II 

110TH CONGRESS 

2D SESSION S. 3095 

To amend title XVIII of the Social Security Act to expand the Medicare 

Rural Hospital Flexibility Program to increase the delivery of mental 

health services and other health services to veterans of Operation Enduring Freedom and Operation Iraqi Freedom and to other residents of 

rural areas, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JUNE 5, 2008 

Mr. BAUCUS introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to expand 

the Medicare Rural Hospital Flexibility Program to increase the delivery of mental health services and other 

health services to veterans of Operation Enduring Freedom and Operation Iraqi Freedom and to other residents 

of rural 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, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Relief for Rural Vet5 erans in Crisis Act of 2008’’. 


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1 SEC. 2. EXPANSION AND EXTENSION OF THE MEDICARE 

2 RURAL HOSPITAL FLEXIBILITY PROGRAM. 

3 (a) IN GENERAL.—Section 1820(g) of the Social Se4 curity Act (42 U.S.C. 1395i–4(g)) is amended by adding 

5 at the end the following new paragraph: 

6 ‘‘(6) PROVIDING MENTAL HEALTH SERVICES

7 AND OTHER HEALTH SERVICES TO VETERANS AND

8 OTHER RESIDENTS OF RURAL AREAS.— 

9 ‘‘(A) GRANTS TO STATES.—The Secretary 

10 may award grants to States that have sub11 mitted applications in accordance with subpara12 graph (B) for increasing the delivery of mental 

13 health services or other health care services 

14 deemed necessary to meet the needs of veterans 

15 of Operation Iraqi Freedom and Operation En16 during Freedom living in rural areas (as de17 fined for purposes of section 1886(d) and in18 cluding areas that are rural census tracks, as 

19 defined by the Administrator of the Health Re20 sources and Services Administration), including 

21 for the provision of crisis intervention services 

22 and the detection of post-traumatic stress dis23 order, traumatic brain injury, and other signa24 ture injuries of veterans of Operation Iraqi 

25 Freedom and Operation Enduring Freedom, 

26 and for referral of such veterans to medical faVerDate Aug 31 2005 03:55 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S3095.IS S3095

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1 cilities operated by the Department of Veterans 

2 Affairs, and for the delivery of such services to 

3 other residents of such rural areas. 

4 ‘‘(B) APPLICATION.— 

5 ‘‘(i) IN GENERAL.—An application is 

6 in accordance with this subparagraph if 

7 the State submits to the Secretary at such 

8 time and in such form as the Secretary 

9 may require an application containing the 

10 assurances described in subparagraphs 

11 (A)(ii) and (A)(iii) of subsection (b)(1). 

12 ‘‘(ii) CONSIDERATION OF REGIONAL

13 APPROACHES, NETWORKS, OR TECH14 NOLOGY.—The Secretary may, as appro15 priate in awarding grants to States under 

16 subparagraph (A), consider whether the 

17 application submitted by a State under 

18 this subparagraph includes 1 or more pro19 posals that utilize regional approaches, 

20 networks, health information technology, 

21 telehealth, or telemedicine to deliver serv22 ices described in subparagraph (A) to indi23 viduals described in that subparagraph. 

24 For purposes of this clause, a network 

25 may, as the Secretary determines approVerDate Aug 31 2005 03:55 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S3095.IS S3095

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1 priate, include Federally qualified health 

2 centers, rural health clinics, home health 

3 agencies, community mental health clinics 

4 and other providers of mental health serv5 ices, pharmacists, local government, and 

6 other providers deemed necessary to meet 

7 the needs of veterans. 

8 ‘‘(iii) COORDINATION AT LOCAL

9 LEVEL.—The Secretary shall require, as 

10 appropriate, a State to demonstrate con11 sultation with the hospital association of 

12 such State, rural hospitals located in such 

13 State, providers of mental health services, 

14 or other appropriate stakeholders for the 

15 provision of services under a grant award16 ed under this paragraph. 

17 ‘‘(iv) SPECIAL CONSIDERATION OF

18 CERTAIN APPLICATIONS.—In awarding 

19 grants to States under subparagraph (A), 

20 the Secretary shall give special consider21 ation to applications submitted by States 

22 in which veterans make up a high percent23 age (as determined by the Secretary) of 

24 the total population of the State. Such 

25 consideration shall be given without regard 


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1 to the number of veterans of Operation 

2 Iraqi Freedom and Operation Enduring 

3 Freedom living in the areas in which men4 tal health services and other health care 

5 services would be delivered under the appli6 cation. 

7 ‘‘(C) COORDINATION WITH VA.—The Sec8 retary shall, as appropriate, consult with the 

9 Director of the Office of Rural Health of the 

10 Department of Veterans Affairs in awarding 

11 grants to States under subparagraph (A). 

12 ‘‘(D) USE OF FUNDS.—A State awarded a 

13 grant under this paragraph may, as appro14 priate, use the funds to reimburse providers of 

15 services described in subparagraph (A) to indi16 viduals described in that subparagraph. 

17 ‘‘(E) LIMITATION ON USE OF GRANT

18 FUNDS FOR ADMINISTRATIVE EXPENSES.—A 

19 State awarded a grant under this paragraph 

20 may not expend more than 15 percent of the 

21 amount of the grant for administrative ex22 penses. 

23 ‘‘(F) FINAL REPORT.—Not later than 1 

24 year after the date on which the last grant is 

25 awarded to a State under subparagraph (A), 


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1 the Secretary shall submit a report to Congress 

2 on the grants awarded under such subpara3 graph. Such report shall include an assessment 

4 of the impact of such grants on increasing the 

5 delivery of mental health services and other 

6 health services to veterans of the United States 

7 Armed Forces living in rural areas (as so de8 fined and including such areas that are rural 

9 census tracks), with particular emphasis on the 

10 impact of such grants on the delivery of such 

11 services to veterans of Operation Enduring 

12 Freedom and Operation Iraqi Freedom, and to 

13 other individuals living in such rural areas.’’. 

14 (b) USE OF FUNDS FOR FEDERAL ADMINISTRATIVE

15 EXPENSES.—Section 1820(g)(5) of the Social Security 

16 Act (42 U.S.C. 1395i–4(g)(5)) is amended— 

17 (1) by striking ‘‘beginning with fiscal year 

18 2005’’ and inserting ‘‘for each of fiscal years 2005 

19 through 2008’’; and 

20 (2) by inserting ‘‘and, of the total amount ap21 propriated for grants under paragraphs (1), (2), and 

22 (6) for a fiscal year (beginning with fiscal year 

23 2009)’’ after ‘‘2005)’’. 


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1 (c) EXTENSION OF AUTHORIZATION FOR FLEX 

2 GRANTS.—Section 1820(j) of the Social Security Act (42 

3 U.S.C. 1395i–4(j)) is amended— 

4 (1) by striking ‘‘and for’’ and inserting ‘‘for’’; 

5 and 

6 (2) by inserting ‘‘, for making grants to all 

7 States under paragraphs (1) and (2) of subsection 

8 (g), $55,000,000 in each of fiscal years 2009 and 

9 2010, and for making grants to all States under 

10 paragraph (6) of subsection (g), $50,000,000 in 

11 each of fiscal years 2009 and 2010, to remain avail12 able until expended’’ before the period at the end. 

Æ 


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