H. R. 1343 

One Hundred Tenth Congress 

of the 

United States of America 

AT THE SECOND SESSION 

Begun and held at the City of Washington on Thursday, 

the third day of January, two thousand and eight 

An Act 

To amend the Public Health Service Act to provide additional authorizations of 

appropriations for the health centers program under section 330 of such Act, 

and for other purposes. 

Be it enacted by the Senate and House of Representatives of 

the United States of America in Congress assembled, 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Health Care Safety Net Act 

of 2008’’. 

SEC. 2. COMMUNITY HEALTH CENTERS PROGRAM OF THE PUBLIC 

HEALTH SERVICE ACT. 

(a) ADDITIONAL AUTHORIZATIONS OF APPROPRIATIONS FOR THE

HEALTH CENTERS PROGRAM OF PUBLIC HEALTH SERVICE ACT.— 

Section 330(r) of the Public Health Service Act (42 U.S.C. 254b(r)) 

is amended by amending paragraph (1) to read as follows: 

‘‘(1) IN GENERAL.—For the purpose of carrying out this 

section, in addition to the amounts authorized to be appropriated under subsection (d), there are authorized to be appropriated— 

‘‘(A) $2,065,000,000 for fiscal year 2008; 

‘‘(B) $2,313,000,000 for fiscal year 2009; 

‘‘(C) $2,602,000,000 for fiscal year 2010; 

‘‘(D) $2,940,000,000 for fiscal year 2011; and 

‘‘(E) $3,337,000,000 for fiscal year 2012.’’. 

(b) STUDIES RELATING TO COMMUNITY HEALTH CENTERS.— 

(1) DEFINITIONS.—For purposes of this subsection— 

(A) the term ‘‘community health center’’ means a health 

center receiving assistance under section 330 of the Public 

Health Service Act (42 U.S.C. 254b); and 

(B) the term ‘‘medically underserved population’’ has 

the meaning given that term in such section 330. 

(2) SCHOOL-BASED HEALTH CENTER STUDY.— 

(A) IN GENERAL.—Not later than 2 years after the 

date of enactment of this Act, the Comptroller General 

of the United States shall issue a study of the economic 

costs and benefits of school-based health centers and the 

impact on the health of students of these centers. 

(B) CONTENT.—In conducting the study under subparagraph (A), the Comptroller General of the United States 

shall analyze— 

(i) the impact that Federal funding could have 

on the operation of school-based health centers; 
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(ii) any cost savings to other Federal programs 

derived from providing health services in school-based 

health centers; 

(iii) the effect on the Federal Budget and the health 

of students of providing Federal funds to school-based 

health centers and clinics, including the result of providing disease prevention and nutrition information; 

(iv) the impact of access to health care from schoolbased health centers in rural or underserved areas; 

and 

(v) other sources of Federal funding for schoolbased health centers. 

(3) HEALTH CARE QUALITY STUDY.— 

(A) IN GENERAL.—Not later than 1 year after the date 

of enactment of this Act, the Secretary of Health and 

Human Services (referred to in this Act as the ‘‘Secretary’’), 

acting through the Administrator of the Health Resources 

and Services Administration, and in collaboration with the 

Agency for Healthcare Research and Quality, shall prepare 

and submit to the Committee on Health, Education, Labor, 

and Pensions of the Senate and the Committee on Energy 

and Commerce of the House of Representatives a report 

that describes agency efforts to expand and accelerate 

quality improvement activities in community health centers. 

(B) CONTENT.—The report under subparagraph (A) 

shall focus on— 

(i) Federal efforts, as of the date of enactment 

of this Act, regarding health care quality in community 

health centers, including quality data collection, analysis, and reporting requirements; 

(ii) identification of effective models for quality 

improvement in community health centers, which may 

include models that— 

(I) incorporate care coordination, disease 

management, and other services demonstrated to 

improve care; 

(II) are designed to address multiple, co-occurring diseases and conditions; 

(III) improve access to providers through nontraditional means, such as the use of remote monitoring equipment; 

(IV) target various medically underserved 

populations, including uninsured patient populations; 

(V) increase access to specialty care, including 

referrals and diagnostic testing; and 

(VI) enhance the use of electronic health 

records to improve quality; 

(iii) efforts to determine how effective quality 

improvement models may be adapted for implementation by community health centers that vary by size, 

budget, staffing, services offered, populations served, 

and other characteristics determined appropriate by 

the Secretary; 
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(iv) types of technical assistance and resources 

provided to community health centers that may facilitate the implementation of quality improvement interventions; 

(v) proposed or adopted methodologies for community health center evaluations of quality improvement 

interventions, including any development of new measures that are tailored to safety-net, community-based 

providers; 

(vi) successful strategies for sustaining quality 

improvement interventions in the long-term; and 

(vii) partnerships with other Federal agencies and 

private organizations or networks as appropriate, to 

enhance health care quality in community health centers. 

