To provide for the restoration of health care-related services in Hurricane 

Katrina-affected areas, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 2, 2006 

Mr. JEFFERSON (for himself, Mrs. CHRISTENSEN, Mr. CLAY, Mr. CLYBURN, 

Mr. RANGEL, Mr. DAVIS of Illinois, Mr. MEEKS of New York, Mrs. 

JONES of Ohio, Ms. LEE, Mr. BISHOP of Georgia, Ms. EDDIE BERNICE

JOHNSON of Texas, Mr. LEWIS of Georgia, Mr. AL GREEN of Texas, Ms. 

CORRINE BROWN of Florida, Mr. HASTINGS of Florida, Mr. SCOTT of 

Virginia, Ms. WATERS, Ms. MOORE of Wisconsin, Ms. MILLENDERMCDONALD, Mr. WYNN, Mr. SCOTT of Georgia, Mr. MEEK of Florida, 

Ms. NORTON, Ms. JACKSON-LEE of Texas, Mr. CLEAVER, Mr. 

CUMMINGS, Ms. KILPATRICK of Michigan, and Mr. OWENS) introduced 

the following bill; which was referred to the Committee on Energy and 

Commerce, and in addition to the Committee on Ways and Means, for 

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

consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To provide for the restoration of health care-related services 

in Hurricane Katrina-affected areas, 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, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Katrina Health Access, 

3 Recovery, and Empowerment Act of 2006’’. 

4 SEC. 2. TABLE OF CONTENTS. 

5 The table of contents for this Act is as follows: 

Sec. 1. Short title. 

Sec. 2. Table of contents. 

Sec. 3. Findings. 

Sec. 4. Hurricane Katrina-affected area defined. 

TITLE I—REBUILDING HEALTH CARE INFRASTRUCTURE 

Sec. 101. Small business concerns. 

Sec. 102. Credit for expenditures by health professionals in Hurricane Katrinaaffected area for medical professional malpractice insurance. 

Sec. 103. Deduction for premiums of physicians in Hurricane Katrina-affected 

area for medical liability insurance for high risk specialties. 

Sec. 104. Deduction for premiums for medical liability insurance for practices 

in Hurricane Katrina-affected area serving medically underserved communities. 

Sec. 105. Grants and contracts regarding health provider shortages. 

TITLE II—REBUILDING PIPELINES OF PROVIDERS IN MEDICALLY NEEDY AND UNDERSERVED AREAS AND COMMUNITIES 

Sec. 201. Amendment to the Public Health Service Act. 

TITLE III—PROVIDING RELIEF TO ACADEMIC INSTITUTIONS 

Sec. 301. Grants to institutions of higher education. 

TITLE IV—RESTORING KEY COMPONENTS OF THE HEALTH CARE 

INFRASTRUCTURE IN MEDICALLY-NEEDY AND MEDICALLY UNDERSERVED AREAS 

Sec. 401. Medically-needy Katrina recovery zones. 

Sec. 402. Repair and disparities grants. 

Sec. 403. Disaster relief Medicaid. 

6 SEC. 3. FINDINGS. 

7 The Congress finds the following: 

8 (1) Many of the communities that were most 

9 affected by Hurricane Katrina had poor health care 

10 infrastructures and some of the highest poverty 

11 rates before the storm reached the coast. For examVerDate Aug 31 2005 23:48 Mar 04, 2006 Jkt 049196 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4858.IH H4858

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1 ple, Louisiana had the fourth highest uninsurance 

2 rate in the Nation and nearly one in four residents 

3 was living in poverty. Today, the number of people 

4 from the Gulf Coast who are uninsured and lack ac5 cess to adequate health care has significantly in6 creased. 

7 (2) Numerous studies show that poverty has a 

8 direct impact on the health, health care, and well9 being of all people. 

10 (3) Studies confirm that numerous factors exac11 erbate health disparities, including: poverty; 

12 uninsurance; unemployment; low educational attain13 ment; the absence of culturally and linguistically 

14 competent care; and a lack of access to housing, 

15 needed health care services and treatments, and 

16 health care information. 

17 (4) In New Orleans, more than 2 in 3 displaced 

18 providers (4,486) were in three central New Orleans 

19 parishes—Plaquemines, St. Bernard, and Jefferson 

20 parishes—all of which were evacuated (Ricketts 

21 2005). Additionally, it is estimated that more than 

22 one in three (35 percent) of the displaced physicians 

23 in these three central New Orleans parishes were 

24 primary care physicians (Ricketts 2005). 


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1 (5) The Medical Center of Louisiana and New 

2 Orleans (MCLNO) was the only Level 1 trauma cen3 ter in the region and included Charity and Univer4 sity Hospitals. More than 50 percent of inpatient 

5 care provided by MCLNO was provided to uninsured 

6 patients and more than 8 in 10 (85 percent) pa7 tients had annual incomes that were $20,000 or less. 

8 SEC. 4. HURRICANE KATRINA-AFFECTED AREA DEFINED. 

9 In this Act, the term ‘‘Hurricane Katrina-affected 

10 area’’ means an area in a county or parish in Alabama, 

11 Louisiana, or Mississippi, for which a major disaster has 

12 been declared in accordance with section 401 of the Robert 

13 T. Stafford Disaster Relief and Emergency Assistance Act 

14 (42 U.S.C. 5170) as a result of Hurricane Katrina. 

15 TITLE I—REBUILDING HEALTH 

16 CARE INFRASTRUCTURE 

17 SEC. 101. SMALL BUSINESS CONCERNS. 

18 (a) LOANS.—During fiscal years 2006 and 2007, the 

19 Secretary of Health and Human Services shall provide 

20 low-interest loans to eligible small business concerns for 

21 the restoration of health care and other services connected 

22 to health care. 

23 (b) CANCELLATION OF LOANS.—At the end of the 

24 5-year period beginning on the date of the provision of 

25 a loan under this section, the Secretary shall cancel the 


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1 unpaid balance and any accrued interest on the loan if 

2 the eligible small business concern meets each of the fol3 lowing: 

4 (1) The eligible small business concern is oper5 ating at 70 percent or greater of the level of oper6 ation of the concern before Hurricane Katrina. 

7 (2) The eligible small business concern has not, 

8 because of a change in ownership, control, or affili9 ation, ceased to be a small business concern. 

10 (3) If the eligible small business concern pro11 vides direct health care, the concern gives an assur12 ance satisfactory to the Secretary that the concern 

13 will not, because of a change in ownership, control, 

14 or affiliation, cease to be a small business concern 

15 during the 5 years following such 5-year period. 

16 (4) If the eligible business concern does not 

17 provide direct health care, the concern gives an as18 surance satisfactory to the Secretary that the owner19 ship of the concern will not, because of a change in 

20 ownership, control, or affiliation, cease to be a small 

21 business concern during the 2 years following such 

22 5-year period. 

23 (c) CONSULTATION.—The Secretary shall carry out 

24 this section in consultation with— 


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1 (1) the Office of Minority Health in the Depart2 ment of Health and Human Services; and 

3 (2) the Director of the Office of Small and Dis4 advantaged Business Utilization (OFSDBU) in each 

5 of the Department of Health and Human Services 

6 and the Department of Homeland Security. 

7 (d) ELIGIBLE SMALL BUSINESS CONCERN.—In this 

8 section, the term ‘‘eligible small business concern’’ means 

9 a small business concern that— 

10 (1) was located in a Hurricane Katrina-affected 

11 area as of August 28, 2005; and 

12 (2) provides health care or health care-related 

13 services to individuals in such area. 

14 (e) USE OF LOANS.—A loan under this section shall 

15 be used for the restoration of health care for individuals 

16 in a Hurricane Katrina-affected area or for the restoration 

17 of other services connected to such health care. Such res18 toration may include rebuilding physical structures. 

19 (f) APPLICATION.— 

20 (1) IN GENERAL.—To seek a loan under this 

21 section, an eligible small business concern shall sub22 mit an application to the Secretary at such time, in 

23 such manner, and containing such information as 

24 the Secretary may require. 


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1 (2) APPROVAL.—Not later than 30 days after 

2 the receipt of an application for a loan under this 

3 section, the Secretary shall approve or disapprove 

4 the application. If the Secretary disapproves the ap5 plication, the Secretary shall provide the applicant 

6 with a written explanation of the reasons for the dis7 approval. 

8 (g) PRIORITY.—In making loans under this section, 

9 the Secretary shall give— 

10 (1) highest priority to eligible small business 

11 concerns providing direct health care primarily to 

12 medically-needy individuals; and 

13 (2) second highest priority to eligible small 

14 business concerns providing health-care related serv15 ices primarily to medically-needy individuals. 

16 (h) OTHER DEFINITIONS.—In this section: 

17 (1) The term ‘‘small business concern’’ has the 

18 meaning given to that term in section 3 of the Small 

19 Business Act (15 U.S.C. 632) and the regulations 

20 promulgated thereunder. 

21 (2) The term ‘‘Secretary’’ means the Secretary 

22 of Health and Human Services. 

23 (i) AUTHORIZATION OF APPROPRIATIONS.—To carry 

24 out this section, there are authorized to be appropriated 


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1 such sums as may be necessary for fiscal years 2006 

2 through 2012. 

3 SEC. 102. CREDIT FOR EXPENDITURES BY HEALTH PROFES4 SIONALS IN HURRICANE KATRINA-AFFECTED 

5 AREA FOR MEDICAL PROFESSIONAL MAL6 PRACTICE INSURANCE. 

7 (a) IN GENERAL.—Subpart D of part IV of sub8 chapter A of chapter 1 of the Internal Revenue Code of 

9 1986 (relating to business tax credits) is amended by add10 ing at the end the following: 

11 ‘‘SEC. 45N. CREDIT FOR EXPENDITURES BY HEALTH PRO12 FESSIONALS IN HURRICANE KATRINA-AF13 FECTED AREA FOR MEDICAL PROFESSIONAL 

14 MALPRACTICE INSURANCE. 

15 ‘‘(a) GENERAL RULE.—For purposes of section 38, 

16 in the case of a taxpayer who is an eligible health profes17 sional, the medical malpractice insurance expenditure tax 

18 credit determined under this section for a covered year 

19 shall equal 15 percent of the qualified medical malpractice 

20 insurance expenditures incurred by the professional during 

21 the covered year. 

22 ‘‘(b) DEFINITIONS.—In this section: 

23 ‘‘(1) COVERED YEAR.—The term ‘covered year’ 

24 means taxable years beginning in 2005 and 2006. 


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1 ‘‘(2) ELIGIBLE HEALTH PROFESSIONAL.—The 

2 term ‘eligible health professional’ means a physician, 

3 nurse, mental health provider, pharmacist, para4 medic, dentist, allied health professional, hospice 

5 care provider, or other individual health care pro6 vider whose primary place of employment is located 

7 in the Hurricane Katrina-affected area. 

8 ‘‘(3) HURRICANE KATRINA-AFFECTED AREA.— 

9 The term ‘Hurricane Katrina-affected area’ means 

10 an area in a county or parish in Alabama, Lou11 isiana, or Mississippi, for which a major disaster has 

12 been declared in accordance with section 401 of the 

13 Robert T. Stafford Disaster Relief and Emergency 

14 Assistance Act as a result of Hurricane Katrina. 

15 ‘‘(4) QUALIFIED MEDICAL MALPRACTICE INSUR16 ANCE EXPENDITURE.—The term ‘qualified medical 

17 malpractice insurance expenditure’ means so much 

18 of any professional insurance premium, surcharge, 

19 payment, or other cost or expense required as a con20 dition of State licensure which is incurred by an eli21 gible health professional in a covered year for the 

22 sole purpose of providing or furnishing general med23 ical malpractice liability insurance for such eligible 

24 health professional as does not exceed twice the 


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1 Statewide average of such costs for similarly situ2 ated eligible health professionals. 

