I 

114TH CONGRESS 

2D SESSION H. R. 5133 

To improve rural health services, including by requiring the Department 

of Health and Human Services to conduct an annual study on such 

services, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 29, 2016 

Mr. HARDY (for himself and Ms. SEWELL of Alabama) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Agriculture, 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 improve rural health services, including by requiring the 

Department of Health and Human Services to conduct 

an annual study on such services, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Rural Hospital En5 hancement and Long Term Health Act of 2016’’. 


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1 SEC. 2. GREATER AVAILABILITY OF COMMUNITY FACILI2 TIES GRANTS FOR RURAL HOSPITALS. 

3 (a) IN GENERAL.—Section 306(a)(19) of the Consoli4 dated Farm and Rural Development Act (7 U.S.C. 

5 1926(a)(19)) is amended by adding at the end the fol6 lowing: 

7 ‘‘(C) SPECIAL RULES APPLICABLE TO

8 GRANTS FOR HOSPITALS.—In the case of a 

9 grant under this paragraph for a hospital: 

10 ‘‘(i) MAXIMUM GRANT.—The max11 imum amount of such a grant shall be 

12 $100,000. 

13 ‘‘(ii) NO FINANCING REQUIREMENT.— 

14 The Secretary may not condition the provi15 sion of such a grant on the inability of the 

16 applicant to finance the proposed project, 

17 in whole or in part, from the resources of 

18 the applicant, through commercial credit at 

19 reasonable rates and terms, or from any 

20 other funding source. 

21 ‘‘(iii) FEDERAL SHARE.—The amount 

22 of such a grant shall not exceed 50 percent 

23 of the cost of developing the hospital.’’. 

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

25 subsection (a) shall take effect on the date that is 90 days 

26 after the date of the enactment of this Act. 


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1 SEC. 3. REAUTHORIZATION OF PROGRAM OF GRANTS TO 

2 STATE OFFICES OF RURAL HEALTH. 

3 Section 338J of the Public Health Service Act (42 

4 U.S.C. 254r) is amended to read as follows: 

5 ‘‘SEC. 338J. GRANTS TO STATE OFFICES OF RURAL HEALTH. 

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

7 the Director of the Office of Rural Health Policy (estab8 lished in section 711 of the Social Security Act), shall 

9 make grants to each State Office of Rural Health for the 

10 purpose of improving health care in rural areas. 

11 ‘‘(b) REQUIREMENT OF MATCHING FUNDS.— 

12 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

13 the Secretary may not make a grant under sub14 section (a) unless the State Office of Rural Health 

15 involved agrees, with respect to the costs to be in16 curred in carrying out the purpose described in such 

17 subsection, to provide non-Federal contributions to18 ward such costs in an amount equal to $3 for each 

19 $1 of Federal funds provided in the grant. 

20 ‘‘(2) WAIVER OR REDUCTION.—The Secretary 

21 may waive or reduce the non-Federal contribution if 

22 the State Office of Rural Health can demonstrate 

23 that requiring matching funds would limit its ability 

24 to carry out the purpose described in subsection (a). 

25 ‘‘(3) DETERMINATION OF AMOUNT OF NON26 FEDERAL CONTRIBUTION.—Non-Federal contribuVerDate Sep 11 2014 04:16 May 05, 2016 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H5133.IH H5133

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1 tions required in paragraph (1) may be in cash or 

2 in kind, fairly evaluated, including plant, equipment, 

3 or services. Amounts provided by the Federal Gov4 ernment, or services assisted or subsidized to any 

5 significant extent by the Federal Government, may 

6 not be included in determining the amount of such 

7 non-Federal contributions. 

8 ‘‘(c) CERTAIN REQUIRED ACTIVITIES.—Activities for 

9 which grant dollars shall be awarded under subsection (a) 

10 include— 

11 ‘‘(1) maintaining within the State Office of 

12 Rural Health a clearinghouse for collecting and dis13 seminating information on— 

14 ‘‘(A) rural health care issues; 

15 ‘‘(B) research findings relating to rural 

16 health care; and 

17 ‘‘(C) innovative approaches to the delivery 

18 of health care in rural areas; 

19 ‘‘(2) coordinating the activities carried out in 

20 the State that relate to rural health care, including 

21 providing coordination for the purpose of avoiding 

22 redundancy in such activities; and 

23 ‘‘(3) identifying Federal and State programs re24 garding rural health, and providing technical assistVerDate Sep 11 2014 04:16 May 05, 2016 Jkt 059200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5133.IH H5133

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1 ance to public and nonprofit private entities regard2 ing participation in such programs. 

3 ‘‘(d) REQUIREMENT REGARDING ANNUAL BUDGET

4 FOR OFFICE.—The Secretary may not make a grant 

5 under subsection (a) unless the State Office of Rural 

6 Health involved agrees that, for any fiscal year for which 

7 the State Office of Rural Health receives such a grant, 

8 the office operated pursuant to subsection (a) will be pro9 vided with an annual budget of not less than $50,000. 