(C) DISSEMINATION.—The Administrator of the Health 

Resources and Services Administration shall establish a 

formal mechanism or mechanisms for the ongoing dissemination of agency initiatives, best practices, and other 

information that may assist health care quality improvement efforts in community health centers. 

(4) GAO STUDY ON INTEGRATED HEALTH SYSTEMS MODEL

FOR THE DELIVERY OF HEALTH CARE SERVICES TO MEDICALLY

UNDERSERVED AND UNINSURED POPULATIONS.— 

(A) STUDY.—The Comptroller General of the United 

States shall conduct a study on integrated health system 

models of at least 15 sites for the delivery of health care 

services to medically underserved and uninsured populations. The study shall include an examination of— 

(i) health care delivery models sponsored by public 

or private non-profit entities that— 

(I) integrate primary, specialty, and acute 

care; and 

(II) serve medically underserved and uninsured populations; and 

(ii) such models in rural and urban areas. 

(B) REPORT.—Not later than 1 year after the date 

of the enactment of this Act, the Comptroller General of 

the United States shall submit to Congress a report on 

the study conducted under subparagraph (A). The report 

shall include— 

(i) an evaluation of the models, as described in 

subparagraph (A), in— 

(I) expanding access to primary, preventive, 

and specialty services for medically underserved 

and uninsured populations; and 

(II) improving care coordination and health 

outcomes; 

(III) increasing efficiency in the delivery of 

quality health care; and 

(IV) conducting some combination of the following services— 

(aa) outreach activities; 

(bb) case management and patient navigation services; 

(cc) chronic care management; 
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(dd) transportation to health care facilities; 

(ee) development of provider networks and 

other innovative models to engage local physicians and other providers to serve the medically underserved within a community; 

(ff) recruitment, training, and compensation of necessary personnel; 

(gg) acquisition of technology for the purpose of coordinating care; 

(hh) improvements to provider communication, including implementation of shared 

information systems or shared clinical systems; 

(ii) determination of eligibility for Federal, 

State, and local programs that provide, or 

financially support the provision of, medical, 

social, housing, educational, or other related 

services; 

(jj) development of prevention and disease 

management tools and processes; 

(kk) translation services; 

(ll) development and implementation of 

evaluation measures and processes to assess 

patient outcomes; 

(mm) integration of primary care and 

mental health services; and 

(nn) carrying out other activities that may 

be appropriate to a community and that would 

increase access by the uninsured to health 

care, such as access initiatives for which private entities provide non-Federal contributions 

to supplement the Federal funds provided 

through the grants for the initiatives; and 

(ii) an assessment of— 

(I) challenges, including barriers to Federal 

programs, encountered by such entities in providing care to medically underserved and uninsured populations; and 

(II) advantages and disadvantages of such 

models compared to other models of care delivery 

for medically underserved and uninsured populations, including— 

(aa) quality measurement and quality outcomes; 

(bb) administrative efficiencies; and 

(cc) geographic distribution of federallysupported clinics compared to geographic distribution of integrated health systems. 

(5) GAO STUDY ON VOLUNTEER ENHANCEMENT.— 

(A) IN GENERAL.—Not later than 6 months after the 

date of enactment of this Act, the Comptroller General 

of the United States shall conduct a study, and submit 

a report to Congress, concerning the implications of 

extending Federal Tort Claims Act (chapter 171 of title 
H. R. 1343—5 

28, United States Code) coverage to health care professionals who volunteer to furnish care to patients of health 

centers. 

(B) CONTENT.—In conducting the study under subparagraph (A), the Comptroller General of the United States 

shall analyze— 

(i) the potential financial implications for the Federal Government of such an extension, including any 

increased funding needed for current health center 

Federal Tort Claims Act coverage; 

(ii) an estimate of the increase in the number 

of health care professionals at health centers, and what 

types of such professionals would most likely volunteer 

given the extension of Federal Tort Claims Act coverage; 

(iii) the increase in services provided by health 

centers as a result of such an increase in health care 

professionals, and in particular the effect of such action 

on the ability of health centers to secure specialty 

and diagnostic services needed by their uninsured and 

other patients; 

(iv) the volume of patient workload at health centers and how volunteer health care professionals may 

help address the patient volume; 

(v) the most appropriate manner of extending such 

coverage to volunteer health care professionals at 

health centers, including any potential difference from 

the mechanism currently used for health care professional volunteers at free clinics; 

(vi) State laws that have been shown to encourage 

physicians and other health care providers to provide 

charity care as an agent of the State; and 

(vii) other policies, including legislative or regulatory changes, that have the potential to increase 

the number of volunteer health care staff at health 

centers and the financial implications of such policies, 

including the cost savings associated with the ability 

to provide more services in health centers rather than 

more expensive sites of care. 