3 ‘‘(c) SPECIAL RULES.— 

4 ‘‘(1) IN GENERAL.—Except as provided in para5 graph (2), the credit determined under this section 

6 shall be claimed by the eligible health professional 

7 incurring the qualified medical malpractice insurance 

8 expenditure. 

9 ‘‘(2) CERTIFICATION.—Each State, through its 

10 board of medical licensure and State board (or agen11 cy) regulating insurance, annually shall provide such 

12 information to the Secretary of Health and Human 

13 Services as is necessary to permit the Secretary to 

14 calculate average costs for purposes of subsection 

15 (b)(4) and to certify such average costs (rounded to 

16 the nearest whole dollar) to the Secretary of the 

17 Treasury on or before the 15th day of November of 

18 each year.’’. 

19 (b) CREDIT MADE PART OF GENERAL BUSINESS

20 CREDIT.—Section 38(b) of such Code (relating to current 

21 year business credit) is amended by striking ‘‘and’’ at the 

22 end of paragraph (25), by striking the period at the end 

23 of paragraph (26) and inserting ‘‘, and’’, and by adding 

24 at the end the following new paragraph: 


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1 ‘‘(27) the medical malpractice insurance ex2 penditure tax credit determined under section 

3 45N(a).’’. 

4 (c) DENIAL OF DOUBLE BENEFIT.—Section 280C of 

5 the Internal Revenue Code of 1986 (relating to certain 

6 expenses for which credits are allowable) is amended by 

7 adding at the end the following new subsection: 

8 ‘‘(d) CREDIT FOR MEDICAL MALPRACTICE LIABILITY

9 INSURANCE PREMIUMS.— 

10 ‘‘(1) IN GENERAL.—No deduction shall be al11 lowed for that portion of the qualified medical mal12 practice insurance expenditures (as defined in sec13 tion 45N(b)) otherwise allowable as a deduction for 

14 the taxable year which is equal to the amount of the 

15 credit allowable for the taxable year under section 

16 45 (determined without regard to section 38(c)). 

17 ‘‘(2) CONTROLLED GROUPS.—In the case of a 

18 corporation which is a member of a controlled group 

19 of corporations (within the meaning of section 

20 41(f)(5)) or a trade or business which is being treat21 ed as being under common control with other trades 

22 or business (within the meaning of section 

23 41(f)(1)(B)), this subsection shall be applied under 

24 rules prescribed by the Secretary similar to the rules 


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1 applicable under subparagraphs (A) and (B) of sec2 tion 41(f)(1).’’. 

3 (d) GRANTS TO NON-PROFIT HOSPITALS AND CLIN4 ICS.— 

5 (1) IN GENERAL.—The Secretary of Health and 

6 Human Services, acting through the Administrator 

7 of the Health Resources and Services Administra8 tion, shall award grants to eligible non-profit hos9 pitals and clinics to assist such hospitals and clinics 

10 in defraying qualified medical malpractice insurance 

11 expenditures. 

12 (2) ELIGIBLE NON-PROFIT HOSPITAL OR CLIN13 IC.—To be eligible to receive a grant under para14 graph (1), an entity shall— 

15 (A) be a non-profit hospital or clinic; 

16 (B) be located in a the Hurricane Katrina17 affected area; 

18 (C) serve primarily medically underserved 

19 communities; 

20 (D) be unable to claim the tax credit de21 scribed in section 45N of the Internal Revenue 

22 Code of 1986 for the year for which an applica23 tion is submitted under subparagraph (E); and 

24 (E) prepare and submit to the Secretary of 

25 Health and Human Services an application at 


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1 such time, in such manner, and containing such 

2 information as the Secretary may require. 

3 (3) AMOUNT OF GRANT.—The amount of a 

4 grant to a non-profit hospital or clinic under para5 graph (1) shall equal 15 percent of the amount of 

6 the qualified medical malpractice insurance expendi7 tures of the hospital or clinic for the year involved. 

8 (4) QUALIFIED MEDICAL MALPRACTICE INSUR9 ANCE EXPENDITURE.—In this subsection, the term 

10 ‘‘qualified medical malpractice insurance expendi11 ture’’ means so much of any professional insurance 

12 premium, surcharge, payment, or other cost or ex13 pense required as a condition of State licensure 

14 which is incurred by a non-profit hospital or clinic 

15 in a year for the sole purpose of providing or fur16 nishing general medical malpractice liability insur17 ance for such hospital or clinic as does not exceed 

18 twice the Statewide average of such costs for simi19 larly situated hospitals or clinics. 

20 (5) HURRICANE KATRINA-AFFECTED AREA.—In 

21 this subsection, the term ‘‘Hurricane Katrina-af22 fected area’’ means an area in a county or parish in 

23 Alabama, Louisiana, or Mississippi, for which a 

24 major disaster has been declared in accordance with 

25 section 401 of the Robert T. Stafford Disaster Relief 


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1 and Emergency Assistance Act (42 U.S.C. 5170) as 

2 a result of Hurricane Katrina. 

3 (6) AUTHORIZATION OF APPROPRIATIONS.— 

4 There are authorized to be appropriated to carry out 

5 this subsection such sums as may be necessary for 

6 each of fiscal years 2005 and 2006. 

7 (e) CLERICAL AMENDMENT.—The table of sections 

8 for subpart D of part IV of subchapter A of chapter 1 

9 of the Internal Revenue Code of 1986 is amended by add10 ing at the end the following new item: 

‘‘Sec. 45N. Credit for expenditures by health professionals in Hurricane 

Katrina-affected area for medical professional malpractice insurance.’’. 

11 (f) EFFECTIVE DATE.—The amendments made by 

12 this section shall apply to expenditures incurred on or 

13 after August 29, 2005, in taxable years ending after such 

14 date. 

15 SEC. 103. DEDUCTION FOR PREMIUMS OF PHYSICIANS IN 

16 HURRICANE KATRINA-AFFECTED AREA FOR 

17 MEDICAL LIABILITY INSURANCE FOR HIGH 

18 RISK SPECIALTIES. 

19 (a) IN GENERAL.—Part VI of subchapter B of chap20 ter 1 of the Internal Revenue Code of 1986 (relating to 

21 itemized deductions for individuals and corporations) is 

22 amended by adding at the end the following new section: 


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1 ‘‘SEC. 199A. DEDUCTION FOR PREMIUMS OF PHYSICIANS IN 

2 HURRICANE KATRINA-AFFECTED AREA FOR 

3 MEDICAL LIABILITY INSURANCE FOR HIGH 

4 RISK SPECIALTIES. 

5 ‘‘(a) IN GENERAL.—In the case of a physician whose 

6 medical practice is located in the Hurricane Katrina-af7 fected area and is in a high risk specialty, there shall be 

8 allowed as a deduction from gross income for the taxable 

9 year an amount equal to 125 percent of the aggregate pre10 miums paid for medical liability insurance with respect to 

11 such specialty for such taxable year. 

12 ‘‘(b) HIGH RISK SPECIALTY.— 

13 ‘‘(1) IN GENERAL.—For purposes of this sec14 tion, a specialty is a high risk specialty for a taxable 

15 year if, for the calendar year in which the taxable 

16 year begins, the average premiums for medical liabil17 ity insurance with respect to such specialty are equal 

18 to or greater than 67 percent of the average pre19 miums for medical liability insurance for all special20 ties for such calendar year, based on a weighted av21 erage of the number of physicians practicing in each 

22 specialty. 

23 ‘‘(2) SPECIALTIES TAKEN INTO ACCOUNT.—For 

24 purposes of paragraph (1), the Secretary, in con25 sultation with the Secretary of Health and Human 

26 Services and appropriate professional organizations, 


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1 shall determine the specialties to be taken into ac2 count for purposes of paragraph (1) and shall con3 sider those specialities for which a payment may be 

4 made under section 1886(h) of the Social Security 

5 Act. In making such determination, the Secretary 

6 shall provide for an appropriate treatment of sub7 specialties. 

8 ‘‘(3) PUBLICATION OF SPECIALITIES.—The Sec9 retary shall publish the high risk specialities. 

10 ‘‘(c) DEFINITIONS.—For purposes of this section— 

11 ‘‘(1) HURRICANE KATRINA-AFFECTED AREA.— 

12 The term ‘Hurricane Katrina-affected area’ means 

13 an area in a county or parish in Alabama, Lou14 isiana, or Mississippi, for which a major disaster has 

15 been declared in accordance with section 401 of the 

16 Robert T. Stafford Disaster Relief and Emergency 

17 Assistance Act as a result of Hurricane Katrina. 

18 ‘‘(2) PHYSICIAN.—The term ‘physician’ has the 

19 meaning given such term by section 1861(r)(1) of 

20 the Social Security Act. 

21 ‘‘(d) SPECIAL RULES.—For purposes of this sec22 tion— 

23 ‘‘(1) MEDICAL PRACTICE SPANNING MORE

24 THAN 1 SPECIALTY.—In the case of a medical prac25 tice a portion of which is in a high risk specialty, the 


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1 portion of the premiums paid for medical liability in2 surance that may be taken into account under sub3 section (a) shall be determined under regulations 

4 prescribed by the Secretary. 

5 ‘‘(2) GROUP PRACTICE, ETC.—Under regula6 tions prescribed by the Secretary, the deduction al7 lowed by this section shall be allowed in case of a 

8 group practice or health care facility which is a C 

9 corporation in the manner prescribed by the Sec10 retary. 

11 ‘‘(3) DENIAL OF DOUBLE BENEFIT.—No deduc12 tion shall be allowed under any other provision of 

13 this chapter for any amount for which a deduction 

14 is allowed under this section. 

15 ‘‘(e) TERMINATION.—This section shall not apply to 

16 taxable years beginning after December 31, 2006.’’. 

17 (b) CLERICAL AMENDMENT.—The table of sections 

18 for part VI of subchapter B of chapter 1 of such Code 

19 is amended by adding at the end the following new item: 

‘‘Sec. 199A. Deduction for premiums of physicians in Hurricane Katrina-affected area for medical liability insurance for high risk specialties.’’. 

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

21 this section shall apply to taxable years ending on or after 

22 August 29, 2005. 


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1 SEC. 104. DEDUCTION FOR PREMIUMS FOR MEDICAL LI2 ABILITY INSURANCE FOR PRACTICES IN HUR3 RICANE KATRINA-AFFECTED AREA SERVING 

4 MEDICALLY UNDERSERVED COMMUNITIES. 

5 (a) IN GENERAL.—Part VI of subchapter B of chap6 ter 1 of the Internal Revenue Code of 1986 (relating to 

7 itemized deductions for individuals and corporations) is 

8 amended by adding at the end the following new section: 

9 ‘‘SEC. 199B. DEDUCTION FOR PREMIUMS FOR MEDICAL LI10 ABILITY INSURANCE FOR PRACTICES IN HUR11 RICANE KATRINA-AFFECTED AREA SERVING 

12 MEDICALLY UNDERSERVED COMMUNITIES. 

13 ‘‘(a) IN GENERAL.—In the case of a physician whose 

14 medical practice is located in the Hurricane Katrina-af15 fected area and serves medically underserved communities, 

16 there shall be allowed as a deduction from gross income 

17 for the taxable year an amount equal to 125 percent of 

18 the aggregate premiums paid for medical liability insur19 ance with respect to such practice for such taxable year. 

20 ‘‘(b) DEFINITIONS.—In this section: 

21 ‘‘(1) HURRICANE KATRINA-AFFECTED AREA.— 

22 The term ‘Hurricane Katrina-affected area’ means 

23 an area in a county or parish in Alabama, Lou24 isiana, or Mississippi, for which a major disaster has 

25 been declared in accordance with section 401 of the 


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1 Robert T. Stafford Disaster Relief and Emergency 

2 Assistance Act as a result of Hurricane Katrina. 

3 ‘‘(2) MEDICALLY UNDERSERVED COMMUNITY.— 

4 The term ‘medically underserved community’ means 

5 a medically underserved community (as defined by 

6 section 799B of the Public Health Service Act) that 

7 has been designated under one of the categories 

8 specified in such section for a calendar year in which 

9 the taxable year of the physician begins. 

