I 

116TH CONGRESS 

1ST SESSION H. R. 4537 

To amend the Public Health Service Act to improve the provision of mobile 

medical health care services to certain underserved areas and populations, 

and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 26, 2019 

Ms. VELA ́ZQUEZ introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

A BILL 

To amend the Public Health Service Act to improve the 

provision of mobile medical health care services to certain 

underserved areas and populations, 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 ‘‘Mobile Health Clinics 

5 Act of 2019’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


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1 (1) According to the Mobile Health Map report, 

2 approximately 1,500 mobile health clinics (MHCs) 

3 operate nationwide. 

4 (2) MHCs can effectively provide care in areas 

5 where health care infrastructure is limited because 

6 of distance, financial capabilities, or inadequate sup7 porting infrastructure, including lack of public 

8 transportation resources. 

9 (3) MHCs can offer services such as primary 

10 care, screenings, dental care, medications, behavioral 

11 health care, immunizations, laboratory tests, case 

12 management, triage, and assistance for public ben13 efit programs. 

14 (4) MHCs help improve community health and 

15 access to medical services in underserved commu16 nities across the United States, including urban, 

17 rural, and suburban areas. 

18 (5) Such clinics are cost-effective and help re19 duce the burden on hospitals, insurers, and govern20 ment entities managing health programs by pro21 viding prevention services, which also reduces unnec22 essary emergency department visits. 

23 (6) The average cost of a visit to a provider of 

24 mobile medical health care services is significantly 

25 lower than the average cost of an emergency departVerDate Sep 11 2014 04:34 Oct 02, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4537.IH H4537

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1 ment visit. Visiting an MHC instead of the emer2 gency department can result in a cost savings of 

3 more than $800 per visit. 

4 (7) Several studies have shown that the return 

5 on investment generated by MHCs ranges from $20 

6 to $36 for every $1 spent. 

7 (8) MHCs are successful when they engage with 

8 other local stakeholders who can provide insight, 

9 knowledge, and strategies to help meet public health 

10 challenges that are immediately relevant to the com11 munities receiving services from MHC providers. 

12 (9) Funding has been the largest barrier to the 

13 development and maintenance of MHCs and their 

14 resources. 

15 (10) With additional Federal support, health 

16 systems would be able to better invest in purchasing, 

17 maintaining, and upgrading mobile units, increasing 

18 the number of staff, dispensing more medication, 

19 and advancing the use of efficient information tech20 nology for health purposes. 

21 SEC. 3. IMPROVING ACCESS TO MOBILE MEDICAL HEALTH 

22 CARE SERVICES. 

23 (a) IN GENERAL.—Subpart I of part D of title III 

24 of the Public Health Service Act (42 U.S.C. 254b et seq.) 

25 is amended by adding at the end the following new section: 


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1 ‘‘SEC. 330N. PARTNERSHIPS TO IMPROVE ACCESS TO MO2 BILE MEDICAL HEALTH CARE SERVICES. 

3 ‘‘(a) AUTHORITY ESTABLISHED.— 

4 ‘‘(1) IN GENERAL.—The Secretary may award 

5 grants, contracts, or cooperative agreements to eligi6 ble entities to provide mobile medical health care 

7 services in accordance with subsection (e). 

8 ‘‘(2) LIMITATION.—A hospital or health care 

9 facility may not be eligible for a grant, contract, or 

10 cooperative agreement under this section with re11 spect to more than one partnership described in sub12 section (b)(1). 

13 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible for a grant, 

14 contract, or cooperative agreement under this section, an 

15 entity shall— 

16 ‘‘(1) be a partnership consisting of— 

17 ‘‘(A) one or more hospitals; or 

18 ‘‘(B) one or more other local health care 

19 facilities, including clinics, rural health clinics, 

20 federally qualified health centers, health cen21 ters, primary care facilities, mental health cen22 ters, pharmacies, or other mobile medical as23 sets, without regard to whether or not such a 

24 local health care facility is owned (either in 

25 whole or in part) by a hospital in a partnership 

26 described in subparagraph (A) or another local 


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1 health care facility as described in this subpara2 graph; and 

3 ‘‘(2) provide services for any one of the fol4 lowing: 

5 ‘‘(A) A medically underserved community 

6 (as defined in section 799B(6)). 