(c) RECOGNITION OF HIGH POVERTY.— 

(1) IN GENERAL.—Section 330(c) of the Public Health 

Service Act (42 U.S.C. 254b(c)) is amended by adding at the 

end the following new paragraph: 

‘‘(3) RECOGNITION OF HIGH POVERTY.— 

‘‘(A) IN GENERAL.—In making grants under this subsection, the Secretary may recognize the unique needs of 

high poverty areas. 

‘‘(B) HIGH POVERTY AREA DEFINED.—For purposes of 

subparagraph (A), the term ‘high poverty area’ means a 

catchment area which is established in a manner that 

is consistent with the factors in subsection (k)(3)(J), and 

the poverty rate of which is greater than the national 

average poverty rate as determined by the Bureau of the 

Census.’’. 

(2) EFFECTIVE DATE.—The amendment made by paragraph 

(1) shall apply to grants made on or after January 1, 2009. 
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SEC. 3. NATIONAL HEALTH SERVICE CORPS. 

(a) FUNDING.— 

(1) REAUTHORIZATION OF NATIONAL HEALTH SERVICE CORPS

PROGRAM.—Section 338(a) of the Public Health Service Act 

(42 U.S.C. 254k(a)) is amended by striking ‘‘2002 through 2006’’ 

and inserting ‘‘2008 through 2012’’. 

(2) SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS.—Subsection (a) of section 338H of such Act (42 U.S.C. 254q) is 

amended by striking ‘‘appropriated $146,250,000’’ and all that 

follows through the period and inserting the following: ‘‘appropriated— 

‘‘(1) for fiscal year 2008, $131,500,000; 

‘‘(2) for fiscal year 2009, $143,335,000; 

‘‘(3) for fiscal year 2010, $156,235,150; 

‘‘(4) for fiscal year 2011, $170,296,310; and 

‘‘(5) for fiscal year 2012, $185,622,980.’’. 

(b) ELIMINATION OF 6-YEAR DEMONSTRATION REQUIREMENT.— 

Section 332(a)(1) of the Public Health Service Act (42 U.S.C. 

254e(a)(1)) is amended by striking ‘‘Not earlier than 6 years’’ and 

all that follows through ‘‘purposes of this section.’’. 

(c) ASSIGNMENT TO SHORTAGE AREA.—Section 333(a)(1)(D)(ii) 

of the Public Health Service Act (42 U.S.C. 254f(a)(1)(D)(ii)) is 

amended— 

(1) in subclause (IV), by striking ‘‘and’’; 

(2) in subclause (V), by striking the period at the end 

and inserting ‘‘; and’’; and 

(3) by adding at the end the following: 

‘‘(VI) the entity demonstrates willingness to 

support or facilitate mentorship, professional 

development, and training opportunities for Corps 

members.’’. 

(d) PROFESSIONAL DEVELOPMENT AND TRAINING.—Subsection 

(d) of section 336 of the Public Health Service Act (42 U.S.C. 

254h–1) is amended to read as follows: 

‘‘(d) PROFESSIONAL DEVELOPMENT AND TRAINING.— 

‘‘(1) IN GENERAL.—The Secretary shall assist Corps members in establishing and maintaining professional relationships 

and development opportunities, including by— 

‘‘(A) establishing appropriate professional relationships 

between the Corps member involved and the health professions community of the geographic area with respect to 

which the member is assigned; 

‘‘(B) establishing professional development, training, 

and mentorship linkages between the Corps member 

involved and the larger health professions community, 

including through distance learning, direct mentorship, and 

development and implementation of training modules 

designed to meet the educational needs of offsite Corps 

members; 

‘‘(C) establishing professional networks among Corps 

members; or 

‘‘(D) engaging in other professional development, 

mentorship, and training activities for Corps members, at 

the discretion of the Secretary. 

‘‘(2) ASSISTANCE IN ESTABLISHING PROFESSIONAL RELATIONSHIPS.—In providing such assistance under paragraph (1), the 
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Secretary shall focus on establishing relationships with hospitals, with academic medical centers and health professions 

schools, with area health education centers under section 751, 

with health education and training centers under section 752, 

and with border health education and training centers under 

such section 752. Such assistance shall include assistance in 

obtaining faculty appointments at health professions schools. 