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

11 meaning given such term by section 1861(r)(1) of 

12 the Social Security Act. 

13 ‘‘(c) SPECIAL RULES.—For purposes of this sec14 tion— 

15 ‘‘(1) MEDICAL PRACTICE SPANNING MORE

16 THAN 1 COMMUNITY.—In the case of a medical prac17 tice a portion of which serves a medically under18 served community, the portion of the premiums paid 

19 for medical liability insurance that may be taken 

20 into account under subsection (a) shall be deter21 mined under regulations prescribed by the Secretary. 

22 ‘‘(2) GROUP PRACTICE, ETC.—Under regula23 tions prescribed by the Secretary, the deduction al24 lowed by this section shall be allowed in case of a 

25 group practice or health care facility which is a C 


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1 corporation in the manner prescribed by the Sec2 retary. 

3 ‘‘(3) DENIAL OF DOUBLE BENEFIT.—No deduc4 tion shall be allowed under any other provision of 

5 this chapter for any amount for which a deduction 

6 is allowed under this section. 

7 ‘‘(4) ELECTION.—A physician may elect wheth8 er to take a deduction under this section or under 

9 section 199A. 

10 ‘‘(d) TERMINATION.—This section shall not apply to 

11 taxable years beginning after December 31, 2006.’’. 

12 (b) CLERICAL AMENDMENT.—The table of sections 

13 for part VI of subchapter B of chapter 1 of such Code 

14 is amended by adding at the end the following new item: 

‘‘Sec. 199B. Deduction for premiums for medical liability insurance for practices 

in Hurricane Katrina-affected area serving medically underserved communities.’’. 

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

16 this section shall apply to taxable years ending on or after 

17 August 29, 2005. 

18 SEC. 105. GRANTS AND CONTRACTS REGARDING HEALTH 

19 PROVIDER SHORTAGES. 

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

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

22 at the end the following: 


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1 ‘‘SEC. 330M. GRANTS TO HEALTH PROVIDERS IN HURRI2 CANE KATRINA-AFFECTED AREA FOR COSTS 

3 OF MEDICAL MALPRACTICE INSURANCE. 

4 ‘‘(a) IN GENERAL.—The Secretary, acting through 

5 the Administrator of the Health Resources and Services 

6 Administration, may make awards of grants or contracts 

7 to health providers in the Hurricane Katrina-affected area 

8 to assist the providers with the costs of maintaining med9 ical malpractice insurance for providing health services in 

10 such area. 

11 ‘‘(b) REQUIREMENT.—In accordance with such cri12 teria as the Secretary may establish, awards under sub13 section (a) may be made to health providers only if such 

14 providers agree to provide health services (or to continue 

15 providing health services, as the case may be) in the Hur16 ricane Katrina-affected area for the period during which 

17 payments under the awards are made to the health pro18 viders. 

19 ‘‘(c) DEFINITIONS.—For purposes of this section: 

20 ‘‘(1) The term ‘health providers’ means physi21 cians and other health professionals, and organiza22 tions that provide health services (including hos23 pitals, clinics, and group practices), that meet appli24 cable legal requirements to provide the health serv25 ices involved. 


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1 ‘‘(2) The term ‘Hurricane Katrina-affected 

2 area’ means an area in a county or parish in Ala3 bama, Louisiana, or Mississippi, for which a major 

4 disaster has been declared in accordance with section 

5 401 of the Robert T. Stafford Disaster Relief and 

6 Emergency Assistance Act (42 U.S.C. 5170) as a re7 sult of Hurricane Katrina.’’. 

8 TITLE II—REBUILDING PIPE9 LINES OF PROVIDERS IN 

10 MEDICALLY NEEDY AND UN11 DERSERVED AREAS AND COM12 MUNITIES 

13 SEC. 201. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

14 ACT. 

15 The Public Health Service Act (42 U.S.C. 201 et 

16 seq.) is amended by adding at the end the following: 

17 ‘‘TITLE XXIX—STRENGTHENING 

18 HEALTH INSTITUTIONS THAT 

19 PROVIDE HEALTH CARE TO 

20 MINORITY POPULATIONS 

21 ‘‘Subtitle A—General Provisions 

22 ‘‘SEC. 2901. PAYMENTS TO HEALTH CARE FACILITIES. 

23 ‘‘(a) IN GENERAL.—The Secretary, with the approval 

24 of the Health Safety Net Infrastructure Trust Fund 

25 Board of Trustees described in section 2904(d) (hereafter 


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1 in this subtitle referred to as the ‘Trust Fund Board’), 

2 shall make payments, from amounts in the Health Safety 

3 Net Infrastructure Trust Fund established under section 

4 2904(a) (hereafter in this title referred to as the ‘Trust 

5 Fund’), for capital financing assistance to eligible health 

6 care facilities whose applications for assistance have been 

7 approved under this title. 

8 ‘‘(b) GENERAL ELIGIBILITY REQUIREMENTS FOR AS9 SISTANCE.— 

10 ‘‘(1) ELIGIBLE HEALTH CARE FACILITIES DE11 SCRIBED.—A health care facility shall be generally 

12 eligible for capital financing assistance under this 

13 title if the health care facility is located in the Hur14 ricane Katrina-affected area and— 

15 ‘‘(A) receives an additional payment under 

16 section 1886(d)(5)(F) of the Social Security 

17 Act and is described in clause (i)(II) or clause 

18 (vii)(I) of such section, or is deemed a dis19 proportionate share hospital under a State plan 

20 for medical assistance under title XIX of the 

21 Social Security Act on the basis described in 

22 section 1923(b)(1) of such Act; 

23 ‘‘(B) is a hospital which meets the criteria 

24 for designation by the Secretary as an essential 

25 access community hospital under section 


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1 1820(i)(1) of such Act or a rural primary care 

2 hospital under section 1820(i)(2) of such Act 

3 (whether or not such hospital is actually des4 ignated under such section); 

5 ‘‘(C) as of August 29, 2005, was a Feder6 ally qualified health center (as defined in sec7 tion 1905(l)(2)(B) of such Act); 

8 ‘‘(D) is a hospital which— 

9 ‘‘(i) is a sole community provider; or 

10 ‘‘(ii) has closed within the preceding 

11 12 months; 

12 ‘‘(E) is a facility which— 

13 ‘‘(i) provides service to ill or injured 

14 individuals prior to the transportation of 

15 such individuals to a hospital or provides 

16 inpatient care to individuals needing such 

17 care for a period not longer than 96 hours; 

18 ‘‘(ii) is located in a county (or equiva19 lent unit of local government) with fewer 

20 than 6 residents per square mile or is lo21 cated more than 35 road miles from the 

22 nearest hospital; 

23 ‘‘(iii) permits a physician assistant or 

24 nurse practitioner to admit and treat paVerDate Aug 31 2005 23:48 Mar 04, 2006 Jkt 049196 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\H4858.IH H4858

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1 tients under the supervision of a physician 

2 not present in such facility; and 

3 ‘‘(iv) has obtained a waiver from the 

4 Secretary permitting the facility to partici5 pate in the medicare program under title 

6 XVIII of the Social Security Act; or 

7 ‘‘(F) is a hospital that the Secretary other8 wise determines to be an appropriate recipient 

9 of assistance under this title on the basis of the 

10 existence of a patient care operating deficit, a 

11 demonstrated inability to secure or repay fi12 nancing for a qualifying project on reasonable 

13 terms, or such other criteria as the Secretary 

14 considers appropriate. 

15 ‘‘(2) OWNERSHIP REQUIREMENTS.—In order to 

16 be eligible for assistance under this title, a health 

17 care facility (other than a health care facility de18 scribed in subparagraphs (B) or (E) of paragraph 

19 (1)) must— 

20 ‘‘(A) be owned or operated by a unit of 

21 State or local government; 

22 ‘‘(B) be a quasi-public corporation, defined 

23 as a private, nonprofit corporation or public 

24 benefit corporation which is formally granted 

25 one or more governmental powers by legislative 


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1 action through (or is otherwise partially funded 

2 by) the State legislature, city or county council; 

3 ‘‘(C) be a private nonprofit health care fa4 cility which has contracted with, or is otherwise 

5 funded by, a governmental agency to provide 

6 health care services to low income individuals 

7 not eligible for assistance under title XVIII or 

8 title XIX of the Social Security Act, where rev9 enue from such contracts constitute at least 10 

10 percent of the facility’s operating revenues over 

11 the prior 3 fiscal years; or 

12 ‘‘(D) be a nonprofit small rural health care 

13 facility (as determined by the Secretary). 

14 ‘‘(3) PRIORITY.—In making payments under 

15 this section, the Secretary shall give priority to eligi16 ble health care entities that are federally qualified 

17 health centers (as defined in section 1905(l)(2)(B) 

18 of the Social Security Act), or other similar entities 

19 at least 50 percent of the patients of which are mi20 nority or low-income individuals. 

21 ‘‘(c) MEETING ADDITIONAL SPECIFIC CRITERIA.— 

22 Health care facilities that are generally eligible for assist23 ance under this title under subsection (b) may apply for 

24 the specific programs described in this title and must meet 

25 any additional criteria for participation in such programs. 


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1 ‘‘(d) ASSISTANCE AVAILABLE.—Capital financing as2 sistance available under this title shall include loan guar3 antees, interest rate subsidies, matching loans, and direct 

4 grants. Health care facilities determined to be generally 

5 eligible for assistance under this title may apply for and 

6 receive more than one type of assistance under this title. 

7 ‘‘SEC. 2902. APPLICATION FOR ASSISTANCE. 

8 ‘‘(a) IN GENERAL.—No health care facilities may re9 ceive assistance for a qualifying project under this title 

10 unless the health care facility— 

11 ‘‘(1) has filed with the Secretary, in a form and 

12 manner specified by the Secretary, with the advice 

13 and approval of the Trust Fund Board (as described 

14 in section 2904(d)), an application for assistance 

15 under this title; 

16 ‘‘(2) establishes in its application (for its most 

17 recent cost reporting period) that it meets the cri18 teria for general eligibility under this title; 

19 ‘‘(3) includes a description of the project, in20 cluding the community in which it is located, and 

21 describes utilization and services characteristics of 

22 the project and the health care facility, and the pa23 tient population that is to be served; 

24 ‘‘(4) describes the extent to which the project 

25 will include the financial participation of State and 


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•HR 4858 IH 

1 local governments if assistance is granted under this 

2 title, and all other sources of financing sought for 

3 the project; and 

4 ‘‘(5) establishes, to the satisfaction of the Sec5 retary and the Trust Fund Board, that the project 

6 meets the additional criteria for each type of capital 

7 financing assistance for which it is applying. 

8 ‘‘(b) CRITERIA FOR APPROVAL.—The Secretary, with 

9 the approval of the Trust Fund Board, shall determine 

10 for each application for assistance under this title— 

11 ‘‘(1) whether the health care facility meets the 

12 general eligibility criteria under section 2901(b); 

13 ‘‘(2) whether the health care facility meets the 

14 specific eligibility criteria of each type of assistance 

15 for which it has applied, including whether the 

16 health care facility meets any criteria for priority 

17 consideration for the type of assistance for which it 

18 has applied; 

19 ‘‘(3) whether the capital project for which as20 sistance is being requested is a qualifying project 

21 under this title; and 

22 ‘‘(4) whether funds are available, pursuant to 

23 the limitations of each program, to fully fund the re24 quest for assistance. 