7 ‘‘(B) A medically underserved population 

8 (as defined in section 330(b)(3)). 

9 ‘‘(c) APPLICATION.—An eligible entity seeking fund10 ing under this section shall submit to the Secretary an 

11 application at such time, in such manner, and containing 

12 such information as the Secretary may require, including, 

13 at a minimum, the following: 

14 ‘‘(1) A long-term strategy and detailed imple15 mentation plan developed in consultation with com16 munity groups and appropriate stakeholders. 

17 ‘‘(2) A demonstration of a specific public health 

18 need that is relevant to a community or population 

19 described in subsection (b)(2). 

20 ‘‘(3) A description of the services that the enti21 ty will provide directly with funds under this section, 

22 and, if applicable, a description of the services that 

23 the eligible entity will provide indirectly with such 

24 funds through contracts or cooperative agreements. 


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1 ‘‘(4) An explanation of the entity’s inability to 

2 address the need in paragraph (2) without Federal 

3 assistance. 

4 ‘‘(5) An identification of any related govern5 mental or community initiative that compliments or 

6 will be coordinated with the long-term strategy and 

7 detailed implementation plan required under para8 graph (1). 

9 ‘‘(6) A plan detailing the methodologies that 

10 will be used to evaluate the access and quality of 

11 mobile medical health care services provided by the 

12 entity to a community or population described in 

13 subsection (b)(2). 

14 ‘‘(7) A description of community outreach 

15 mechanisms that the entity will employ to ensure the 

16 participation of a community or population described 

17 in subsection (b)(2). 

18 ‘‘(8) An identification of best practices for 

19 treatment, outreach, and data collection that the en20 tity will employ to track program participation and 

21 program effectiveness. 

22 ‘‘(9) A plan for providing mobile medical health 

23 care services to individuals of limited English-speak24 ing ability. Such plan shall— 


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1 ‘‘(A) take into account data from the Bu2 reau of the Census and previously documented 

3 qualitative or quantitative observations from 

4 community service providers offering health 

5 care services in the areas in which the entity 

6 will provide mobile medical health care services; 

7 and 

8 ‘‘(B) outline which languages are most 

9 prevalent and commonly requested for trans10 lation services in such areas. 

11 ‘‘(10)(A) Subject to subparagraph (B), an as12 surance that, if the entity receives a grant, contract, 

13 or cooperative agreement or a renewal of such grant, 

14 contract, or cooperative agreement under this sec15 tion, the entity will develop a plan to secure other 

16 public or private funding resources to ensure the 

17 continued operation and maintenance of mobile med18 ical health care services provided under this section 

19 after funds under such grant, contract, or coopera20 tive agreement, or renewal, are no longer available. 

21 ‘‘(B) The Secretary shall waive the requirement 

22 under subparagraph (A) for the entity if the entity 

23 demonstrates that complying with such requirement 

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1 cant disruption of the provision of mobile medical 

2 health care services. 

3 ‘‘(11) Any additional information required by 

4 the Secretary. 

5 ‘‘(d) REQUIREMENTS.— 

6 ‘‘(1) AMOUNT.—A grant contract, or coopera7 tive agreement awarded under this section may not 

8 exceed $750,000. 

9 ‘‘(2) DURATION.—A grant, contract, or cooper10 ative agreement awarded under this section shall be 

11 for a period of 3 years. 