10 ‘‘(e) CERTAIN USES OF FUNDS.— 

11 ‘‘(1) RESTRICTIONS.—The Secretary may not 

12 make a grant under subsection (a) unless the State 

13 Office of Rural Health involved agrees that the 

14 grant will not be expended— 

15 ‘‘(A) to provide health care (including pro16 viding cash payments regarding such care); 

17 ‘‘(B) to conduct activities for which Fed18 eral funds are expended— 

19 ‘‘(i) within the State to provide tech20 nical and other nonfinancial assistance 

21 under subsection (f) of section 330; 

22 ‘‘(ii) under a memorandum of agree23 ment entered into with the State Office of 

24 Rural Health under subsection (h) of such 

25 section; or 


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1 ‘‘(iii) under a grant under section 

2 338I; 

3 ‘‘(C) to purchase medical equipment, to 

4 purchase ambulances, aircraft, or other vehicles, 

5 or to purchase major communications equip6 ment; 

7 ‘‘(D) to purchase or improve real property; 

8 or 

9 ‘‘(E) to carry out any activity regarding a 

10 certificate of need. 

11 ‘‘(2) AUTHORITIES.—Activities for which a 

12 State Office of Rural Health may expend a grant 

13 under subsection (a) include— 

14 ‘‘(A) paying the costs of maintaining such 

15 Office for the purpose described in subsection 

16 (a); 

17 ‘‘(B) subject to paragraph (1)(B)(iii), pay18 ing the costs of any activity carried out with re19 spect to recruiting and retaining health profes20 sionals to serve in rural areas of the State; and 

21 ‘‘(C) providing grants and contracts to 

22 public and nonprofit private entities to carry 

23 out activities authorized in this section. 


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1 ‘‘(f) REPORTS.—The Secretary may not make a 

2 grant under subsection (a) unless the State Office of 

3 Rural Health involved agrees— 

4 ‘‘(1) to submit to the Secretary reports or per5 formance data containing such information as the 

6 Secretary may require regarding activities carried 

7 out under this section; and 

8 ‘‘(2) to submit such a report or performance 

9 data not later than the close of the fiscal year imme10 diately following any fiscal year for which the State 

11 Office of Rural Health has received such a grant. 

12 ‘‘(g) REQUIREMENT OF APPLICATION.—The Sec13 retary may not make a grant under subsection (a) unless 

14 an application for the grant is submitted to the Secretary 

15 and the application is in such form, is made in such man16 ner, and contains such agreements, assurances, and infor17 mation as the Secretary determines to be necessary to 

18 carry out such subsection. 

19 ‘‘(h) NONCOMPLIANCE.—The Secretary may not 

20 make payments under subsection (a) to a State Office of 

21 Rural Health for any fiscal year subsequent to the first 

22 fiscal year of such payments unless the Secretary deter23 mines that, for the immediately preceding fiscal year, the 

24 State Office of Rural Health has complied with each of 


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1 the agreements made by the State Office of Rural Health 

2 under this section. 

3 ‘‘(i) DEFINITIONS.—In this section: 

4 ‘‘(1) The term ‘State’ means each of the several 

5 States. 

6 ‘‘(2) The term ‘State Office of Rural Health’ 

7 means, with respect to a State, the agency or office 

8 that is primarily responsible for improving health 

9 care in rural areas. 

10 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.— 

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

12 grants under subsection (a), there are authorized to 

13 be appropriated, $15,000,000 for fiscal year 2017 

14 and such sums as may be necessary for fiscal years 

15 2018 through 2021. 

16 ‘‘(2) AVAILABILITY.—Amounts appropriated 

17 under paragraph (1) shall remain available until ex18 pended.’’. 

19 SEC. 4. ANNUAL STUDY AND REPORT ON RURAL HOS20 PITALS. 

21 (a) STUDY.—The Secretary of Health and Human 

22 Services shall, with respect to the first fiscal year begin23 ning after the date of the enactment of this Act and each 

24 fiscal year thereafter, conduct an annual study on the fol25 lowing: 


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1 (1) The number of rural hospitals that closed in 

2 such fiscal year. 

3 (2) With respect to the rural hospitals that so 

4 closed in such fiscal year, the reasons for such clo5 sures. 

6 (3) With respect to the rural hospitals that so 

7 closed in such fiscal year, the effect such closure had 

8 on patient access to care for the given area. 

9 (4) With respect to each category of rural hos10 pitals described in subsection (b), the financial well11 being of the rural hospitals in such category during 

12 such fiscal year. 

13 (b) CATEGORIES DESCRIBED.—The categories of 

14 rural hospitals described in this subsection are the fol15 lowing: 

16 (1) Rural hospitals that are critical access hos17 pitals (as defined in section 1861(mm)(1) of the So18 cial Security Act (42 U.S.C. 1395x(mm)(1))). 

19 (2) Rural hospitals that are sole community 

20 hospitals (as defined in section 1886(d)(5)(D)(iii) of 

21 such Act (42 U.S.C. 1395ww(d)(5)(D)(iii))). 

22 (3) Rural hospitals that are a medicare-depend23 ent, small rural hospital (as defined in section 

24 1886(d)(5)(G) of such Act (42 U.S.C. 

25 1395ww(d)(5)(G))). 


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1 (4) Any other such category of rural hospitals 

2 that the Secretary of Health and Human Services 

3 determines appropriate. 

4 (c) DEFINITION OF RURAL HOSPITAL.—For pur5 poses of this section, the term ‘‘rural hospital’’ means a 

6 hospital located in a rural area (as defined in section 

7 1886(d)(2)(D) of the Social Security Act (42 U.S.C. 

8 1395ww(d)(2)(D))). 

9 (d) REPORT.—With respect to each study conducted 

10 pursuant to subsection (a) with respect to a fiscal year, 

11 the Secretary of Health and Human Services shall, not 

12 later than December 31 of the following fiscal year, submit 

13 to Congress and to each State office of rural health (as 

14 described in section 338J(a) of the Public Health Service 

15 Act (42 U.S.C. 254r(a))) a report on such study. 

Æ 


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