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1 ‘‘(c) PRIORITY OF APPLICATIONS.—In addition to 

2 meeting the criteria otherwise described in this title, at 

3 the discretion of the Trust Fund Board, the Secretary 

4 shall give preference to those applications for qualifying 

5 projects that— 

6 ‘‘(1)(A) are necessary to bring existing safety 

7 net health care facilities into compliance with ac8 creditation standards of fire and life safety, seismic, 

9 or other related Federal, State or local regulatory 

10 standards; 

11 ‘‘(B) improve the provision of essential services 

12 such as emergency medical and trauma services, 

13 AIDS and infectious disease, perinatal, burn, pri14 mary care, and other services which the Trust Fund 

15 Board may designate; or 

16 ‘‘(C) provide access to otherwise unavailable es17 sential health services to the indigent and other 

18 needy persons within the health care facility’s terri19 torial area; 

20 ‘‘(2) include specific State or local governmental 

21 or other non-Federal assurances of financial support 

22 if assistance for a qualifying project is granted 

23 under this title; and 

24 ‘‘(3) are unlikely to be financed without assist25 ance granted under this title. 


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1 ‘‘(d) SUBMISSION OF APPLICATIONS.—Applications 

2 under this title shall be submitted to the Secretary 

3 through the Trust Fund Board. If two or more health care 

4 facilities join in the project, the application shall be sub5 mitted by all participating health care facilities jointly. 

6 Such applications shall set forth all of the descriptions, 

7 plans, specifications, and assurances as required by this 

8 title and contain other such information as the Trust 

9 Fund Board shall require. 

10 ‘‘(e) OPPORTUNITY FOR APPEAL.—The Trust Fund 

11 Board shall afford a health care facility applying for a loan 

12 guarantee under this section an opportunity for a hearing 

13 if the guarantee is denied. 

14 ‘‘(f) APPLICATIONS FOR AMENDMENTS.—Amend15 ment of an approved application shall be subject to ap16 proval in the same manner as an original application. 

17 ‘‘SEC. 2903. PUBLIC SERVICE RESPONSIBILITIES. 

18 ‘‘(a) IN GENERAL.—Any health care facility accept19 ing capital financing assistance under this title shall 

20 agree— 

21 ‘‘(1) to make the services of the facility or por22 tion thereof to be constructed, acquired, or modern23 ized available to all persons; and 

24 ‘‘(2) to provide a significant volume of services 

25 to persons unable to pay therefore, consistent with 


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1 other provisions of this Act and the amount of as2 sistance received under this title. 

3 ‘‘(b) ENFORCEMENT.—The Director of the Office for 

4 Civil Rights of the Department of Health and Human 

5 Services shall be given the power to enforce the public 

6 service responsibilities described in this section. 

7 ‘‘SEC. 2904. HEALTH SAFETY NET INFRASTRUCTURE TRUST 

8 FUND. 

9 ‘‘(a) CREATION OF TRUST FUND.—There is estab10 lished in the Treasury of the United States a trust fund 

11 to be known as the Health Safety Net Infrastructure 

12 Trust Fund, consisting of such amounts as may be trans13 ferred, appropriated, or credited to such Trust Fund as 

14 provided in this title. 

15 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS TO

16 TRUST FUND.—There are authorized to be appropriated 

17 to the Trust Fund such sums as may be necessary to carry 

18 out the purposes of this title. 

19 ‘‘(c) EXPENDITURES FROM TRUST FUND.—Amounts 

20 in the Trust Fund shall be available, pursuant to appro21 priations Acts, only for making expenditures to carry out 

22 the purposes of this title. 

23 ‘‘(d) BOARD OF TRUSTEES; COMPOSITION; MEET24 INGS; DUTIES.— 


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1 ‘‘(1) IN GENERAL.—There shall be created a 

2 Health Safety Net Infrastructure Trust Fund Board 

3 of Trustees composed of the Secretary of Health and 

4 Human Services, the Secretary of the Treasury, the 

5 Assistant Secretary for Health, the Director of the 

6 Office of Minority Health, and the Administrator of 

7 the Centers for Medicare and Medicaid Services (all 

8 serving in their ex officio capacities), and 5 public 

9 members who shall be appointed for 4 year terms by 

10 the President, from the following categories— 

11 ‘‘(A) one chief health officer from a State; 

12 ‘‘(B) one chief executive officer of a health 

13 care facility that meets the general eligibility 

14 criteria of this title; 

15 ‘‘(C) one representative of the financial 

16 community; and 

17 ‘‘(D) two additional public or consumer 

18 representatives. 

19 ‘‘(2) DUTIES.—The Board of Trustees shall 

20 meet no less than quarterly and shall have the re21 sponsibility to approve implementing regulations, to 

22 establish criteria, and to recommend and approve ex23 penditures by the Secretary under the programs set 

24 forth in this title. 


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1 ‘‘(3) MANAGING TRUSTEE.—The Secretary of 

2 the Treasury shall serve as the Managing Trustee of 

3 the Trust Fund, and shall be responsible for the in4 vestment of funds. The provisions of subsections (b) 

5 through (e) of section 1817 of the Social Security 

6 Act shall apply to the Trust Fund and the Managing 

7 Trustee of the Trust Fund in the same manner as 

8 they apply to the Federal Hospital Insurance Trust 

9 Fund and the Managing Trustee of that Trust 

10 Fund. 

11 ‘‘SEC. 2905. ADMINISTRATION. 

12 ‘‘(a) IN GENERAL.—The Administrator of the Cen13 ters for Medicare and Medicaid Services shall serve as Sec14 retary of the Board of Trustees and shall administer the 

15 programs under this title. 

16 ‘‘(b) LIMITATION ON ADMINISTRATIVE EXPENSES.— 

17 Not more than 5 percent of the funds annually appro18 priated to the Trust Fund may be available for adminis19 tration of the Trust Fund or programs under this title. 

20 ‘‘Subtitle B—Loan Guarantees 

21 ‘‘SEC. 2911. PROVISION OF LOAN GUARANTEES TO SAFETY 

22 NET HEALTH CARE FACILITIES. 

23 ‘‘(a) IN GENERAL.—The Safety Net Infrastructure 

24 Trust Fund will provide a Federal guarantee of loan re25 payment, including guarantees of repayment of refiVerDate Aug 31 2005 23:48 Mar 04, 2006 Jkt 049196 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 E:\BILLS\H4858.IH H4858

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1 nancing loans, to non-Federal lenders making loans to eli2 gible health care facilities for health care facility replace3 ment (either by construction or acquisition), moderniza4 tion and renovation projects, and capital equipment acqui5 sition. 

6 ‘‘(b) PURPOSES.—The loan guarantee program shall 

7 be designed by the Trust Fund Board with the goal of 

8 rebuilding and maintaining the essential health services of 

9 health care facilities eligible for assistance under this title. 

10 ‘‘SEC. 2912. ELIGIBLE LOANS. 

11 ‘‘(a) IN GENERAL.—Loan guarantees under this sub12 title are available for loans made to eligible health care 

13 facilities for replacement facilities (either newly con14 structed or acquired), modernization and renovation of ex15 isting facilities, and for capital equipment acquisition. 

16 ‘‘(b) LOAN GUARANTEE MUST BE ESSENTIAL TO

17 BOND FINANCING.—Eligible health care facilities must 

18 demonstrate that a Federal loan guarantee is essential to 

19 obtaining bond financing from non-Federal lenders at a 

20 reasonably affordable rate of interest. 

21 ‘‘(c) ADDITIONAL ELIGIBILITY CRITERIA FOR LOAN

22 GUARANTEES.—In order to be eligible for assistance 

23 under this subtitle, a health care facility must demonstrate 

24 that the following criteria are met: 


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1 ‘‘(1) The health care facility has evidence of an 

2 ability to meet debt service. 

3 ‘‘(2) The assistance, when considered with other 

4 resources available to the project, is necessary and 

5 will restore, improve, or maintain the financial or 

6 physical soundness of the health care facility. 

7 ‘‘(3) The applicant agrees to assume the public 

8 service responsibilities described in section 2903. 

9 ‘‘(4) The project is being, or will be, operated 

10 and managed in accordance with a management-im11 provement-and-operating plan which is designed to 

12 reduce the operating costs of the project, which has 

13 been approved by the Trust Fund Board, and which 

14 includes— 

15 ‘‘(A) a detailed maintenance schedule; 

16 ‘‘(B) a schedule for correcting past defi17 ciencies in maintenance, repairs, and replace18 ments; 

19 ‘‘(C) a plan to upgrade the project to meet 

20 cost-effective energy efficiency standards pre21 scribed by the Trust Fund Board; 

22 ‘‘(D) a plan to improve financial and man23 agement control systems; 

24 ‘‘(E) a detailed annual operating budget 

25 taking into account such standards for operVerDate Aug 31 2005 23:48 Mar 04, 2006 Jkt 049196 PO 00000 Frm 00035 Fmt 6652 Sfmt 6201 E:\BILLS\H4858.IH H4858

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1 ating costs in the area as may be determined by 

2 the Trust Fund Board; and 

3 ‘‘(F) such other requirements as the Trust 

4 Fund Board may determine. 

5 ‘‘(5) The application includes stringent provi6 sions for continued State or local support of the pro7 gram, both with respect to operating and financial 

8 capital. 

9 ‘‘(6) The terms, conditions, maturity, security 

10 (if any), and schedule and amount of repayments 

11 with respect to the loan are sufficient to protect the 

12 financial interests of the United States and are oth13 erwise reasonable and in accord with regulation, in14 cluding a determination that the rate of interest 

15 does not exceed such annual percentage on the prin16 cipal obligation outstanding as the Trust Fund 

17 Board determines to be reasonable, taking into ac18 count the range of interest rates prevailing in the 

19 private market for similar loans and the risks as20 sumed by the United States. 

21 ‘‘(7) The health care facility must meet such 

22 other additional criteria as the Secretary may im23 pose. 

24 ‘‘(d) STATE OR LOCAL PARTICIPATION.—Projects in 

25 which State or local governmental entities participate in 


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1 the form of first guarantees of part or all of the total loan 

2 value shall be given a preference for loan guarantees under 

3 this subtitle. 

4 ‘‘SEC. 2913. GUARANTEE ALLOTMENTS. 

5 ‘‘(a) IN GENERAL.—$150,000,000 shall be annually 

6 allocated within the Trust Fund to the loan guarantee pro7 gram established by this subtitle in order to create a cu8 mulative reserve in support of loan guarantees. 

9 ‘‘(b) LOAN GUARANTEES FOR RURAL HEALTH CARE

10 FACILITIES.—At least 20 percent of the dollar value of 

11 loan guarantees made under this program during any 

12 given year shall be allocated for eligible rural health care 

13 facilities, to the extent a sufficient number of applications 

14 are made by such health care facilities. 

15 ‘‘(c) GUARANTEES FOR SMALL LOANS.—At least 

16 $200,000,000 of the annual dollar value of loan guaran17 tees made under the program shall be reserved for loans 

18 of under $50,000,000, if there are a sufficient number of 

19 applicants for loans of that size. 

20 ‘‘(d) SPECIAL RULE FOR REFINANCING LOANS.— 

21 Not more than 20 percent of the amount allocated each 

22 year to the loan guarantee program established by this 

23 subtitle may be allocated to guarantee refinancing loans 

24 during the year. 


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1 ‘‘SEC. 2914. TERMS AND CONDITIONS OF LOAN GUARAN2 TEES. 

3 ‘‘(a) IN GENERAL.—The principal amount of the 

4 guaranteed loan, when added to any Federal grant assist5 ance made under this title, may not exceed 95 percent of 

6 the total value of the project, including land. 

7 ‘‘(b) GUARANTEES PROVIDED MAY NOT SUPPLANT

8 OTHER FUNDS.—Guarantees provided under this subtitle 

9 may not be used to supplant other forms of State or local 

10 support. 