12 ‘‘(3) RENEWALS.— 

13 ‘‘(A) IN GENERAL.—The Secretary may 

14 renew a grant, contract, or cooperative agree15 ment awarded under this section with respect to 

16 an eligible entity if the entity— 

17 ‘‘(i) submits to the Secretary an appli18 cation for renewal at such time, in such 

19 manner, and containing such information 

20 as the Secretary may require; and 

21 ‘‘(ii) demonstrates in such application 

22 that— 

23 ‘‘(I) grant, contract, or coopera24 tive agreement funds made available 

25 to the entity were used in a manner 


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1 required under the most recently ap2 proved application of the entity under 

3 this section; and 

4 ‘‘(II) the entity has made signifi5 cant progress in achieving the objec6 tives of the initial application ap7 proved for the entity under this sec8 tion. 

9 ‘‘(B) DURATION.—An initial renewal for 

10 an eligible entity under subparagraph (A) shall, 

11 at a minimum, be for a period of 2 years. Any 

12 subsequent renewal for such an entity shall be 

13 for a period of 1 year. 

14 ‘‘(e) USE OF FUNDS.—A grant, contract, or coopera15 tive agreement awarded under this section may be ex16 pended for— 

17 ‘‘(1) purchases of mobile medical health care 

18 service vehicles; 

19 ‘‘(2) maintenance or upgrade of mobile medical 

20 health care service vehicles; 

21 ‘‘(3) hiring of casework staff, physicians, practi22 tioners, pharmacists, nursing personnel, or similar 

23 medical professionals; 

24 ‘‘(4) hiring and professional development of ad25 ministrative, oversight, clerical, or other support 


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1 staff managing the operations or care provided by 

2 mobile medical health care service vehicles; 

3 ‘‘(5) professional development, including appro4 priate training for medical professionals specified in 

5 paragraph (3); 

6 ‘‘(6) distributing or dispensing prescriptions; 

7 ‘‘(7) advancing the use of information tech8 nology for treatment purposes, including the employ9 ment of appropriate staff required for maintenance 

10 to ensure the secure and stable operations of com11 puters, servers, and other appropriate information 

12 technology infrastructure; and 

13 ‘‘(8) increasing access of medically underserved 

14 communities (as defined in section 799B(6)) or 

15 medically underserved populations (as defined in sec16 tion 330(b)(3)) to mobile medical health care serv17 ices, including required primary health services (as 

18 defined in section 330(b)(1)), substance use disorder 

19 services (as defined in section 330(h)(5)(C)), and 

20 mental health counseling. 

21 ‘‘(f) SUPPLEMENT, NOT SUPPLANT, REQUIRE22 MENT.—A grant, contract, or cooperative agreement 

23 awarded under this section shall be expended to supple24 ment, and not supplant, the expenditures of the eligible 

25 entity involved and the value of in-kind contributions for 


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1 the delivery of services to medically underserved commu2 nities or medically underserved populations. 

3 ‘‘(g) ANNUAL REPORT.—An eligible entity that re4 ceives funds under this section during a fiscal year shall 

5 submit to the Secretary, on a date specified by the Sec6 retary, an annual report detailing the progress in address7 ing the public health need specified in subsection (c)(2). 

8 ‘‘(h) MOBILE MEDICAL HEALTH CARE SERVICE DE9 FINED.—In this section, the term ‘mobile medical health 

10 care service’ means any health care-related service pro11 vided in a moveable vehicle or a non-permanent clinic. 

12 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is 

13 authorized to be appropriated to carry out this section 

14 $15,000,000 for fiscal year 2020 and each succeeding fis15 cal year.’’. 

16 (b) RULEMAKING.—Not later than the date that is 

17 one year after the date of enactment of this Act, the Sec18 retary of Health and Human Services shall, through notice 

19 and comment rulemaking, establish— 

20 (1) a process for awarding grants, contract, and 

21 cooperative agreement including renewing and termi22 nating grants, contract, and cooperative agreement 

23 under section 330N of the Public Health Service 

24 Act, as added by subsection (a); 


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1 (2) benchmarks for measuring significant 

2 progress as described in subsection (d)(3)(A)(ii)(II) 

3 of such section; and 

4 (3) a process for providing entities described in 

5 such section a fair hearing and appellate review re6 garding any decision by the Secretary to renew or 

7 terminate a grant, contract, or cooperative agree8 ment under such section. 

Æ 


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