‘‘(3) SUPPLEMENT NOT SUPPLANT.—Such efforts under this 

subsection shall supplement, not supplant, non-government 

efforts by professional health provider societies to establish 

and maintain professional relationships and development 

opportunities.’’. 

(e) ELIGIBILITY OF THE DISTRICT OF COLUMBIA AND TERRITORIES

FOR THE STATE LOAN REPAYMENT PROGRAM.— (1) IN GENERAL.—Section 338I(h) of the Public Health 

Service Act (42 U.S.C. 254q–1(h)) is amended by striking ‘‘several States’’ and inserting ‘‘50 States, the District of Columbia, 

the Commonwealth of Puerto Rico, the United States Virgin 

Islands, Guam, American Samoa, Palau, the Marshall Islands, 

and the Commonwealth of the Northern Mariana Islands’’. 

(2) AUTHORIZATION OF APPROPRIATIONS.—Section 338I(i)(1) 

of such Act (42 U.S.C. 254q–1(i)(1)) is amended by striking 

‘‘2002’’ and all that follows through the period and inserting 

‘‘2008, and such sums as may be necessary for each of fiscal 

years 2009 through 2012.’’. 

SEC. 4. REAUTHORIZATION OF RURAL HEALTH CARE PROGRAMS. 

Section 330A(j) of the Public Health Service Act (42 U.S.C. 254c(j)) is amended by striking ‘‘$40,000,000’’ and all that follows 

through the period and inserting ‘‘$45,000,000 for each of fiscal 

years 2008 through 2012.’’. 

SEC. 5. REAUTHORIZATION OF PRIMARY DENTAL HEALTH 

WORKFORCE PROGRAMS. 

Section 340G(f) of the Public Health Service Act (42 U.S.C. 

256g(f)) is amended— 

(1) by striking ‘‘$50,000,000’’ and inserting ‘‘$25,000,000’’; 

and 

(2) by striking ‘‘2002’’ and inserting ‘‘2008’’. 

SEC. 6. EMERGENCY RESPONSE COORDINATION OF PRIMARY CARE 

PROVIDERS. 

(a) IN GENERAL.—Subtitle B of title XXVIII of the Public Health 

Service Act (42 U.S.C. 300hh–10 et seq.) is amended by adding 

at the end the following: 

‘‘SEC. 2815. EMERGENCY RESPONSE COORDINATION OF PRIMARY CARE 

PROVIDERS. 

‘‘The Secretary, acting through Administrator of the Health 

Resources and Services Administration, and in coordination with 

the Assistant Secretary for Preparedness and Response, shall 

‘‘(1) provide guidance and technical assistance to health 

centers funded under section 330 and to State and local health 

departments and emergency managers to integrate health centers into State and local emergency response plans and to 

better meet the primary care needs of populations served by 

health centers during public health emergencies; and 
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‘‘(2) encourage employees at health centers funded under 

section 330 to participate in emergency medical response programs including the National Disaster Medical System authorized in section 2812, the Volunteer Medical Reserve Corps 

authorized in section 2813, and the Emergency System for 

Advance Registration of Health Professions Volunteers authorized in section 319I.’’. 

(b) SENSE OF THE CONGRESS.—It is the Sense of Congress 

that the Secretary of Health and Human Services, to the extent 

permitted by law, utilize the existing authority provided under 

the Federal Tort Claims Act for health centers funded under section 

330 of the Public Health Service Act (42 U.S.C. 254b) in order 

to establish expedited procedures under which such health centers 

and their health care professionals that have been deemed eligible 

for Federal Tort Claims Act coverage are able to respond promptly 

in a coordinated manner and on a temporary basis to public health 

emergencies outside their traditional service area and sites, and 

across State lines, as necessary and appropriate. 

SEC. 7. REVISION OF THE TIMEFRAME FOR THE RECOGNITION OF 

CERTAIN DESIGNATIONS IN CERTIFYING RURAL HEALTH 

CLINICS UNDER THE MEDICARE PROGRAM. 

(a) IN GENERAL.—The second sentence of section 1861(aa)(2) 

of the Social Security Act (42 U.S.C. 1395x(aa)(2)) is amended 

by striking ‘‘3-year period’’ and inserting ‘‘4-year period’’ in the 

matter in clause (i) preceding subclause (I). 

(b) EFFECTIVE DATE.—The amendment made by subsection (a) 

shall take effect on the date of the enactment of this Act. 

Speaker of the House of Representatives. 

Vice President of the United States and

President of the Senate.