11 ‘‘(c) RIGHT TO RECOVER FUNDS.—The United 

12 States shall be entitled to recover from any applicant 

13 health care facility the amount of payments made pursu14 ant to any loan guarantee under this subtitle, unless the 

15 Trust Fund Board for good cause waives its right of recov16 ery, and the United States shall, upon making any such 

17 payment pursuant to any such loan guarantee be sub18 rogated to all of the rights of the recipients of the pay19 ments. 

20 ‘‘(d) MODIFICATION OF TERMS.—Loan guarantees 

21 made under this subtitle shall be subject to further terms 

22 and conditions as the Trust Fund Board determines to 

23 be necessary to assure that the purposes of this Act will 

24 be achieved, and any such terms and conditions may be 

25 modified by the Trust Fund Board to the extent that it 


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•HR 4858 IH 

1 determines such modifications to be consistent with the 

2 financial interest of the United States. 

3 ‘‘(e) TERMS ARE INCONTESTABLE ABSENT FRAUD

4 OR MISREPRESENTATION.—Any loan guarantee made by 

5 the Trust Fund Board pursuant to this subtitle shall be 

6 incontestable in the hands of an applicant on whose behalf 

7 such guarantee is made, and as to any person who makes 

8 or contracts to make a loan to such applicant in reliance 

9 thereon, except for fraud or misrepresentation on the part 

10 of such applicant or other person. 

11 ‘‘SEC. 2915. PREMIUMS FOR LOAN GUARANTEES. 

12 ‘‘(a) IN GENERAL.—The Trust Fund Board shall de13 termine a reasonable loan insurance premium which shall 

14 be charged for loan guarantees under this subtitle, taking 

15 into account the availability of the reserves created under 

16 section 2913. Premium charges shall be payable in cash 

17 to the Trust Fund Board, either in full upon issuance, 

18 or annually in advance. In addition to the premium charge 

19 herein provided for, the Trust Fund Board is authorized 

20 to charge and collect such amount as it may deem reason21 able for the appraisal of a property or project offered for 

22 insurance and for the inspection of such property or 

23 project. 

24 ‘‘(b) PAYMENT IN ADVANCE.—In the event that the 

25 principal obligation of any loan accepted for insurance 


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1 under this subtitle is paid in full prior to the maturity 

2 date, the Trust Fund Board is authorized in its discretion 

3 to require the payment by the borrower of an adjusted 

4 premium charge in such amount as the Board determines 

5 to be equitable, but not in excess of the aggregate amount 

6 of the premium charges that the health care facility would 

7 otherwise have been required to pay if the loan had contin8 ued to be insured until maturity date. 

9 ‘‘(c) CANCELLATION OF LOAN.—In the event that 

10 any portion of a loan accepted for insurance under this 

11 subtitle is cancelled by the lender, the Trust Fund Board 

12 shall cancel the obligation of the borrower to pay premium 

13 charges on such portion for the period remaining through 

14 the maturity date of the loan. 

15 ‘‘(d) TRUST FUND BOARD MAY WAIVE PREMIUMS.— 

16 The Trust Fund Board may in its discretion partially or 

17 totally waive premiums charged for loan insurance under 

18 this section for financially distressed health care facilities 

19 (as described by the Secretary). 

20 ‘‘SEC. 2916. PROCEDURES IN THE EVENT OF LOAN DE21 FAULT. 

22 ‘‘(a) IN GENERAL.—Failure of the borrower to make 

23 payments due under or provided by the terms of a loan 

24 accepted for insurance under this subtitle shall constitute 

25 a default. 


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1 ‘‘(b) ASSIGNMENT OF DEFAULTED LOANS.—If a de2 fault continues for 30 days, then, upon the lender’s trans3 fer to the Trust Fund Board of all its rights and interests 

4 arising under the defaulted loan or in connection with the 

5 loan transaction, the lender shall be entitled to debentures 

6 which, together with a certificate of claim, are equal in 

7 value to the amount the lender would have received if, on 

8 the date of transfer, the borrower had repaid the loan in 

9 full, together with the amount of necessary expenses in10 curred by the lender in connection with the default. 

11 ‘‘(c) FORECLOSURE BY LENDER.—Subject to the ap12 proval of the Trust Fund Board, or as provided in regula13 tions, the lender may foreclose on the property securing 

14 the defaulted loan. 

15 ‘‘(d) FORECLOSURE BY TRUST FUND BOARD.—The 

16 Trust Fund Board is authorized to— 

17 ‘‘(1) acquire possession of and title to any prop18 erty securing a defaulted loan by voluntary convey19 ance in extinguishment of the indebtedness, or 

20 ‘‘(2) institute proceedings for foreclosure on the 

21 property securing any such defaulted loan and pros22 ecute such proceedings to conclusion. 

23 ‘‘(e) HANDLING AND DISPOSAL OF PROPERTY; SET24 TLEMENT OF CLAIMS.— 


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1 ‘‘(1) PAYMENT FOR CERTAIN EXPENSES.—Not2 withstanding any other provision of law relating to 

3 the acquisition, handling, or disposal of real and 

4 other property by the United States, the Trust Fund 

5 Board shall also have power, for the protection of 

6 the interests of the Trust Fund, to pay out of the 

7 Trust Fund all expenses or charges in connection 

8 with, and to deal with, complete, reconstruct, rent, 

9 renovate, modernize, insure, make contracts for the 

10 management of, or establish suitable agencies for 

11 the management of, or sell for cash or credit or lease 

12 in its discretion, any property acquired by the Trust 

13 Fund under this section. 

14 ‘‘(2) SETTLEMENT OF CLAIMS.—Notwith15 standing any other provision of law, the Trust Fund 

16 Board shall also have the power to pursue to final 

17 collection by way of compromise or otherwise all 

18 claims assigned and transferred to the Trust Fund 

19 in connection with the assignment, transfer, and de20 livery provided for in this section, and at any time, 

21 upon default, to foreclose or refrain from foreclosing 

22 on any property secured by any defaulted loan as23 signed and transferred to or held by the Trust 

24 Fund. 


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1 ‘‘(3) LIMITATIONS ON AUTHORITY.—Sub2 sections (a) and (b) shall not be construed to apply 

3 to any contract for hazard insurance, or to any pur4 chase or contract for services or supplies on account 

5 of such property if the amount thereof does not ex6 ceed $1,000. 

7 ‘‘(f) REGULATIONS.—The Trust Fund Board shall 

8 propose and the Secretary shall promulgate regulations 

9 governing procedures in the event of a default on a loan 

10 accepted for insurance under this subtitle.’’. 

11 TITLE III—PROVIDING RELIEF 

12 TO ACADEMIC INSTITUTIONS 

13 SEC. 301. GRANTS TO INSTITUTIONS OF HIGHER EDU14 CATION. 

15 (a) IN GENERAL.—The Secretary of Health and 

16 Human Services, in consultation with the Secretary of 

17 Education, shall enter into cooperative agreements with 

18 institutions of higher education in the Hurricane Katrina19 affected area to enable such institutions to resume health 

20 care-related programs, including by— 

21 (1) retaining health and health care-related 

22 staff and personnel; and 

23 (2) paying costs incurred during the period be24 ginning on August 28, 2005, during which such in25 stitutions are unable to provide academic services at 


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•HR 4858 IH 

1 full capacity because of the effects Hurricane 

2 Katrina. 

3 (b) APPLICATION.—To seek to enter into a coopera4 tive agreement under this section, an institution of higher 

5 education shall submit an application to the Secretary at 

6 such time, in such manner, and containing such informa7 tion as the Secretary may require. 

8 (c) DEFINITIONS.—In this section: 

9 (1) The term ‘‘institution of education’’ has the 

10 meaning given to that term in section 101 of the 

11 Higher Education Act of 1965 (20 U.S.C. 1001). 

12 (2) The term ‘‘Secretary’’ means the Secretary 

13 of Health and Human Services. 

14 (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 

15 out this section, there are authorized to be appropriated 

16 such sums as may be necessary for fiscal year 2006 and 

17 2007. 


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1 TITLE IV—RESTORING KEY COM2 PONENTS OF THE HEALTH 

3 CARE INFRASTRUCTURE IN 

4 MEDICALLY-NEEDY AND 

5 MEDICALLY UNDERSERVED 

6 AREAS 

7 SEC. 401. MEDICALLY-NEEDY KATRINA RECOVERY ZONES. 

8 (a) MEDICALLY-NEEDY KATRINA RECOVERY ZONE

9 PROGRAM.— 

10 (1) IN GENERAL.—The Secretary of Health and 

11 Human Services, acting through the Administrator 

12 of the Health Resources and Services Administration 

13 and the Director of the Office of Minority Health, 

14 and in cooperation with the Director of the Office of 

15 Community Services and the Director of the Na16 tional Center on Minority Health and Health Dis17 parities— 

18 (A) shall designate medically-needy 

19 Katrina recovery zones in accordance with para20 graph (2); and 

21 (B) shall make grants in accordance with 

22 paragraph (3). 

23 (2) DESIGNATION OF MEDICALLY-NEEDY

24 KATRINA RECOVERY ZONES.—The Secretary shall 


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•HR 4858 IH 

1 designate a community as a medically-needy Katrina 

2 recovery zone if— 

3 (A) a community partnership seeking a 

4 grant under this section requests that the com5 munity be designated as a medically-needy 

6 Katrina recovery zone; and 

7 (B) the community partnership dem8 onstrates, to the Secretary’s satisfaction, that 

9 the community— 

10 (i) is located in a Hurricane Katrina11 affected area; and 

12 (ii) experiences disproportionate racial 

13 and ethnic disparities in health status and 

14 health care. 

15 (3) GRANTS.—The Secretary shall make grants 

16 to community partnerships of private and public en17 tities to establish medically-needy Katrina recovery 

18 zone programs. 

19 (4) USE OF FUNDS.—Grants under this section 

20 shall be used for the establishment of a medically21 needy Katrina recovery zone program to assist indi22 viduals, businesses, schools, minority health associa23 tions, nonprofit organizations, community-based or24 ganizations, hospitals, health care clinics, dental and 

25 mental health facilities and centers, substance abuse 


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•HR 4858 IH 

1 facilities, hospice care organizations, and founda2 tions in a medically-needy Katrina recovery zone 

3 that are seeking— 

4 (A) to effectively access Federal programs 

5 to eliminate racial and ethnic disparities in 

6 health status and health care; and 

7 (B) to coordinate the efforts of govern8 mental and private entities regarding the elimi9 nation of racial and ethnic disparities in health 

10 status and health care. 

11 (5) APPLICATION.—To seek the designation of 

12 a community as a medically-needy Katrina recovery 

13 zone and to obtain a grant under this section, a 

14 community partnership shall submit to the Secretary 

15 an application in such form and in such manner as 

16 the Secretary may require. An application under this 

17 paragraph shall— 

18 (A) demonstrate that the community to be 

19 served is a low-income community that experi20 ences disproportionate disparities in health sta21 tus and health care; 

22 (B) set forth a strategic plan for the pro23 posed medically-needy Katrina recovery zone 

24 program, by— 


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1 (i) describing the coordinated health, 

2 economic, human, community, and physical 

3 development plan and related activities 

4 proposed for the community involved; 

5 (ii) describing the inclusion of the 

6 community involved as a full partner in the 

7 process of developing, implementing, moni8 toring, and evaluating the strategic plan 

9 and the extent to which local institutions 

10 and organizations have contributed to the 

11 planning process; 

12 (iii) identifying the projected amount 

13 of Federal, State, local, and private re14 sources that will be available in the area 

15 and the private and public community 

16 partnerships to be used (including any par17 ticipation by or cooperation with univer18 sities, colleges, foundations, nonprofit orga19 nizations, medical centers, hospitals, health 

20 clinics, dental and mental health facilities 

21 and centers, substance abuse facilities, hos22 pice care organizations, school districts, or 

23 other private and public entities); 

24 (iv) identifying the funding requested 

25 under any Federal program in support of 


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1 the proposed health, economic, human, 

2 community, and physical development, and 

3 related activities; 

4 (v) identifying baselines, methods, 

5 health outcomes, and benchmarks for 

6 measuring the success of carrying out the 

7 strategic plan; 

8 (vi) demonstrating the ability to effec9 tively reach and service the targeted under10 served community populations in a cul11 turally appropriate and linguistically re12 sponsive manner; 

13 (vii) demonstrating a capacity and in14 frastructure to provide long-term commu15 nity response that is culturally appropriate 

16 and linguistically responsive to a commu17 nity that experiences disproportionate dis18 parities in health status and health care; 

19 and 

20 (viii) identifying the individuals who 

21 have agreed to serve as members of a 

22 medically-needy Katrina recovery zone co23 ordinating committee for the community 

24 involved; and 


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1 (C) include such other information as the 

2 Secretary may require. 

3 (6) PREFERENCE.—In awarding grants under 

4 this subsection, the Secretary shall give preference 

5 to proposals from indigenous community entities 

6 that have an expertise in providing culturally appro7 priate and linguistically responsive services to low-in8 come communities that experience disproportionate 

9 disparities in health status and health care. 

10 (b) FEDERAL ASSISTANCE FOR MEDICALLY-NEEDY

11 KATRINA RECOVERY ZONE GRANT PROGRAMS.—The Sec12 retary of Health and Human Services, the Administrator 

13 of the Small Business Administration, the Secretary of 

14 Agriculture, the Secretary of Education, the Secretary of 

15 Labor, and the Secretary of Housing and Urban Develop16 ment shall each— 

17 (1) where appropriate, provide entity-specific 

18 technical assistance and evidence-based strategies to 

19 low-income communities that experience dispropor20 tionate disparities in health status and health care 

21 to further the purposes of a medically-needy Katrina 

22 recovery zone program described in subsection 

23 (a)(5); 

24 (2) identify all programs administered by the 

25 Department of Health and Human Services, the 


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1 Small Business Administration, the Department of 

2 Agriculture, the Department of Education, the De3 partment of Labor, and the Department of Housing 

4 and Urban Development, respectively, that may be 

5 used to further the purposes of a medically-needy 

6 Katrina recovery zone program described in sub7 section (a)(5); and 

8 (3) in administering any program identified 

9 under paragraph (2), give priority to any individual 

10 or entity located in a community served by a medi11 cally-needy Katrina recovery zone program under 

12 subsection (a) if such priority would further the pur13 poses of the medically-needy Katrina recovery zone 

14 program described in subsection (a)(5). 

15 (c) MEDICALLY-NEEDY KATRINA RECOVERY ZONE

16 COORDINATING COMMITTEE.— 

17 (1) ESTABLISHMENT.—For each medically18 needy Katrina recovery zone program established 

19 with a grant under subsection (a), the Secretary, 

20 acting through the Director of the Office of Minority 

21 Health and the Administrator of the Health Re22 sources and Services Administration, shall establish 

23 a medically-needy Katrina recovery zone coordi24 nating committee. 


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1 (2) DUTIES.—Each coordinating committee es2 tablished, in coordination with the Director of the 

3 Office of Minority Health and the Administrator of 

4 the Health Resources and Services Administration, 

5 shall provide technical assistance and evidence-based 

6 strategies to the grant recipient involved, including 

7 providing guidance on research, strategies, health 

8 outcomes, program goals, management, implementa9 tion, monitoring, assessment, and evaluation proc10 esses. 

11 (3) MEMBERSHIP.— 

12 (A) APPOINTMENT.—The Director of the 

13 Office of Minority Health and the Adminis14 trator of the Health Resources and Services Ad15 ministration, in consultation with the respective 

16 grant recipient, shall appoint the members of 

17 each coordinating committee. 

18 (B) COMPOSITION.—The Director of the 

19 Office of Minority Health and the Adminis20 trator of the Health Resources and Services Ad21 ministration shall ensure that each coordinating 

22 committee— 

23 (i) has not more than 20 members; 

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1 proportionate disparities in health status 

2 and health care; 

3 (iii) includes community leaders and 

4 leaders of community-based organizations; 

5 (iv) includes representatives of aca6 demia and lay and professional organiza7 tions and associations including those hav8 ing expertise in medicine, technical, social 

9 and behavioral science, health policy, advo10 cacy, cultural and linguistic competency, 

11 research management, dental and mental 

12 health, substance abuse, hospice care, and 

13 organization; and 

14 (v) represents a reasonable cross-sec15 tion of knowledge, views, and application 

16 of expertise on societal, ethical, behavioral, 

17 educational, policy, legal, cultural, lin18 guistic, and workforce issues related to 

19 eliminating disparities in health and health 

20 care. 

21 (C) QUALIFICATIONS.—The Director of 

22 the Office of Minority Health and the Adminis23 trator of the Health Resources and Services Ad24 ministration shall ensure that the members of 

25 each coordinating committee meet the following: 


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1 (i) No member is employed by the 

2 Federal Government. 

3 (ii) Each member has appropriate ex4 perience, including experience in the areas 

5 of community development, cultural and 

6 linguistic competency, reducing and elimi7 nating racial and ethnic disparities in 

8 health and health care, or minority health. 

9 (iii) A majority of the members reside 

10 in the medically-needy Katrina recovery 

11 zone involved. 

12 (D) SELECTION.—In selecting individuals 

13 to serve on a coordinating committee, the Di14 rector of the Office of Minority Health and the 

15 Administrator of the Health Resources and 

16 Services Administration shall give due consider17 ation to the recommendations of the Congress, 

18 industry leaders, the scientific community (in19 cluding the Institute of Medicine), academia, 

20 community-based nonprofit organizations, mi21 nority health and related organizations, the 

22 education community, State and local govern23 ments, and other appropriate organizations. 

24 (E) CHAIRPERSON.—The Director of the 

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1 trator of the Health Resources and Services Ad2 ministration, in consultation with the members 

3 of the coordinating committee involved, shall 

4 designate a chairperson of the coordinating 

5 committee, who shall serve for a term of 3 

6 years and who may be reappointed at the expi7 ration of each such term. 

8 (F) TERMS.—Each member of a coordi9 nating committee shall be appointed for a term 

10 of 1 to 3 years in overlapping staggered terms, 

11 as determined by the Director of the Office of 

12 Minority Health and the Administrator of the 

13 Health Resources and Services Administration 

14 at the time of appointment, and may be re15 appointed at the expiration of each such term. 

16 (G) VACANCIES.—A vacancy on a coordi17 nating committee shall be filled in the same 

18 manner in which the original appointment was 

19 made. 

20 (H) COMPENSATION.—The members of a 

21 coordinating committee shall serve without pay. 

22 (I) TRAVEL EXPENSES.—Each member of 

23 a coordinating committee shall receive travel ex24 penses, including per diem in lieu of subsist25 ence, in accordance with applicable provisions 


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1 under subchapter I of chapter 57 of title 5, 

2 United States Code. 

3 (4) STAFF; EXPERTS AND CONSULTANTS.— 

4 (A) STAFF.—The chairperson of a coordi5 nating committee may appoint and fix the pay 

6 of additional personnel as the chairperson con7 siders appropriate. 

8 (B) EXPERTS AND CONSULTANTS.—The 

9 chairperson of a coordinating committee may 

10 procure temporary and intermittent services 

11 under section 3109(b) of title 5, United States 

12 Code. 

13 (5) MEETINGS.—A coordinating committee 

14 shall meet 3 to 5 times each year, at the call of the 

15 coordinating committee’s chairperson and in con16 sultation with the Director of the Office of Minority 

17 Health and the Administrator of the Health Re18 sources and Services Administration. 

19 (6) REPORT.—Each coordinating committee 

20 shall transmit to the Congress an annual report 

21 that, with respect to the medically-needy Katrina re22 covery zone program involved, includes the following: 

23 (A) A review of the program’s effectiveness 

24 in achieving stated goals and outcomes, and 

25 overcoming challenges. 


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1 (B) A review of the program’s manage2 ment and coordination of the entities involved. 

3 (C) A review of the activities in the pro4 gram’s portfolio and components. 

5 (D) An identification of policy issues raised 

6 by the program. 

7 (E) An assessment of program’s results in8 cluding that of capacity, infrastructure, number 

9 of underserved minority communities reached 

10 and retained in the effort in a defined time 

11 frame. 

12 (F) Recommendations for new program 

13 goals, research areas, enhanced approaches, 

14 community partnerships, coordination and man15 agement mechanisms, and projects to be estab16 lished to achieve the program’s stated goals, to 

17 improve outcomes, assessments, monitoring, 

18 and evaluation. 

19 (G) A review of the degree of minority en20 tities participation in the program, and an iden21 tification of a strategy to increase such partici22 pation. 

23 (H) Any other reviews or recommendations 

24 determined to be appropriate by the coordi25 nating committee. 


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1 (d) REPORT.—The Director of the Office of Minority 

2 Health and the Administrator of the Health Resources 

3 and Services Administration shall submit a joint annual 

4 report to the appropriate committees of the Congress on 

5 the results of the implementation of programs under this 

6 section. 

7 (e) DEFINITIONS.—In this section: 

8 (1) COORDINATING COMMITTEE.—The term 

9 ‘‘coordinating committee’’ means a medically-needy 

10 Katrina recovery zone coordinating committee estab11 lished under this section. 

12 (2) SECRETARY.—The term ‘‘Secretary’’ means 

13 the Secretary of Health and Human Services. 

14 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

15 are authorized to be appropriated to carry out this section 

16 $100,000,000 for the period of fiscal year 2006 through 

17 fiscal year 2007, and such sums as may be necessary for 

18 each of fiscal years 2008 through 2013. 

19 SEC. 402. REPAIR AND DISPARITIES GRANTS. 

20 (a) CONSTRUCTION AND REPAIR GRANTS.—The Sec21 retary of Health and Human Services (in this section re22 ferred to as the ‘‘Secretary’’) shall make grants to public 

23 health facilities and loans to private health facilities, for 

24 the purpose of constructing, modernizing, or repairing 

25 hospitals; clinics; health centers; laboratories; medical, 


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1 mental, and dental health and hospice care clinics and cen2 ters; and other health facilities in the Hurricane Katrina3 affected area damaged as a result of Hurricane Katrina 

4 including— 

5 (1) construction of hospitals, clinics, health cen6 ters, laboratories, hospice centers, mental health and 

7 substance abuse facilities that meet the standards of 

8 the Joint Commission on the Accreditation of Health 

9 care Organizations (referred to in this section as the 

10 ‘‘JCAHO standards’’); 

11 (2) repair or modernization of such public or 

12 private hospitals or public facilities as provide health 

13 care or health-related services; and 

14 (3) bringing hospitals and public health facili15 ties in compliance with such JCAHO standards and 

16 requirements of the Centers for Medicare & Med17 icaid Services. 

18 (b) HEALTH DISPARITY GRANTS.—The Secretary, 

19 acting through the Administrator of the Health and 

20 Human Resources Administration and the Director of the 

21 Office of Minority Health, and in consultation with the 

22 Director of the Office of Community Services and the Di23 rector of the National Center on Minority Health and 

24 Health Disparities, shall make grants to assist individuals, 

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1 tions, nonprofit organizations, community-based organiza2 tions, health care clinics, foundations, and other entities 

3 in communities that are located in a Hurricane Katrina4 affected area, disproportionately experience disparities in 

5 health status and health care, and are seeking— 

6 (1) to improve the health of minority individ7 uals in the community and to reduce disparities in 

8 health status and health care by assisting individuals 

9 in accessing Federal programs or by other means; 

10 and 

11 (2) to coordinate the efforts of governmental 

12 and private entities regarding the elimination of ra13 cial and ethnic health status and health care. 

14 (c) APPLICATION.—To obtain a grant under this sec15 tion, an applicant shall submit to the Secretary an applica16 tion in such form and in such manner as the Secretary 

17 may require. An application for a grant under— 

18 (1) subsection (a) shall describe, with such 

19 specificity as the Secretary shall require, the damage 

20 sustained as a result of Hurricane Katrina and the 

21 steps proposed to address the damage; and 

22 (2) subsection (b) shall demonstrate that the 

23 communities to be served are those that dispropor24 tionately experience disparities in health status and 


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•HR 4858 IH 

1 health care and shall set forth a strategic plan for 

2 reducing those disparities by— 

3 (A) describing the coordinated health, eco4 nomic, human, community, and physical devel5 opment plan and related activities proposed for 

6 the community; 

7 (B) identifying the projected amount of 

8 Federal, State, local and private resources that 

9 will be available in the area and the private and 

10 public partnerships to be used (including any 

11 participation by or cooperation with univer12 sities, colleges, foundations, non-profit organiza13 tions, medical centers, hospitals, health clinics, 

14 dental and mental health facilities and centers, 

15 substance abuse facilities, hospice care organi16 zations, school districts, or other private and 

17 public entities); 

18 (C) identifying the funding requested 

19 under any Federal program in support of the 

20 proposed activities; 

21 (D) identifying benchmarks for measuring 

22 the success of carrying out the strategic plan; 

23 (E) demonstrating the ability to reach and 

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1 munity populations in a culturally appropriate 

2 and linguistically responsive manner; and 

3 (F) demonstrating a capacity and infra4 structure to provide long-term community re5 sponse that is culturally appropriate and lin6 guistically responsive to communities that dis7 proportionately experience disparities in health 

8 and health care. 

9 (d) AUTHORIZATION OF APPROPRIATION.—There are 

10 authorized to be appropriated to carry out this section 

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

12 2006 through 2008. 

13 SEC. 403. DISASTER RELIEF MEDICAID. 

14 (a) AUTHORITY TO PROVIDE DISASTER RELIEF

15 MEDICAID.—Notwithstanding any provision of title XIX 

16 of the Social Security Act, a State shall, as a condition 

17 of participation in the Medicaid program established 

18 under title XIX of the Social Security (42 U.S.C. 1396 

19 et seq.), provide medical assistance to DRM-eligible 

20 Katrina Survivors (as defined in subsection (b)) under a 

21 State Medicaid plan established under such title during 

22 the disaster relief Medicaid coverage period in accordance 

23 with the following provisions of this section and without 

24 submitting an amendment to the State Medicaid plan. 


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1 Such assistance shall be referred to as ‘‘Disaster Relief 

2 Medicaid Assistance (DRM assistance)’’. 

3 (b) DRM-ELIGIBLE KATRINA SURVIVOR DE4 FINED.— 

5 (1) IN GENERAL.—In this section, the term 

6 ‘‘DRM-eligible Katrina Survivor’’ means a Katrina 

7 Survivor whose family income does not exceed the 

8 higher of— 

9 (A) 100 percent (200 percent, in the case 

10 of such a Survivor who is a pregnant woman, 

11 child, or a recipient of disability benefits under 

12 section 223 of the Social Security Act) of the 

13 poverty line; or 

14 (B) the income eligibility standard which 

15 would apply to the Survivor under the State 

16 Medicaid plan. 

17 (2) NO RESOURCES, RESIDENCY, OR CATEGOR18 ICAL ELIGIBILITY REQUIREMENTS.—Eligibility 

19 under paragraph (1) shall be determined without ap20 plication of any resources test, State residency, or 

21 categorical eligibility requirements. 

22 (3) INCOME DETERMINATION.— 

23 (A) LEAST RESTRICTIVE INCOME METH24 ODOLOGIES.—The State shall use the least re25 strictive methodologies applied under the State 


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1 Medicaid plan under section 1902(r)(2) of the 

2 Social Security Act (42 U.S.C. 1396a(r)(2)) in 

3 determining income eligibility for Katrina Sur4 vivors under paragraph (1). 

5 (B) DISREGARD OF UNEMPLOYMENT BEN6 EFITS.—In determining such income eligibility, 

7 the State shall disregard any amount received 

8 under a law of the United States or of a State 

9 which is in the nature of unemployment com10 pensation by a Katrina Survivor during the 

11 DRM coverage period. 

12 (4) DEFINITION OF CHILD.—For purposes of 

13 paragraph (1), a DRM-eligible Katrina Survivor 

14 shall be determined to be a ‘‘child’’ in accordance 

15 with the definition of ‘‘child’’ under the State Med16 icaid plan. 

17 (c) ELIGIBILITY DETERMINATION; NO CONTINU18 ATION OF DRM ASSISTANCE.— 

19 (1) STREAMLINED ELIGIBILITY PROCESS.—The 

20 State shall use the following streamlined procedures 

21 in processing applications and determining eligibility 

22 for DRM assistance for DRM-eligible Katrina Sur23 vivors: 

24 (A) A common 1-page application form de25 veloped by the Secretary of Health and Human 


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•HR 4858 IH 

1 Services in consultation with the National Asso2 ciation of State Medicaid Directors. Such form 

3 shall— 

4 (i) require an applicant to provide an 

5 expected address for the duration of the 

6 DRM coverage period and to agree to up7 date that information if it changes during 

8 such period; 

9 (ii) include notice regarding the pen10 alties for making a fraudulent application 

11 under subsection (h); 

12 (iii) require the applicant to assign to 

13 the State any rights of the applicant (or 

14 any other person who is a DRM-eligible 

15 Katrina Survivor and on whose behalf the 

16 applicant has the legal authority to execute 

17 an assignment of such rights) under any 

18 group health plan or other third-party cov19 erage for health care; and 

20 (iv) require the applicant to list any 

21 health insurance coverage which the appli22 cant was enrolled in immediately prior to 

23 submitting such application. 

24 (B) Self-attestation by the applicant that 

25 the applicant— 


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1 (i) is a DRM-eligible Katrina Sur2 vivor; and 

3 (ii) if applicable, requires home and 

4 community-based services provided under 

5 such DRM assistance in accordance with 

6 subsection (d)(3). 

7 (C) No requirement for documentation evi8 dencing the basis on which the applicant quali9 fies to be a DRM-eligible Katrina Survivor or, 

10 if applicable, requires home and community11 based services. 

12 (D) Issuance of a DRM assistance eligi13 bility card to an applicant who completes such 

14 application, including the self-attestation re15 quired under subparagraph (B). Such card shall 

16 be valid as long as the DRM coverage period is 

17 in effect and shall be accompanied by notice of 

18 the termination date for the DRM coverage pe19 riod and, if applicable, notice that such termi20 nation date may be extended. If the President 

21 extends the DRM coverage period, the State 

22 shall notify DRM-eligible Katrina Survivors en23 rolled in DRM assistance of the new termi24 nation date for the DRM coverage period. 


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1 (E) If an applicant completes the applica2 tion and presents it to a provider or facility 

3 participating in the State Medicaid plan that is 

4 qualified to make presumptive eligibility deter5 minations under such plan (which at a min6 imum shall consist of facilities identified in sec7 tion 1902(a)(55) of the Social Security Act (42 

8 U.S.C. 1396a(a)(55)) and it appears to the pro9 vider that the applicant is a DRM-eligible 

10 Katrina Survivor based on the information in 

11 the application, the applicant will be deemed to 

12 be a DRM-eligible Katrina Survivor eligible for 

13 DRM assistance in accordance with this section, 

14 subject to subsection (g). 

15 (F) Continuous eligibility, without the need 

16 for any re-determination of eligibility, for the 

17 duration of the DRM coverage period. 

18 (2) NO CONTINUATION OF DRM ASSISTANCE.— 

19 (A) IN GENERAL.—Except as provided in 

20 subparagraphs (B) and (C), no DRM assistance 

21 shall be provided after the end of the DRM cov22 erage period. 

23 (B) PRESUMPTIVE ELIGIBILITY.—In the 

24 case of any DRM-eligible Katrina Survivor who 

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1 cordance with this section and who, as of the 

2 end of the DRM coverage period, has an appli3 cation pending for medical assistance under the 

4 State Medicaid plan for periods beginning after 

5 the end of such period, the State shall provide 

6 such Survivor with a period of presumptive eli7 gibility for medical assistance under the State 

8 Medicaid plan (not to exceed 60 days) until a 

9 determination with respect to the Survivor’s ap10 plication has been made. 

11 (C) PREGNANT WOMEN.—In the case of a 

12 DRM-eligible Katrina Survivor who is receiving 

13 DRM assistance from a State in accordance 

14 with this section and whose pregnancy ended 

15 during the 60-day period prior to the end of the 

16 DRM coverage period, or who is pregnant as of 

17 the end of such period, such Survivor shall con18 tinue to be eligible for DRM assistance after 

19 the end of the DRM coverage period, including 

20 (but not limited to) for all pregnancy-related 

21 and postpartum medical assistance available 

22 under the State Medicaid plan, through the end 

23 of the month in which the 60-day period (begin24 ning on the last day of her pregnancy) ends. 


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1 (3) TREATMENT OF KATRINA SURVIVORS PRO2 VIDED ASSISTANCE PRIOR TO DATE OF ENACT3 MENT.—Any Katrina Survivor who is provided med4 ical assistance under a State Medicaid plan in ac5 cordance with guidance from the Secretary during 

6 the period that begins on August 28, 2005, and ends 

7 on the date of enactment of this Act shall be treated 

8 as a DRM-eligible Katrina Survivor, without the 

9 need to file an additional application, for purposes of 

10 eligibility for DRM assistance under this section. 

11 (d) SCOPE OF COVERAGE.— 

12 (1) CATEGORICALLY NEEDY BENEFITS.—The 

13 State shall treat a DRM-eligible Katrina Survivor as 

14 an individual eligible for medical assistance under 

15 the State plan under title XIX of the Social Security 

16 Act on the basis of section 1902(a)(10)(A)(i) of the 

17 Social Security Act (42 U.S.C. 1396a(a)(10)(A)(i)), 

18 with coverage for such assistance retroactive to 

19 items and services furnished on or after August 28, 

20 2005 (or in the case of applications for DRM assist21 ance submitted after January 1 2006, the first day 

22 of the 5th month preceding the date on which such 

23 application is submitted). 

24 (2) EXTENDED MENTAL HEALTH AND CARE CO25 ORDINATION BENEFITS.—The State may provide, 


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1 without regard to any restrictions on amount, dura2 tion, and scope, comparability, or restrictions other3 wise applicable under the State medicaid plan (other 

4 than restrictions applicable under such plan with re5 spect to services provided in an institution for men6 tal diseases), to DRM-eligible Katrina Survivors ex7 tended mental health and care coordination benefits 

8 which may include the following: 

9 (A) Screening, assessment, and diagnostic 

10 services (including specialized assessments for 

11 individuals with cognitive impairments). 

12 (B) Coverage for a full range of mental 

13 health medications at the dosages and fre14 quencies prescribed by health professionals for 

15 depression, post-traumatic stress disorder, and 

16 other mental disorders. 

17 (C) Treatment of alcohol and substance 

18 abuse determined to result from circumstances 

19 related to Hurricane Katrina. 

20 (D) Psychotherapy, rehabilitation and 

21 other treatments administered by psychiatrists, 

22 psychologists, or social workers for conditions 

23 exacerbated by, or resulting from, Hurricane 

24 Katrina. 

25 (E) In-patient mental health care. 


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1 (F) Family counseling for families where a 

2 member of the immediate family is a Katrina 

3 Survivor or first responder to Hurricane 

4 Katrina or includes an individual who has died 

5 as a result of Hurricane Katrina. 

6 (G) In connection with the provision of 

7 health and long-term care services, arranging 

8 for, (and when necessary, enrollment in waiver 

9 programs or other specialized programs), and 

10 coordination related to, primary and specialty 

11 medical care, which may include personal care 

12 services, durable medical equipment and sup13 plies, assistive technology, and transportation. 

14 (3) HOME AND COMMUNITY-BASED SERV15 ICES.— 

16 (A) IN GENERAL.—In the case of a State 

17 with a waiver to provide home and community18 based services granted under section 1115 of 

19 the Social Security Act or under subsection (c) 

20 or (d) of section 1915 of such Act, the State 

21 may provide such services to DRM-eligible 

22 Katrina Survivors who self-attest in accordance 

23 with subsection (c)(1)(B)(ii) that they require 

24 immediate home and community-based services 

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1 gard to whether the Survivors would require the 

2 level of care provided in a hospital, nursing fa3 cility, or intermediate care facility for the men4 tally retarded, including to DRM-eligible 

5 Katrina Survivors who are individuals described 

6 in subparagraph (B). 

7 (B) INDIVIDUALS DESCRIBED.—Individ8 uals described in this subparagraph are individ9 uals who— 

10 (i) on any day during the week pre11 ceding August 28, 2005— 

12 (I) had been receiving home and 

13 community-based services under a 

14 waiver described in subparagraph (A) 

15 in a direct impact parish or county; 

16 (II) had been receiving support 

17 services from a primary family care18 giver who, as a result of Hurricane 

19 Katrina, is no longer available to pro20 vide services; or 

21 (III) had been receiving personal 

22 care, home health, or rehabilitative 

23 services under the State Medicaid 

24 plan or under a waiver granted under 


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1 section 1915 or 1115 of the Social Se2 curity Act; or 

3 (ii) are disabled (as determined under 

4 the State Medicaid plan). 

5 (C) WAIVER OF RESTRICTIONS.—The Sec6 retary shall waive with respect to the provision 

7 of home and community-based services under 

8 this paragraph any limitations on— 

9 (i) the number of individuals who 

10 shall receive home or community-based 

11 services under a waiver described in sub12 paragraph (A); 

13 (ii) budget neutrality requirements ap14 plicable to such waiver; and 

15 (iii) targeted populations eligible for 

16 services under such waiver. 

17 The Secretary may waive other restrictions ap18 plicable under such a waiver, that would pre19 vent a State from providing home and commu20 nity-based services in accordance with this 

21 paragraph. 

22 (4) CHILDREN BORN TO PREGNANT WOMEN.— 

23 In the case of a child born to a DRM-eligible 

24 Katrina Survivor who is provided DRM assistance 

25 during the DRM coverage period, such child shall be 


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1 treated as having been born to a pregnant woman el2 igible for medical assistance under the State Med3 icaid plan and shall be eligible for medical assistance 

4 under such plan in accordance with section 

5 1902(e)(4) of the Social Security Act (42 U.S.C. 

6 1396a(e)(4)). The Federal medical assistance per7 centage applicable to the State Medicaid plan shall 

8 apply to medical assistance provided to a child under 

9 such plan in accordance with the preceding sentence. 

10 (e) TERMINATION OF COVERAGE; ASSISTANCE WITH

11 APPLYING FOR REGULAR MEDICAID COVERAGE.— 

12 (1) NOTICE OF EXPECTED TERMINATION OF

13 DRM COVERAGE PERIOD.—A State shall provide 

14 DRM-eligible Katrina Survivors who are receiving 

15 DRM assistance from the State in accordance with 

16 this section, as of the beginning of the 4th month 

17 (and, if applicable, 9th month) of the DRM coverage 

18 period with— 

19 (A) notice of the expected termination date 

20 for DRM assistance for such period; 

21 (B) information regarding eligibility for 

22 medical assistance under the State’s eligibility 

23 rules otherwise applicable under the State med24 icaid plan; and 


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1 (C) an application for such assistance and 

2 information regarding where to obtain assist3 ance with completing such application in ac4 cordance with paragraph (2). 

5 (2) APPLICATION ASSISTANCE.—A State shall 

6 provide DRM-eligible Katrina Survivors who are re7 ceiving DRM assistance from the State in accord8 ance with this section with assistance in applying for 

9 medical assistance under the State medicaid plan for 

10 periods beginning after the end of the DRM cov11 erage period, at State Medicaid offices and at loca12 tions easily accessible to such Survivors. 

13 (3) STATE REPORTS.—A State providing DRM 

14 assistance in accordance with this section shall sub15 mit to the Secretary the following reports: 

16 (A) TERMINATION AND TRANSITION AS17 SISTANCE TO REGULAR MEDICAID COVERAGE

18 FOR DRM-ELIGIBLE KATRINA SURVIVORS ELIGI19 BLE FOR SUCH ASSISTANCE.—A report detail20 ing how the State intends to satisfy the require21 ments of paragraphs (1) and (2). 

22 (B) ENROLLMENT.—Reports regarding— 

23 (i) the number of Katrina Survivors 

24 who are determined to be DRM-eligible 

25 Katrina Survivors; and 


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1 (ii) the number of DRM-eligible 

2 Katrina Survivors who are determined to 

3 be eligible for, and enrolled in, the State 

4 Medicaid plan. 

5 (4) SECRETARIAL OVERSIGHT.—The Secretary 

6 of Health and Human Services shall ensure that a 

7 State is complying with the requirements of para8 graphs (1) and (2) and that applications for medical 

9 assistance under the State Medicaid plan from 

10 DRM-eligible Katrina Survivors for periods begin11 ning after the end of the DRM coverage period are 

12 processed in a timely and appropriate manner. 

13 (5) NO PRIVATE RIGHT OF ACTION AGAINST A

14 STATE FOR FAILURE TO PROVIDE NOTICE.—No pri15 vate right of action shall be brought against a State 

16 for failure to provide the notices required under 

17 paragraph (1) or subsection (c)(1) so long as the 

18 State makes a good faith effort to provide such no19 tices. 

20 (f) 100 PERCENT FEDERAL MATCHING PAY21 MENTS.— 

22 (1) IN GENERAL.—Notwithstanding section 

23 1905(b) of the Social Security Act (42 U.S.C. 

24 1396d(b), the Federal medical assistance percentage 

25 or the Federal matching rate otherwise applied 


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1 under section 1903(a) of such Act (42 U.S.C. 

2 1396b(a)) shall be 100 percent for— 

3 (A) providing DRM assistance to DRM-eli4 gible Katrina Survivors during the DRM cov5 erage period in accordance with this section; 

6 (B) costs directly attributable to adminis7 trative activities related to the provision of such 

8 DRM assistance, including costs attributable to 

9 obtaining recoveries under subsection (h); 

10 (C) costs directly attributable to providing 

11 application assistance in accordance with sub12 section (e)(2); and 

13 (D) DRM assistance provided in accord14 ance with subparagraph (B) or (C) of sub15 section (c)(2) after the end of the DRM cov16 erage period. 

17 (2) DISREGARD OF PAYMENTS.—Payments pro18 vided to a State in accordance with this subsection 

19 shall be disregarded for purposes of applying sub20 sections (f) and (g) of section 1108 of the Social Se21 curity Act (42 U.S.C. 1308). 

22 (g) VERIFICATION OF STATUS AS A KATRINA SUR23 VIVOR.— 

24 (1) IN GENERAL.—The State shall make a good 

25 faith effort to verify the status of an individual who 


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1 is enrolled in the State Medicaid plan as a DRM-eli2 gible Katrina Survivor under the provisions of this 

3 section. Such effort shall not delay the determina4 tion of the eligibility of the Survivor for DRM assist5 ance under this section. 

6 (2) EVIDENCE OF VERIFICATION.—A State may 

7 satisfy the verification requirement under subpara8 graph (A) with respect to an individual by showing 

9 that the State providing DRM assistance obtained 

10 information from the Social Security Administration, 

11 the Internal Revenue Service, or the State Medicaid 

12 Agency for the State from which individual is from 

13 (if the individual was not a resident of such State 

14 on any day during the week preceding August 28, 

15 2005). 

16 (h) PENALTY FOR FRAUDULENT APPLICATIONS.— 

17 (1) INDIVIDUAL LIABLE FOR COSTS.—If a 

18 State, as the result of verification activities con19 ducted under subsection (g) or otherwise, determines 

20 after a fair hearing that an individual has knowingly 

21 made a false self-attestation described in subsection 

22 (c)(1)(B), the State may, subject to paragraph (2), 

23 seek recovery from the individual for the full amount 

24 of the cost of DRM assistance provided to the indi25 vidual under this section. 


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1 (2) EXCEPTION.—The Secretary shall exempt a 

2 State from seeking recovery under paragraph (1) if 

3 the Secretary determines that it would not be cost4 effective for the State to do so. 

5 (3) REIMBURSEMENT TO THE FEDERAL GOV6 ERNMENT.—Any amounts recovered by a State in 

7 accordance with this subsection shall be returned to 

8 the Federal government. 

9 (i) EXEMPTION FROM ERROR RATE PENALTIES.— 

10 All payments attributable to providing DRM assistance in 

11 accordance with this section shall be disregarded for pur12 poses of section 1903(u) of the Social Security Act (42 

13 U.S.C. 1396b(u)). 

14 (j) PROVIDER PAYMENT RATES.—In the case of any 

15 DRM assistance provided in accordance with this section 

16 to a DRM-eligible Katrina Survivor that is covered under 

17 the State Medicaid plan (as applied without regard to this 

18 section) the State shall pay a provider of such assistance 

19 the same payment rate as the State would otherwise pay 

20 for the assistance if the assistance were provided under 

21 the State Medicaid plan (or, if no such payment rate ap22 plies under the State Medicaid plan, the usual and cus23 tomary prevailing rate for the item or service for the com24 munity in which it is provided). 


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1 (k) APPLICATION TO INDIVIDUALS ELIGIBLE FOR

2 MEDICAL ASSISTANCE.—Nothing in this section shall be 

3 construed as affecting any rights accorded to an individual 

4 who is a recipient of medical assistance under a State 

5 Medicaid plan who is determined to be a DRM-eligible 

6 Katrina Survivor but the provision of DRM assistance to 

7 such individual shall be limited to the provision of such 

8 assistance in accordance with this section. 

9 (l) DEFINITIONS.— 

10 (1) DRM COVERAGE PERIOD.— 

11 (A) IN GENERAL.—The term ‘‘DRM cov12 erage period’’ means the period beginning on 

13 August 28, 2005, and, subject to subparagraph 

14 (B), ending on the date that is 12 months after 

15 the date of enactment of this Act. 

16 (B) PRESIDENTIAL AUTHORITY TO EX17 TEND DRM COVERAGE PERIOD.— 

18 (i) IN GENERAL.—The President may 

19 extend the DRM coverage period for an 

20 additional 12 months. Any reference to the 

21 term ‘‘DRM coverage period’’ in this title 

22 shall include any extension under this 

23 clause. 

24 (ii) NOTICE TO CONGRESS AND

25 STATES.—The President shall notify the 


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1 majority and minority leaders of the Sen2 ate, the Speaker of the House of Rep3 resentatives, the minority leader of the 

4 House of Representatives, the Chairs and 

5 Ranking Members of the Committee on Fi6 nance of the Senate and the Committees 

7 on Energy and Commerce and Ways and 

8 Means of the House of Representatives, 

9 and the States at least 30 days prior to— 

10 (I) extending the DRM coverage 

11 period; or 

12 (II) if the President determines 

13 not to extend such period, the ending 

14 date described in subparagraph (A). 

15 (2) POVERTY LINE.—The term ‘‘poverty line’’ 

16 has the meaning given that term in section 

17 2110(c)(5) of the Social Security Act (42 U.S.C. 

18 1397jj(c)(5)). 

19 (3) SECRETARY.—The term ‘‘Secretary’’ means 

20 the Secretary of Health and Human Services. 

Æ 


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